Measures Of Hardship Research Articles

The economic divide that isn’t: A comparative study on economic hardship and affective polarisation

This article examines the role of economic hardship in contributing to our understanding of the causes of affective polarisation – that is, the animosity between partisan groups. Evidence suggests that a variety of political attitudes and behaviours are influenced by economic hardship, but the relationship between individual economic hardship and affective polarisation has not yet been demonstrated. Thus, the purpose of this study is to investigate whether individuals facing economic insecurities are more affectively polarised. This study leverages two novel surveys, the first conducted in 11 European countries ( N = 12,000), the second in Belgium and the Netherlands ( N = 2174). Both contain individual-level measurements of economic hardship novel to the field of affective polarisation. Whereas the first allows for making generalisable claims across European multiparty systems, the second contains a more thorough operationalisation of the central concepts. The paper finds little to no evidence to support the existence of a link between economic hardship and affective polarisation. Across countries, objective and subjective measures of economic hardship are not linked to affective polarisation, neither when based on employment or financial status. Future research should now examine whether these cross-sectional findings are supported by longitudinal or experimental evidence.

Asking the "Right" Questions about Financial Hardship: Using Cognitive Interviews with Adolescents and Young Adults with Cancer and Their Caregivers to Inform Measure Development.

Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers.

Closing the Loop: Exploring Food Waste Management in the Near East and North Africa (NENA) Region during the COVID-19 Pandemic

The COVID-19 pandemic disrupted global food waste patterns through unanticipated shifts in composition and quantities. This review explores the impacts of COVID-19 on food waste generation and management approaches in the Near East and North Africa (NENA) region during the recovery phase. This paper comprehensively explores food loss and waste in the NENA region. It presents a detailed analysis of pandemic-induced changes in household food waste behaviors, analyses the integration of circular economy principles in recovery strategies and policy implications, and outlines potential avenues for future research in this critical area. The key findings are threefold: First, this study reaffirms that food waste is a critical challenge in NENA, contributing to food insecurity, water scarcity, and environmental issues. Second, the pandemic catalyzed a dichotomy in consumer behaviors—panic buying initially increased waste, while hardship measures later encouraged sustainable waste reduction practices like meal planning and leftover use. Third, adopting a circular economy approach holds potential, yet its implementation remains limited in terms of curbing food waste and promoting sustainability in NENA. Overall, while the pandemic accentuated the urgency of tackling food waste, it also stimulated innovative policy thinking and strategic planning for building more resilient food systems. This paper concludes that leveraging pandemic-driven sustainability mindsets while addressing systemic drivers of waste will be key to mitigating food waste and its impacts moving forward. This paper offers timely insights into the evolving food waste management landscape in NENA, underscoring the need for integrated policies to navigate post-pandemic recovery effectively.

Financial hardship after cancer: revision of a conceptual model and development of patient-reported outcome measures.

Aim: This qualitative study refined a conceptual model of financial hardship and developed measures corresponding to model constructs. Methods: Eighteen women with breast cancer recruited through a comprehensive cancer center completed interviews. A qualitative framework analysis was conducted of the interviews. Results: Participants experienced varying levels of financial hardship. Protective factors included good health insurance, work accommodations and social support. Participants worried about cancer care costs and employment. Programs for alleviating financial hardship had high administrative burdens. Four preliminary financial hardship measures were developed: coping, impacts, depression and worry. Conclusion: Reducing administrative barriers to benefits could reduce financial hardship after cancer. More research is needed on the effects of out-of-network/formulary care and denials of coverage and to validate the measures.

Financial Hardship Among Women With Breast Cancer in Addis Ababa Ethiopia: A Comparative Cross-Sectional Study

PURPOSE Breast cancer (BC) is the leading cause of cancer morbidity and mortality in Ethiopia, yet financial hardship is often overlooked. Herein, we examined the financial hardship of BC among women newly diagnosed with the disease in Addis Ababa, Ethiopia. MATERIALS AND METHODS We conducted a comparative cross-sectional study of financial hardship between 353 women diagnosed with BC from 2017 to 2018 in Addis Ababa and 618 women without a history of the disease but with medical expenses selected by multistaging sampling from the city's general population. Financial hardship measures, coded as binary variables (yes, no), included selling assets to pay for medical expenses, borrowing money to meet medical expenses, and worrying about family's financial security. The associations between BC diagnoses and each of the financial hardship measures were evaluated using the multivariable logistic regression model. RESULTS Women with BC compared with those without a history of the disease were more likely to report out-of-pocket costs (98% v 38.9%), sell properties (10.2% v 4.2%), and worry about families' financial security (53.8% v 41.8%), but they were equally likely to report borrowing money (19.8% v 17.8%). In the multivariable-adjusted model, women with BC compared with those without the disease were three times as likely to sell their property to cover medical expenses (adjusted odds ratio [AOR], 2.94 [95% CI, 1.49 to 5.83]) and 1.4 more likely to worry about their family's financial security (AOR, 1.42 [95% CI, 1.02 to 1.96]). CONCLUSION The material and psychological burden of BC is considerably high among women in Addis Ababa, Ethiopia, suggesting the need for discussion of cost as part of delivering high-quality care and expanding health care coverage.

The Relation Between Classroom Adversity and Students’ Problem Behavior as a Function of Teachers’ Emotional Support

The purpose of this study was to examine the relation between teachers’ reports of classroom adversity, a measure of classroom hardship, and student problem behavior in a sample of students with or at risk of emotional/behavioral disorders. We also examined the extent to which this relation varied as a function of multiple domains of classroom quality. A series of multiple regression models, adjusting for the nesting of students within classrooms, were conducted. Models revealed a significant effect of the interaction between classroom adversity and classroom emotional support on teachers’ reports of student problem behaviors. This effect indicated that in low-adversity classrooms, teachers differed in their reports of students’ problem behaviors depending on their level of emotional support. In high-adversity classrooms, however, teachers’ reports of students’ problem behaviors were relatively similar regardless of their level of emotional support. Findings suggest classroom adversity is likely an important contextual factor to consider when examining student outcomes and that teacher emotional support may mitigate the influence of classroom adversity. We conclude with a discussion of the implications of this work for research and practice.

Racial and ethnic disparities in the association between financial hardship and self-reported weight change during the first year of the pandemic in the U.S.

Studies have shown that financial hardship can impact weight change; however, it is unclear what the economic impact of the COVID-19 pandemic has had on weight change in U.S. adults, or whether racial-ethnic groups were impacted differentially. We estimated the association between financial hardship and self-reported weight change using data from the cross-sectional COVID-19’s Unequal Racial Burden (CURB) survey, a nationally representative online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults conducted from 12/2020 to 2/2021. Financial hardship was measured over six domains (lost income, debt, unmet general expenses, unmet healthcare expenses, housing insecurity, and food insecurity). The association between each financial hardship domain and self-reported 3-level weight change variable were estimated using multinomial logistic regression, adjusting for sociodemographic and self-reported health. After adjustment, food insecurity was strongly associated with weight loss among American Indian/Alaska Native (aOR = 2.18, 95% CI = 1.05–4.77), Black/African American (aOR = 1.77, 95% CI = 1.02–3.11), and Spanish-speaking Latino adults (aOR = 2.32, 95% CI = 1.01–5.35). Unmet healthcare expenses were also strongly associated with weight loss among Black/African American, English-speaking Latino, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults (aORs = 2.00-2.14). Other domains were associated with weight loss and/or weight gain, but associations were not as strong and less consistent across race-ethnicity. In conclusion, food insecurity and unmet healthcare expenses during the pandemic were strongly associated with weight loss among racial-ethnic minority groups. Using multi-dimensional measures of financial hardship provides a comprehensive assessment of the effects of specific financial hardship domains on weight change among diverse racial-ethnic groups

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations.

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth's own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth-caregiver dyads (youth: 14-16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69-0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability (β = .19-.47). Youth-reported financial stress positively predicted within-individual variation in externalizing (β = .18), while youth reports of material deprivation predicted externalizing when looking between families (β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

Predicting food insecurity among UK university students during the COVID-19 pandemic.

The present study investigated potential predictors of food insecurity among UK university students during the COVID-19 pandemic. Close-ended questionnaire administered to a cross-sectional sample of UK university students. Data were collected using an online survey platform in October 2020, during the COVID-19 pandemic. A nationally representative sample of UK university students (n 640). Odds ratios (OR) obtained from logistic regression were statistically significant for three measures of economic hardship. First, students who relied on financial aid from student loans were 1·9 times more likely to report being food insecure than students who did not rely on financial aid from student loans. Second, students who could not pay their utility bill (v. those that could pay) were 3·1 times the odds of being food insecure. Finally, as perceived difficulty in paying for accommodation increased across the sample, the odds of being food insecure also increased (OR = 1·9). We also found that students who were recently ill were 2·2 times more likely to be food insecure compared with students who were not recently ill. We did not find any evidence that testing positive for COVID-19 predicted food insecurity, and university supplied food parcels/boxes did not reduce student food insecurity. Both economic factors and illness play a significant role in self-reported food insecurity in higher education students during pandemic lockdown. Further research is needed to explore food insecurity, economic factors and illness outside of a pandemic context.

Medicaid generosity and food hardship among children

AbstractWe explore the role of the largest means‐tested transfer program, Medicaid, on multiple measures of food hardship among households with children, including measures that capture hardship explicitly experienced by children. Using data from the 2001 to 2020 waves of the December Current Population Survey, we identify the effect of having a Medicaid‐eligible child on household food hardship by exploiting between‐state, over‐time, and between‐household income eligibility criteria. We find that having an eligible child reduces rates of household food insecurity and very low food security by 20% and 26%, respectively. Among children themselves, eligibility reduces rates of food insecurity and very low food security by 22% each. The effects are stronger for households headed by Black and Hispanic individuals as well as households that have children under 6 years old.

“I felt super lucky:” Luck and administrative burden in cancer-related financial hardship.

198 Background: Financial hardship after cancer diagnosis is common and leads to earlier mortality and worse quality of life. This qualitative study sought to identify causal and protective factors for financial hardship as part of a larger study to refine a theoretical model and measure of financial hardship. Methods: We recruited female breast cancer survivors at a large comprehensive cancer center. Participants completed a semi-structured interview focused on their reflections of cancer diagnosis and active treatment. Interviews assessed multiple dimensions of financial hardship (coping, impacts, worry/anxiety, depression) and contributing, protective, and contextual factors. We conducted framework qualitative analysis of interview transcripts. Results: We interviewed eighteen women with breast cancer (100% early or regional stage; 77% White; mean age 57; time since diagnosis 3-24 years). Participants reported varying levels of financial hardship during diagnosis and treatment. Financial coping behaviors ranged from minor rebudgeting, to skipping or delaying healthcare, to major decisions about family structure (e.g. having children; marriage or divorce). Even successful financial coping induced stress (“it was just really painful”) because of administrative and time burden: hypervigilance to bills and finances; waiting in phone queues; negotiating with insurance companies and employers; liaising between employer, insurance company, and care team; and learning about, gathering documents, and applying for benefits (e.g. FMLA; disability). Employment and generous health insurance were protective, but out-of-network care and coverage denials tempered this protection and introduced stress. Worry about employment or insurance loss and the administrative burdens required to financially cope also created stress. Other protective factors were largely described as good luck, such as understanding bosses, flexible work arrangements, multiple household incomes, assistance from family and friends, or avoidance of more severe hardship (“we were fortunate we didn't lose our home"). Easily accessible health insurance was also described as good luck. Conclusions: Administrative and time burden required for financial coping behaviors can induce distress for women with breast cancer, even if successful in mitigating financial hardship. Luck emerged as a prominent protective factor. Luck and its relationship to structural factors that generate inequity may have ethical and policy implications for addressing cancer-related financial hardship and is worthy of further study.

The association between material-psychological-behavioral framework of financial hardship and markers of inflammation: a cross-sectional study of the Midlife in the United States (MIDUS) Refresher cohort

BackgroundMeasures of financial hardship have been suggested to supplement traditional indicators of socioeconomic status (SES) to elucidate household economic well-being. This study formally tested the construct validity of financial hardship and examined its association with markers of inflammation.MethodsThis study utilized data from the Midlife Development in the United States Refresher Study (MIDUS-R; Age = 23-76, 53.7% female, 71% white). Participants were divided into exploratory factor analysis (EFA; completed SAQs only; N = 2,243) and confirmatory factor analysis sample (CFA; completed SAQs and biomarker assessment; N = 863). Analysis was divided into three steps. First, exploratory factor analysis (EFA) is used to examine if the three-domain factor (material, psychological, and behavioral) is the best fitting model for financial hardship measures. Second, we conducted CFA to test the hypothesized three-factor measurement model of financial hardship. Third, we tested the association between domains and the general latent factor of financial hardship and inflammation (interleukin 6/IL6, c-reactive protein/CRP, and fibrinogen).ResultsResults from EFA supported the three-domain model of financial hardship. The hypothesized three-domain measurement model fits well in a different sample within MIDUS-R. In the models adjusted for age and sex, higher material hardship was associated with elevated IL6, CRP, and fibrinogen, while higher behavioral hardship was associated with higher CRP. The association between the material domain and IL6 remained significant after adding body mass index, education, and race as additional covariates. The second-order financial hardship measurement model was associated with IL6, CRP, and fibrinogen, adjusted for age, sex, BMI, education, and race.ConclusionExplicating the socioeconomic environment to include indicators of financial hardship can help researchers better understand the pathway between SES and the inflammation process, which may help elucidate pathways between SES and age-related chronic diseases associated with inflammation.

Catastrophic health expenditure in nonneurological injury due to motor vehicle crash.

Motor vehicle crashes (MVCs) are a leading cause of nonfatal injury in the United States and impose a high financial cost to the patient and the economy. For many patients, this cost may be financially devastating and contribute to worsening health outcomes after injury. We aimed to describe the population level risk of catastrophic health expenditure (CHE) and determine factors associated with risk of CHE. We performed a retrospective review using the 2014-2017 Nationwide Inpatient Sample. The study population consisted of uninsured and privately insured adults aged 26 to 64 years who were hospitalized for nonneurologic traumatic injury due to MVCs. Our measure of financial hardship was CHE, which was defined as hospital charges ≥40% of postsubsistence income. Income estimates were derived from zip-code level data using Γ distribution modeling. Our sample included 189,000 patients, of which 149,705 had private insurance and 39,375 were uninsured. The median estimated income for the study cohort was $66,118 (interquartile range, $65,353-$66,884). The median cost of hospitalization was $53,467 (interquartile range, $29,854-$99,914). In addition, 91.5% of uninsured patients suffering from MVC are at risk for CHE, and 10.1% of privately insured patients are at risk for CHE. Among the insured, Black, Hispanic, and low income were associated with CHE. Nine of 10 uninsured patients are at risk for CHE after hospitalization for MVC. Despite having insurance, 10% of patients are still at risk of CHE. Black, Hispanic, and low-income communities are at highest risk of having private insurance and still experiencing CHE. This is the first population level analysis after the implementation of the Affordable Care Act that assesses the financial burden of no insurance and underinsurance. These data are important to understand the effectiveness of insurance coverage and guide hospital and policy level interventions to prevent CHE. Prognostic and Epidemiological; Level III.

Mental health of agricultural adolescents and adults: Preliminary results of a five-year study.

Work-related stressors common to agriculture have been associated with adverse mental health outcomes among adult farmers and ranchers. However, the mental health status of agricultural youth is unknown, despite farm and ranch youth being exposed to the same occupational hazards as their adult counterparts. The objective of this study was to estimate the prevalence of symptoms of depression and anxiety among farm adults and their adolescent child and examine the correlation between symptoms of mental health conditions and financial indicators described in the Family Stress Model (FSM). Farm families were recruited to participate in online surveys by mail, email, and social media. One adolescent and at least one adult from each family were invited to complete on online survey. Where available, validated instruments were used to collect mental health, stress, family dynamics, and household financial variables. Descriptive statistics were used to describe sample demographics and prevalence of symptoms of depression and anxiety. Pearson correlations describe associations between variables within the Family Stress Model. Farm families (N = 122) completed the online survey. The mean age of farm parents was 41.4 years (SD = 4.4) and the mean age of farm adolescents was 15.4 (1.2). A majority of farm parents and farm adolescents were male, 58.2% and 70.5%, respectively. The sample was primarily white, non-Hispanic. In this sample of farm parents and adolescents alike, 60% met the criteria for at least mild depression, based on the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-A (PHQ-A). Similarly, among adolescents, 45.1% met the criteria for Generalized Anxiety Disorder (GAD), as did 54.9% of adults. As a measure of economic hardship, per capita income by itself showed relatively low correlations, even with other economic measures (r = 0.11 with negative financial events, r = 0.20 with financial needs, r = 0.17 with financial situation, and r = 0.27 with debt). Parent depressed mood was in turn highly associated with adolescent depression (r = 0.83), social anxiety (r = 0.54), and generalized anxiety (r = 0.69). The results show a strong association between parent and adolescent mental health and parental depressed mood and debt. There is not a clear association between economic stress and mental health in this sample, but further work is needed to be done at a population level. Preliminary results are promising for application of the full Family Stress Model as we continue to accrue farm families into the study cohort.

Associations between relative deprivation with opioid use among working-age adults during the great recession

Recessions, poverty, and unemployment have been associated with opioid use. However, these measures of financial hardship may be imprecise, limiting our ability to understand this relationship. We tested associations between relative deprivation and non-medical prescription opioid use (NMPOU) and heroin use among working-age adults (ages 18–64) during the Great Recession. Our sample included working-age adults in the 2005–2013 United States National Survey of Drug Use and Health (n = 320,186). Relative deprivation compared the lowest limit of participants’ income category to the national 25th percentile individual income for people with similar socio-demographic characteristics (race and ethnicity, gender, year). We distinguished the period before (1/2005-11/2007), during (12/2007-06/2009), and after (07/2007-12/2013) the Great Recession. We estimated odds of past-year NMPOU and heroin use for each past-year exposure (i.e., relative deprivation, poverty, unemployment) using separate logistic regressions adjusting for individual-level covariates (gender, age, race/ethnicity, marital status, and education) and national-level annual Gini coefficient. Our results show that NMPOU was higher among people experiencing relative deprivation (aOR = 1.13, 95% CI = 1.06–1.20), poverty (aOR = 1.22, 95% CI = 1.16–1.29), and unemployment (aOR = 1.42, 95% CI = 1.32–1.53) between 2005 and 2013, as was heroin use (aORs = 2.54, 2.09, 3.55, respectively). The association between relative deprivation and NMPOU was modified by recession timing, and was significantly higher after the Recession (aOR = 1.21, 95% CI = 1.11–1.33). Relative deprivation was associated with higher odds of NMPOU and heroin use, and higher odds of NMPOU after the Great Recession. Our findings suggest contextual-level factors may modify the relationship between relative deprivation and opioid use, and support the need for new measures of financial hardship.

Latent classes and longitudinal patterns of material hardship as predictors of child well-being.

This study examined the associations of multifaceted material hardship measured cross-sectionally and longitudinally with children's wellbeing in the United States. Results from linear regression and child fixed effects models indicated that more intense material hardship had consistent, detrimental associations with child health status and internalizing and externalizing behaviors. More intense longitudinal patterns of material hardship were consistently associated with behaviors only. These findings examine new, multifaceted measures of material hardship and suggest associations between child wellbeing, particularly behavior challenges, and exposure both to multiple forms of material hardship and to more intense long-term patterns of hardship.

Alleviating Financial Hardships Associated with High-Deductible Health Plans for Adults with Chronic Conditions Through Health Savings Accounts.

High-deductible health plans (HDHPs) are becoming increasingly common, but their financial implications for enrollees with and without chronic conditions and the mitigating effects of health savings accounts (HSAs) are relatively unknown. Our aim was to compare financial hardship between non-HDHPs and HDHPs with and without HSAs, stratified by enrollees' number of chronic conditions. We used data from 2015 to 2018 Medical Expenditure Panels Surveys (MEPS) to compare rates of financial hardship across individuals with HDHPs and non-HDHPs using linear and logistic regression models. A nationally representative sample of 30,981 adults aged 18-64 enrolled in HDHPs and non-HDHPs. We examined several measures of financial hardship, including total yearly out-of-pocket medical spending as well as rates of delaying medical care or prescriptions in the past year due to cost, forgoing medical care or prescriptions in the past year due to cost, paying medical bills over time, or having problems paying medical bills. We compared rates using the non-HDHP as the control. On most measures, HDHPs are associated with greater financial hardship compared to non-HDHPs, including average annual out-of-pocket spending of $637 for non-HDHPs, $939 for HDHPs with HSAs, and $825 for HDHPs without HSAs (p < 0.01). However, for HDHP enrollees with multiple chronic conditions, having an HSA was associated with less financial hardship (p < 0.05). Our findings suggest that HSAs may be most beneficial for those with chronic conditions, in part due to the tax benefits they offer as well as the fact that those with chronic conditions are more likely to take advantage of their HSAs than their younger, healthier counterparts. However, as HDHPs are more likely to be correlated with worse financial outcomes regardless of health status, recent trends of increasing participation may be a reason for concern.

256: FAMILY FINANCIAL HARDSHIP BEFORE AND AFTER PEDIATRIC CRITICAL ILLNESS

Introduction: Little is known about caregiver financial hardship before versus after a child’s Pediatric Intensive Care Unit (PICU) hospitalization. Methods: We used a novel dataset linking statewide commercial insurance claims to cross-sectional commercial credit data. Using validated revenue codes, we identified PICU hospitalizations (age ≤18 years) in January-June 2020 and January-June 2021. Caregivers of these children were identified as adults listed as the primary plan holder or spouse of the primary plan holder. Financial measures in January 2021 assessed pre-PICU status in the January-June 2021 cohort and post-PICU status in the January-June 2020 cohort. Financial measures included delinquent debt, debt in collections by type (medical and non-medical), low credit score(< 660), and financial hardship(composite of any outcome). Logistic and generalized linear regression models were used to compare caregiver financial status in the 2021 vs 2020 cohorts (pre- vs post-PICU). Models were adjusted for child’s age and comorbidity status, hospital length of stay, and household status (primary plan holder with a spouse on the plan; spouse; and primary plan holder with no spouse on the plan). Results: We identified 1038 caregivers for 608 children pre-PICU and 1092 caregivers for 631 children post-PICU. 99.8% (n=2,126) of caregivers were linked to their credit report data; 1035 pre-PICU and 1091 post-PICU caregivers. Post-PICU caregivers had higher adjusted odds of any delinquent debt [adjusted Odds Ratio 1.22; 95%CI 1.00-1.48; p=0.04]. Post-PICU caregivers had higher frequencies of medical and non-medical debt in collections, and low credit score, though not statistically significant. For those with delinquent debt, post-PICU caregivers had higher adjusted mean debt than pre-PICU caregivers ($3692 vs $2536, p< 0.01). Amounts of medical and non-medical debt in collections were similar. 45.7% and 49.8% of pre- and post-PICU families had any measure of financial hardship. Conclusions: Financial hardship is common in caregivers of critically ill children—present in nearly half before and after PICU hospitalization. While delinquent debt was higher after PICU hospitalization, medical debt in collections was similar pre- vs post-PICU, suggesting non-medical costs may be a key driver of financial hardship post-PICU.

Comparison of two validated instruments to measure financial hardship in cancer survivors: comprehensive score for financial toxicity (COST) versus personal financial wellness (PFW) scale.

Financial distress and financial toxicity are recognized challenges in cancer survivorship. Financial toxicity includes both objective measures of hardship and subjective distress. We hypothesized that subjective financial distress is correlated to overall holistic financial toxicity. We compared two widely accepted instruments to measure financial distress and financial toxicity. Patients in the follow-up phase of care at a single institution were surveyed regarding demographic and economic status. Financial toxicity was measured using the comprehensive score for financial toxicity-functional assessment of chronic illness (COST-FACIT) and financial distress using the personal financial wellness (PFW) scale. Surveys were analyzed for correlation and internal consistency. Patient score distributions were compared. Associations between survey scores and patient factors were assessed using multivariable linear regression models. A total of 116 patients were included. Scores from the COST-FACIT showed a strong correlation with PFW scores (r = 0.90, p < 0.0001). Scale reliability was high for both the COST-FACIT (α = 0.92) and PFW (α = 0.97) surveys. Score distributions exhibited left skew for both surveys, with 9.5% of patient scores falling in the worst quartile of possible scores on each respective survey. The strongest predictors of financial distress and financial toxicity included young age, lower monetary savings, lower household income, and less perceived social support during cancer treatment. The COST-FACIT measure of financial toxicity correlated strongly with PFW measure of financial distress. Although these instruments were designed to assess different concepts (financial distress vs financial toxicity), they gave strikingly similar results. Either instrument may be used as a meaningful patient-reported outcome for study of financial distress in cancer survivors. However, the COST-FACIT construct of financial toxicity does not appear to add additional information beyond financial distress.

Maternal stress and hair cortisol among pregnant women following hurricane Florence.

We analyzed multiple stress measures among 37 participants who were pregnant during Hurricane Florence. We used questionnaires modeled on previous studies to assess hardship associated with the hurricane, psychological distress, sociodemographic characteristics, social support, and food security. We analyzed cortisol concentrations in proximal and distal hair sections, representing stress around the time of the disaster (distal) and 3-4months following the disaster (proximal). We used linear regression to test relationships between hair cortisol and self-report stress measures, and variations based on marital status. Self-report measures of distress and hardship were similar among married and unmarried participants. Mean cortisol levels in distal and proximal sections were higher among unmarried participants. Controlling for confounding variables, hardship was not associated with hair cortisol. Distress predicted cortisol in distal sections (β=.482, p=.018), with a trend for proximal sections (β=.368, p=.055). Marital status was a significant predictor of distal (β=.388, p=.027) and proximal (β=.333, p=.047) hair cortisol, explaining 8.6%-11.7% of unique variance. Preexisting and intersecting risk factors likely place unmarried pregnant individuals at risk of stress during and following a disaster.