Highest Income Category Research Articles

Perceived Influence of a State-Level Universal Free School Meal Policy on Households With Varying Income Levels: An Analysis of Parental Perspectives

BackgroundIn the United States, a means-tested approach is often used to provide free or reduced-price meals (FRPM) to students from lower-income households. However, federal income thresholds do not account for regional cost of living variations. Thus, many ineligible households may be at risk for food insecurity. Universal free school meal (UFSM) policies may help address this issue, especially in states with a higher cost of living. ObjectiveTo evaluate parent perceptions of the influence of Massachusetts’ statewide UFSM policy on households eligible and ineligible for FRPM. DesignCross-sectional survey of parents across income categories conducted during the 2022-2023 school year. Participants/settingMassachusetts parents (N = 403) with children in grades kindergarten through grade 12 with incomes ranging from <185% of the federal poverty level to >300% of the federal poverty level. Main outcome measuresParents’ perceived influence of Massachusetts’ UFSM policy on their child and household. Statistical analyses performedAnalysis of variance examined differences in the perceived impact of UFSM by FRPM eligibility, adjusting for demographic characteristics. ResultsHouseholds that were FRPM eligible or near eligible were significantly more likely to report that their ability to have enough food for their family would be harder without UFSM (P < .0001) compared with those in the highest income category. Across all income categories, approximately 75% of parents reported that school meals should be free for all children, and UFSM saved their family money and time and reduced stress, with no significant differences by FRPM eligibility. Roughly half (52%) reported their household finances would be hurt and 42% of parents from households eligible for FRPM reported their child would be less likely to eat school meals if the UFSM policy ended. ConclusionsThis study found strong parent support of UFSM policies regardless of income level. In addition, parents perceived that discontinuing UFSM may adversely influence school meal participation, including among students from lower-income households, as well as food security among households ineligible for FRPM, particularly in areas with higher costs of living. Policies to expand UFSM should be considered among additional states and at the national level.

Employment, income, and sleep in South Africa: An actor-partner interdependence model approach

ObjectiveWe analyze the relationship between employment status, income, and sleep in South Africa to address two research questions: (1) How does employment status influence the sleep quantity of the individual and their partner? (2) How does income impact the sleep quantity of the individual and their partner? MethodUsing data from 1600 Black African couples in the South African Time Use Study, we employ the Actor-Partner Interdependence Model to investigate the relationship between employment status, income, and sleep in couples. We categorize nighttime sleep into three categories: recommended sleep (7-9 hours), short sleep (<7 hours), and long sleep (>9 hours). ResultsEmployed individuals were more likely to get the recommended amount of sleep and less likely to experience long sleep. However, men whose wives are employed are almost twice as likely as men whose wives are unemployed to experience short sleep, and they experience 47% lower risk of long sleep. Men with a medium level of income have a higher risk of short sleep than those with low income, while those in the highest income category are more likely to get the recommended amount of sleep. ConclusionThese results highlight the intricate dynamics between managing employment demands and securing economic stability for both men and women in the context of high unemployment and shifting gender norms.

Trends in Pediatric Attention-Deficit Hyperactive Disorder Diagnoses and Prescription Utilization: 2016 to 2019.

Attention-deficit hyperactive disorder (ADHD) is one of the most common psychiatric disorders among children, with estimated prevalence of 7% to 15% worldwide. The aim of this analysis was to update and summarize trends in diagnosis, demographics, and drug utilization of pediatric patients with ADHD. We used the Agency for Health care Research and Quality Medical Expenditure Panel Survey (MEPS), a survey of US individuals, families, their medical providers, and employers, using datasets from 2016 to 2019. The data sources from the MEPS database included the full-year consolidated files, medical conditions files, prescribed-medicines files, and condition-event link files for each year. We summarized trends in the proportion of children, ages 17 years and younger, with a diagnosis of ADHD, demographic information and a prescription for medication known to treat ADHD. In addition, we further stratified ADHD medication use by stimulant/nonstimulant categories. There was a 1.6% and 4.7% absolute increase in children with an ADHD diagnosis and those prescribed ADHD medications, respectively, from 2016 to 2019. Most of these children were male, non-Hispanic, and on public insurance. Of the children prescribed an ADHD medication and concomitant behavioral medications, stimulants-only use was the highest (60%-67%), followed by stimulants/nonstimulants (13%-15%), stimulant/antidepressants (6%-9%), and nonstimulants only (5%-9%). The proportion of patients with ADHD in the high-income and near-poor categories increased by 4% from 2016 to 2019. Diagnosis of ADHD among children is trending upward in the United States. Central nervous system stimulants, especially methylphenidate formulations, are the most prescribed ADHD medications for children 17 years and younger.

Fibrolamellar hepatocellular carcinoma (FL-HCC) epidemiology, survival characteristics, and outcomes: Surveillance, epidemiology, and end results database (SEER) study.

e16213 Background: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare and distinctive form of liver cancer that primarily affects adolescents and young adults without underlying liver disease. Unlike conventional HCC, it exhibits unique clinical and histological features and poses a diagnostic and therapeutic challenge. Using a national registry, we sought to evaluate the incidence, demographics, survival, and treatment characteristics of FL-HCC. Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with microscopically confirmed FL-HCC between 2000-2020 using ICD-O-3 site code C22.0 and an 8171/3 histology code. The epidemiological characteristics included were age, gender, ethnicity, American Joint Committee on Cancer [AJCC] staging, annual income, and treatment modalities. The Kaplan-Meier survival curve was used to compare survival. Survival was stratified according to age, gender, race, stage, income, and treatment modalities. Multivariate analysis was done with Cox regression analysis on R programming language version 3.6.3. Results: We identified a total of 362 patients with fibrolamellar hepatocellular carcinoma with median age at diagnosis 27(8-84) years. It was found to be more common in males (62.2%) and among whites (78.2%). There was a striking increment in incidence with 1.9% in 2005 compared to 5.8% in 2020. The majority of the patients had stage IV disease (26.4%). Alpha-fetoprotein was noted to be positive only in 15.8% of patients. The majority of the patients received surgery (50.3%) and chemotherapy (48.1%) with a median time from diagnosis to treatment of 1.00 month (IQR: 0.00–1.00). A total of 11% of patients received radiation, and 25% received multiple treatments. Survival analysis revealed a median overall survival of 24.50 months (IQR: 7.00, 63.00), with a majority experiencing death attributable to the cancer diagnosis (60.2%). Median overall and cause-specific survival for stage I disease was 92 months, and stage IV disease was 21 months (p &lt; 0.05). Patients below the age of 20 had a median survival of 85 months (95% CI: 41 to NA) compared to those aged between 20 and 59, i.e., 30 months (95% CI: 22 to 41 months). The higher-income categories, $55,000−59,999 (HR = 0.29, p = 0.05) and $60,000−64,999 (HR = 0.24, p = 0.03), demonstrated significantly lower hazards compared to &lt; $35,000. We concluded that sex, location, and race did not influence the survival of FL-HCC. Conclusions: Our comprehensive analysis of FL-HCC revealed that diagnosis at a younger age, stage I disease, and higher annual income improved survival, whereas gender and race did not affect outcomes. Further collaborative efforts are warranted to advance our understanding of FL-HCC pathogenesis, optimize treatment strategies, and improve outcomes for affected individuals.

Inequality in dental flossing behavior among Korean adults based on household income levels.

The aim of this study was to estimate the association between household income and dental flossing. This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yes/no), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices. In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27 to 2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86 to 7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05 to 2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07 to 2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24 to 2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23 to 2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10 to 2.44). The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.

Who Demands Technical and Vocational Education in Pakistan? A PSLM Analysis of Socio-Economic Determinants

Purpose: The present study investigates the influence of demographic factors on the demand for Technical and Vocational Education and Training (TVET) in Pakistan. The government of Pakistan has implemented various skill enhancement programs to harness the demographic dividend. However, only a small portion of the workforce receives any form of TVET, contributing to a shortage of skilled workers in the country. Many industries, particularly in manufacturing and mining, face deficits in the skilled labour. Consequently, this study aims to examine the role of demographic factors in shaping the demand for TVET within the Pakistani context. Methods: For the TVET demand's estimation, this study employed the Pakistan Social and Living Standard Measurement (PSLM) dataset of 2018–19 by using binary logistic regression analysis (BLRA). The demographic variables include the household's income, household head's education, household size, male proportion of the target age group, household head's age, and region of the household. Findings: The findings indicate that households in the higher income category do not demand TVET. Moreover, if the head of the household is highly educated, then the household is less likely to participate in TEVT. So, the higher the socio-economic status, the lower the probability of demand for TVET from the better-off students. Further, this study also indicates that boys are more likely to participate in TVET-related degrees, while females are less likely to participate in TVET due to the non-availability of institutes and hostel facilities, poor transportation, the limited number of trades available for females, and security issues. Conclusion: The findings provide insightful evidence to support the idea that the higher the socio-economic status of households, the lower the probability of demand for a TVET degree or diploma. Similarly, children of parents with university education are less likely to pursue TVET-related degrees. The reason is likely attributed to the perception that TVET-associated degrees and diplomas are considered inferior due to their lower standing and prestige as compared to general or professional degrees. This study suggests that the attractiveness of TVET can be enhanced by improving the quality of TVET, improving labour market outcomes, and creating a pathway to general education. Overall, this study not only contributes to empirical analyses of socio-economic determinants in TVET demand but also suggests that its findings can be applied not only to South Asian countries but also to other comparable nations with similar cultural ties and affinities.

Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018.

Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P<0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%-5.1%, P<0.05; PIR 3-4.99: 7.6%-6.1%, P<0.05). The 10-year PCE risk for the lowest income category (PIR <1) did not significantly change (8.1%-8.7%). In 1988-1994, the 10-year PCE risk for PIR <1 was 6% higher than PIR 5; by 2015-2018, this relative inequity increased to 70% (P<0.05). When using metrics that account for all income categories, the achievement index improved (8.0%-7.1%, P<0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health. In this serial cross-sectional survey of US adults spanning 30 years, the population's mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.

Categorizing land: an account of leftover land in Patna

This paper is an account of Bihar State Housing Board (BSHB) and its role in allocating housing and land from the 1970s onwards in Patna. The housing board typifies the bureaucratic practices of property-making at its best and demonstrates how the bureaucracy strategically aligned itself with caste-driven state politics. The unstable nature of forward–backward caste-based partisan politics meant politicians made unceasing efforts to garner support to stay in power including that of the bureaucrats who had far more control and knowledge about administration rules. By creating the discretionary category of chit-put land, loosely translated as leftover or not useful for anyone, an elaborate rationale was created for land allocation. This flexibility was used for carving out new land parcels for the high-income and middle-income category in Patna. The board dexterously encroached on the land allocated for the urban poor in whose name the land acquisition was undertaken at the outset. Using minutes of the meetings of BSHB, the paper also argues for alternative approaches for drafting and mapping the spatial history of a non-metropolitan city without a master plan and maps.

Feasibility of financing nature-based solutions for water security through water tariffs: Evidence from South Africa

Abstract In many countries, catchment restoration is underfunded. This study aims to address whether household water pricing could be used as a mechanism for securing funds for catchment restoration. The objectives were to determine households' willingness to pay (WTP) for their existing water use, investigate whether institutional trust and municipal satisfaction influenced WTP, and establish whether aggregate consumer surplus at the municipal scale could cover the costs needed to finance catchment restoration. Surveys were conducted on 502 households in three metropolitan municipalities in the City of Cape Town, eThekwini, and Nelson Mandela Bay. Contingent valuation revealed that average WTP for water was between 12 and 137% more and 32 and 73% more than what households currently pay for water per month in the City of Cape Town and eThekwini, respectively. Satisfaction with municipal service delivery positively influenced WTP, while institutional trust did not. The City of Cape Town, based on the aggregate WTP from the higher income categories, consumer surplus was 779 million South African Rand (ZAR)/year, more than double the estimated cost required to restore the catchment areas supplying water to the city over 30 years. In eThekwini, consumer surplus was equal to the amount needed over 30 years (250 million ZAR/year). These results demonstrate the significant potential to raise water tariffs for higher income households in metropolitan municipalities.

Association between Family Household Income and Cognitive Resilience among Older US Adults: A Cross-Sectional Study.

Cognitive resilience has emerged as a mechanism that may help explain individual differences in cognitive function associated with aging and/or pathology. It is unknown whether an association exists between family income level and cognitive resilience. We performed a cross-sectional study to estimate the relationship between family income level and high cognitive resilience using the National Health and Nutrition Examination Survey (NHANES) among older adults (age≥60). Logistic regression was used to estimate the association between income level and high cognitive resilience adjusted for other factors. Accounting for differences in education, occupation, and health status, older adults in the highest income category were twice as likely compared to those with very low income to have high cognitive resilience (OR: 1.90, 95% CI: 1.05,3.43). A doseresponse was apparent between income category and high cognitive resilience. The finding that income, above and beyond that of known factors, affects cognitive function is important for future public health strategies that aim to prevent or delay cognitive impairment.

The global incidence, mortality, and burden of uterine cancer in 2019 and correlation with SDI, tobacco, dietary risks, and metabolic risk factors: An ecological study.

Endometrial cancer (EC) is the sixth most common cancer among women worldwide. Since global studies are based on awareness of the incidence trend, mortality, geographical diversity, and level of social development and income of countries, this study was conducted to investigate the trend of uterine cancer (UC) in the world in 2019. Age-standardized rates (ASR) of incidence, deaths, prevalence, and disability-adjusted life years (DALYs) of UC, as well as targeted risk factors, were extracted from the Global Burden of Disease (GBD) online database 2019. Pearson correlation coefficient and SPSS 16 were used to calculate the correlation between risk factors and ASR of epidemiological indicators. Statistical significance was considered as p < 0.05. In 2019, the age-specific incidence and death rate of UC was peaking at 60-64 and 65-69 years, respectively. The highest age-standardized incidence rate per 100,000 people for UC has been reported in the Northern Mariana Islands, high sociodemographic index (SDI) countries, World Bank High-Income category, Europe continent and among World Health Organization (WHO) regions were found in the European Region. The highest age-standardized death rateper 100,000 people for UC has been reported in Grenada, high SDI countries, the World Bank High-Income category, Europe continent, and among WHO regions found in the European Region. In 2019, the age-standardized DALYs rate was 53.54 per 100,000 inhabitants, of which 48.49 cases were related to years of life lost (YLLs) and 5.05 cases were related to years lived with disability. According to GBD-2019, the highest incidence, mortality, and DALY of UC are in Europe. The evidence and traces of diversity can be seen in the inequalities of UC. Race, ethnicity, economic status, level of education and awareness, co-morbidities, access, grade, and histological type of tumor are the most important causes of this inequality.

Understanding the association between county-level unemployment and health stratified by education and income in the southwestern United States

Past research on the relationship between unemployment rates and population health has produced mixed findings. The relationship can be influenced by the kinds of health outcomes observed, time frame, level of geographic aggregation, and other factors. Given these mixed findings, there is a need to add to our knowledge about how unemployment rates and population health are related. There is limited research that examines the association of unemployment rates with both physical and mental health, while simultaneously stratifying populations by income and education levels. Using survey-based self-reported data, this first population-based study examined the association between unemployment rates and physically and mentally unhealthy days in the southwestern United States, by county-level stratification of income (high and low) as well as education (high and low), from 2015 to 2019. After controlling for covariates, associations were modelled using negative binomial regression, with autocorrelative residuals, and were reported as rate ratios (RR). Overall, we found that a 1% rise in unemployment rates was significantly associated with an increase in physically unhealthy days [adjusted RR 1.007; 95% CI, 1.004–1.011, P < 0.001] and mentally unhealthy days [RR 1.006; 95% CI, 1.003–1.009, P < 0.001]. Upon stratification, a significant risk was found among the high education and high income category [RR 1.035; 95% CI, 1.021–1.049, P < 0.001], as well as for the high education and low income category [RR 1.026; 95% CI, 1.013–1.040, P < 0.001]. A better understanding of how unemployment is associated with the health of communities with different education and income levels could help reduce the burden on society through tailored interventions and social policies not only in the United States, but also in other developed nations.

Solow Growth Model dan Kausalitas Hubungan Saving dan Pertumbuhan Ekonomi: Perbandingan Negara Maju (High Level Income) dan Negara Berkembang (Upper-Middle Level Income)

At a theoretical level, it is believed that there is a relationship between savings rates and economic growth. In this case, accumulated savings can be used for investment purposes, which will then encourage GDP growth in the short term. On the contrary, in Keynes's view, GDP growth actually triggers growth in the savings rate. Debate then emerged as to which factors were the cause of a country's economic growth. This research uses the Solow Growth Model theoretical approach, which states that under the assumption of a closed economy, the level of savings will influence the level of investment and in turn have an impact on economic growth. Based on these arguments, this research conducted a comparative analysis of two countries, namely Indonesia and Singapore, in the period 2008-2022. The research results show that there is a tendency in the same direction of causality between savings levels and economic growth, at the two extremes of country income levels. Indonesia as a country in the upper-middle income category, and Singapore as a country in the high income category, have economic growth rates caused by the level of capital accumulation through savings. So that policies related to savings accumulation will still be relevant in the future. For future research, it is recommended to consider the influence of other macro variables, considering that the Solow Growth Model requires long-term longitudinal analysis, so that distortion of macro variables such as interest rates can have an impact on the causality of the relationship.

Vegetable and fruit consumption during the COVID-19 lockdown: eating habits in Ecuador

This study identifies changes in fruit and vegetable (FV) consumption habits during the COVID-19 pandemic in Quito-Ecuador and observe relationships regarding household income and the relevance of FV nutritional value. The study used an online survey among urban residents (n = 1093) in Quito-Ecuador, regarding FV consumption patterns during the lockdown along with household socioeconomic status. A multiple response logistic model was used to analyse changes in FV eating habits across four income categories. Income had a statistically significant effect over the healthy food consumption of FV for the low- and high-income category. Families did not change eating habits nor decide to maintain a diet based on differences of income. Further, approximately two thirds of the families increased FV consumption during the lockdown. Eating habits changed during the lockdown of urban households in Ecuador. Income explained changes in FV consumption for low- and high-income households but did not for the middle-income group. Households that purchased more FV had a higher perception of their own healthy eating habits. The consumption of FV with high content of vitamin C increased, however, families did not purchase products with the highest vitamin-C content.

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism.

This study aims to (1) describe trends in explanations provided for racial/ethnic inequities in dental caries and periodontitis, and (2) explore the patterns of relatedness among explanations for these inequities. Highly cited publications based on studies indexed in the Scopus database were retrieved and assessed for eligibility. Explanations for racial/ethnic inequities were classified into eight different, but interrelated domains. We assessed trends and examined the relations among explanations using multiple correspondence analysis. A total of 200 articles among the most cited publications were selected. The proportion of studies invoking racism as an explanation for racial inequities in oral health increased from 0% to 14.3%, from 1937 to 2020. The proportions of individual socio-economic factors increased from 52.0% to 82.9%, and dental care from 28.0% to 62.9%. The remaining explanations were stable: psychological/behavioural processes (62.5%), biological factors (49.5%), contextual/area-level effects (24.0%) and immigrant paradox (4.0%). Multiple correspondence analysis revealed a smaller axial distance between racism and the following categories: studies from Brazil, recent publications and Blacks/Hispanics/mixed-race groups. Publications about immigrants were axially closer to the high-income countries category. Our findings call on dental researchers to consider racism as a cause for existing racial/ethnic inequities in oral health.

Exploring the impact of digitalisation and technology on corruption: evidence from cross-country panel data within a cultural-economic framework

PurposeThis study aims to contribute to the existing literature by empirically investigating the impact of digital competitiveness and technology on corruption under the moderating effect of some cultural and economic control variables and providing evidence on the links between corruption and various cultural dimensions at the country level.Design/methodology/approachThe cross-sectional sample covers 61 countries (41 high-income and 20 lower-income countries) during the 2016–2020 period, and the analysis was carried out for both the full sample and the subsamples.FindingsThe results provide clear evidence supporting the hypothesis that digitalisation and technology significantly affect the perceived level of corruption under the moderating role of cultural framework and economic development. Furthermore, the most significant cultural dimensions of corruption are individualism versus collectivism, uncertainty avoidance, long-term orientation and indulgence versus restraint, even if, in some cases, its influence might be felt differently when the results are estimated on subsamples. Thus, in the case of indulgence versus restraint, high-income countries with higher indulgence scores would register higher scores for the corruption perception index and thus a better control of corruption, while for lower-income countries, the more indulgent these countries are, the weaker the corruption control will be. Furthermore, our results validate a powerful and significant correlation between the index of economic freedom and corruption in both digitalisation and technology.Research limitations/implicationsThis study may have relevant implications for policymakers who need to recognise the role of digitalisation and technology in the fight against corruption but considering the cultural and economic characteristics specific to each country.Originality/valueTo the authors' knowledge, the relationship between digital competitiveness, technology and corruption within an economic and cultural framework, while highlighting the differences between high-income and lower-income countries, has not been previously documented in the literature. Thus, this article argues that the level of digital competitiveness and the adoption of technology would significantly impact the level of perceived corruption, although this impact could be felt differently by countries in the high-income category compared to countries in the lower-level income category.

Public Knowledge of Inflammatory Bowel Diseases in Saudi Arabia: A Cross-Sectional Survey Study

Background: Lack of public understanding and perception may lead to a general downplaying of inflammatory bowel disorder (IBD) symptoms as they affect a less socially acceptable area of the body, which may be a significant component in the everyday struggles of an individual with IBD. Aim: The aim is to assess the public knowledge of Crohn's disease and ulcerative colitis in Saudi Arabia. Method: This was an online survey study that examined public knowledge of IBD in Saudi Arabia for the duration between February and March 2023. Participants were invited to participate in this study using social media websites. The questionnaire tool comprised three sections: a sociodemographic characteristics section (seven questions), an awareness section (two questions), and a knowledge section (24 questions). A binary logistic regression analysis was utilized to identify the factors that influenced the participants’ knowledge of Crohn's disease and ulcerative colitis. Results: A total of 630 individuals participated in this study. Around 28% of the participants reported that they had never heard of, read about, or dealt with Crohn’s disease. Around 16% of them reported that they had never heard of, read about, or dealt with ulcerative colitis. The mean overall knowledge score of the study participants was 8.3 (standard deviation: 2.4) out of 24, which is equal to 34.6% and represents a weak level of knowledge of IBD. The participants showed a weak level of knowledge for all sub-scales of knowledge related to IBD general knowledge, diet, treatments, and complications. The knowledge sub-scale level ranged between 30% and 36.7%. Females, the participants in the moderate and high-income category, those who lived in urban areas, those with a higher level of education, and those who reported having osteoarthritis were more likely to be knowledgeable about IBD compared to others (p≤0.001). Conclusion: In Saudi Arabia, a low level of IBD awareness was identified among the general population, supporting findings from other countries. Future research should aim to identify effective educational interventions to increase public awareness of this group of diseases, which would ultimately facilitate early diagnosis and improve patient outcomes.

Subjective social status, race, and metabolic syndrome in women with breast cancer.

To evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Multicenter cross-sectional study (10 US hospitals) in women (n = 1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identified as non-Hispanic White or Black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history, and behavioral risks. SSS was measured with the 10-rung MacArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. Average age was 58years. On average, the SSS of Black women, given equivalent level of income and education, was lower than the SSS of White women: 6.6 (6.1-7.0) vs 7.7 (7.54-7.79) among college graduates and 6.8 (6.4-7.2) vs 7.6 (7.5-7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet, and physical activity, increasing SSS was associated with a decrease in MetS-Zscore, -0.10 (-0.16 to -0.04) per every 2 rung increase in the MacArthur scale. Black women with breast cancer rank their SSS lower than White women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.

Urbanization-Growth-Environment: How Are They Related? An Evidence from the Global Asia-Pacific Region

Asia and the Pacific have made rapid progress in economic growth but still have work to do in environmental degradation. Logical consequence because pursuing economic progress has raised environmental problems and has become one of the central issues for development. The Asia-Pacific region became the most significant contributor and growth in carbon dioxide emissions compared to other regions. The research objective is to analyze the impact of urbanization on environmental quality and its interaction through economic growth using the standard Dynamic Model of the Autoregressive Distributed Lag approach. The result show demonstrates consistency in developed countries and the High-Income countries categories. Urbanization has a significant negative effect on emissions, and the Growth variable is significantly positive; nevertheless, the EKC curve does not occur. Urbanization deteriorates the relationship between growth and emissions. It is not proven in developing countries and the lower and upper middle income. Equitable development needs to be carried out by every country by considering the quality and sustainable economic institutions and pro-environmental innovations, especially in developing or lower and upper-middle countries.

Prevalence of dietary supplement use and knowledge, attitudes, practice (KAP) and associated factors in student population: A cross-sectional study

Dietary supplements (DSs) intake has been increasing worldwide despite no consensus evidence for the efficacy and safety of disease prevention, control, or treatment in nutrient-replete populations. This study aimed to determine the prevalence of DSs use, knowledge, attitude, and practice (KAP) and associated factors among university students in Jordan. A national cross-sectional study was carried over across universities in Jordan. Participants completed a valid and reliable online questionnaire (Cronbach's alpha = 0.802 and correlation coefficients between 0.72 and 0.26). Univariate analyses were used to determine the relationship between variables. Multivariable regression was carried out to identify significant factors contributing DSs usage. A total of 448 university students completed the study (73.7% females). More than half of the students used DSs (60.9%), with single-nutrient ingredient supplements being the most commonly used type. The primary motivators were maintaining health and most students reported no side effects associated with consumption. The results revealed poor knowledge, a negative attitude towards DSs usage among all participants, even non-users, and high-risk practices among the DSs users. Normal weight and overweight individuals were more likely to use DSs (OR:2.88, 95%CI:1.61–5.16, OR:1.95, 95%CI:1.01–3.79, respectively). Low and medium-family income categories were more likely to use DSs than those in the high-income category (OR: 0.04, 95%CI: 0.02–0.07, OR: 0.06, 95CI:0.03–0.11, respectively). Undergraduate students were more likely to use DSs than postgraduate students (OR:5.56, 95%CI:3.19–9.69). In this study, a high prevalence of DSs use was highlighted. The results suggest that nutrition education is required to improve awareness of DSs and to promote safe practices.