High Levels Of Socioeconomic Disadvantage Research Articles

The Intersection of Rurality, Unmet Treatment Need, and Cannabis Use for Adults with Chronic Pain

Objective: Rates of chronic pain are higher among rural versus urban individuals and rural individuals experience higher levels of socioeconomic disadvantage, poor or no health insurance coverage, and unmet treatment need. Medical cannabis is legal in Oklahoma. With 40% of Oklahoma’s population living in rural areas, and nearly 17% uninsured, the medical legalization of cannabis may present as an accessible and relatively low-cost alternative treatment, particularly for those with chronic pain. This study investigated differences in cannabis use by rural (vs. urban) status and unmet (vs. met) treatment need among adults with and without chronic pain living in Oklahoma. Method: To be eligible, participants had to be 18 years or older, reside in Oklahoma, and be able to read and write English-language surveys. Results: The sample (N = 3622) was primarily made up of non-Hispanic White (70.4%) females (53.8%) in their early middle age (M = 41.80, SD = 16.88), employed full-time or part-time (53.8%), with some college/technical school (37.2%) or a bachelor’s degree (28.5%). Nearly one-fifth of the sample (18.2%) endorsed chronic pain, and individuals with chronic pain were eight times more likely to report past 30-day cannabis use. No difference was detected when only rurality (vs. urban residence) was examined. Among adults with chronic pain, those who were rural dwelling and who reported unmet treatment need were almost two times more likely to report past 30-day cannabis use, compared to urban dwelling chronic pain adults with unmet treatment need. Conclusions: In Oklahoma, adults in rural areas with unmet treatment need and chronic pain may benefit from increasing access to chronic pain treatment, as well as education on cannabis use and harm reduction strategies to inform healthcare decision-making.

Community engagement in a seaside town: evaluation of Good Grief Weston festival.

Festivals play an important role in improving death and grief literacy, enabling members of the public to engage with these often-sensitive topics. Good Grief Weston festival was co-designed and delivered with the community in Weston-super-Mare, a coastal town in South-West England with high levels of socioeconomic disadvantage but rich community assets. It was held in person over 8 days in May 2023. To evaluate the reach and impact of Good Grief Weston festival and gather data to inform future festivals. Mixed methods evaluation (survey and focus groups). Online and paper surveys assessing participants' characteristics and experiences were administrated during and after the festival. Survey participants who indicated their willingness to participate were invited to attend a focus group. Focus groups were recorded, transcribed and analysed using thematic analysis. Data were collected by trained community co-researchers. Approximately 3000 people attended the festival. Of 204 completed surveys, 64.5% were from women, age range ⩽15 to ⩾75 years; 88.2% identified as White; 14.9% deaf, disabled/with a chronic condition; 18.9% neurodivergent; 9.0% gay, bisexual or queer. Festival participants were entertained (70.9%), inspired (68.5%), felt part of a like-minded community (54.3%), talked to someone new (49.2%), learnt about grief/bereavement (34.3%), shared or expressed experiences (30.3%) and found out about local support (19.7%). 71.3% reported that they felt more confident talking about grief after attending. Median experience rating was 5 (IQR 0; possible range 1 = poor to 5 = excellent). In free-text comments, participants expressed appreciation for the festival and described benefits in attending. Two focus groups were conducted (n = 8 participants, all women), lasting c.1.5 h. Focus groups added rich descriptions of the festival's value, and data to inform the next festival. Findings suggest festivals of this nature can play a central role in a public health approach.

Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

Background: Socioeconomic disparities correlate with worse outcomes after arthroscopic rotator cuff repair. However, use of a surrogate to describe socioeconomic disadvantage has been a challenge. The Area Deprivation Index (ADI) is a tool that encompasses 17 socioeconomic variables into a single metric based on census location. Hypothesis: Higher ADI would result in a worse minimal clinically important difference (MCID) for the Patient Reported Outcomes Measurement Information System (PROMIS) and have less improvement in range of motion (ROM) following arthroscopic rotator cuff repair (ARCR). Study Design: Cohort study; Level of evidence, 3. Method: A retrospective review was performed for patients who underwent arthroscopic rotator cuff repair. Patients in the most socioeconomically disadvantaged quartile (ADIHigh) were compared with the least disadvantaged quartile (ADILow) in the ability to reach MCID. Demographic and surgical features were assessed for attainment of MCID. Results: In total 1382 patients were identified who underwent ARCR, of which a total of 306 patients met final inclusion criteria. A higher percentage of patients within the ADIHigh cohort identified as “Black” or “other” race and had government-issued insurance compared with the ADILow cohort (P < .05). The ADIHigh cohort had significantly worse postoperative forward flexion compared with the ADILow cohort (145.0°± 32.5° vs 156.3°± 23.4°; P = .001) despite starting with comparable preoperative ROM (P = .17). Logistic regression showed that ADI was the only variable significant for predicting achievement of MCID for all 3 PROMIS domains, with the ADIHigh cohort having significantly worse odds of achieving MCID Physical Function (odds ratio [OR], 0.31; P = .001), Pain Interference (OR, 0.21; P = .001), and Depression (OR, 0.28; P = .001). Meanwhile, age, sex, body mass index, and smoking history were nonsignificant. Moreover, “other” for race and Medicare insurance were significant for achievement of MCID Depression but not Physical Function or Pain Interference. Finally, ADI was the main feature for predictive logistic regression modeling. Conclusion: ADI served as the only significant predictor for achieving MCID for all 3 PROMIS domains after arthroscopic rotator cuff repair. Patients who face high levels of socioeconomic disadvantage have lower rates of achieving MCID. In addition, patients with greater neighborhood disadvantage demonstrated significantly worse improvement in active forward flexion. Further investigation is required to understand the role of ADI on physical therapy compliance and to identify the barriers that prevent equitable postoperative care.

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Disparities in SARS-CoV-2 Infection by Race, Ethnicity, Language, and Social Vulnerability: Evidence from a Citywide Seroprevalence Study in Massachusetts, USA

ObjectivesUncovering and addressing disparities in infectious disease outbreaks require a rapid, methodical understanding of local epidemiology. We conducted a seroprevalence study of SARS-CoV-2 infection in Holyoke, Massachusetts, a majority Hispanic city with high levels of socio-economic disadvantage to estimate seroprevalence and identify disparities in SARS-CoV-2 infection.MethodsWe invited 2000 randomly sampled households between 11/5/2020 and 12/31/2020 to complete questionnaires and provide dried blood spots for SARS-CoV-2 antibody testing. We calculated seroprevalence based on the presence of IgG antibodies using a weighted Bayesian procedure that incorporated uncertainty in antibody test sensitivity and specificity and accounted for household clustering.ResultsTwo hundred eighty households including 472 individuals were enrolled. Three hundred twenty-eight individuals underwent antibody testing. Citywide seroprevalence of SARS-CoV-2 IgG was 13.1% (95% CI 6.9–22.3) compared to 9.8% of the population infected based on publicly reported cases. Seroprevalence was 16.1% (95% CI 6.2–31.8) among Hispanic individuals compared to 9.4% (95% CI 4.6–16.4) among non-Hispanic white individuals. Seroprevalence was higher among Spanish-speaking households (21.9%; 95% CI 8.3–43.9) compared to English-speaking households (10.2%; 95% CI 5.2–18.0) and among individuals in high social vulnerability index (SVI) areas based on the CDC SVI (14.4%; 95% CI 7.1–25.5) compared to low SVI areas (8.2%; 95% CI 3.1–16.9).ConclusionsThe SARS-CoV-2 IgG seroprevalence in a city with high levels of social vulnerability was 13.1% during the pre-vaccination period of the COVID-19 pandemic. Hispanic individuals and individuals in communities characterized by high SVI were at the highest risk of infection. Public health interventions should be designed to ensure that individuals in high social vulnerability communities have access to the tools to combat COVID-19.

Reflections on the in-prison recruitment and participation of men with a history of injecting drug use, in a longitudinal cohort study in Australia

Studies aimed at improving the health and well-being needs of people in prison are increasing in number. The ethical and logistical challenges of conducting this research, however, pose challenges for researchers which can limit its scope. Emerging literature provides insights into these challenges, but little is focused on the Australian perspective, and most are based on the experiences of recruiting and collecting data for ethnographic and qualitative research. Literature describing the challenges of conducting quantitative prospective studies in prisons is limited. Furthermore, despite the fact that people who inject drugs are overrepresented amongst prison populations, and experience higher levels of socioeconomic disadvantage and poorer health than the general prison population, we are unaware of literature describing the particular sensitivities associated with their recruitment and participation in research in prisons. We intend to address these gaps by drawing on our experience and reflecting on learnings that emerged from longitudinal research we conducted with 400 incarcerated males with recent histories of injecting drug use, in Victoria, Australia. Our aim is to provide guidance and lessons for future research.

A Comparison of Self-Referral and Referral via Primary Care Providers, through Two Similar Digital Mental Health Services in Western Australia.

Digital mental health services (DMHSs) deliver mental health information, assessment, and treatment, via the internet, telephone, or other digital channels. The current study compares two DMHSs operating in Western Australia (WA)—The Practitioner Online Referral System (PORTS) and MindSpot. Both provide telephone and online psychological services at no cost to patients or referrers. However, PORTS is accessed by patients via referral from health practitioners, and is designed to reach those who are financially, geographically, or otherwise disadvantaged. In contrast, MindSpot services are available to all Australian residents and patients can self-refer. This observational study compares characteristics and treatment outcomes for patients of PORTS and MindSpot in WA. Eligible patients were people who resided in WA and registered with either clinic from January 2019 to December 2020. Results showed that PORTS patients were more likely to be older, male, and unemployed. They were less likely to report a tertiary education and were more likely to live in areas with higher levels of socioeconomic disadvantage. Despite these differences, treatment outcomes were excellent for patients from both clinics. Results provide further evidence for the accessibility, acceptability, and effectiveness of DMHSs regardless of referral pathway or patient characteristics.

No Appetite for Change: Culture, Liberalism, and Other Acts of Depoliticization in the Australian Obesity Debate

There is wealth of evidence that points to the pernicious ways in which inequities in food, bodies, and health are disproportionally borne. Equally, there is a wealth of evidence that critiques the role of neoliberal imperatives for individuals to take responsibility for their health, and how this tenet reproduces inequity. However, health interventions and public policy remain immune to addressing social determinants of health and ignore the cultural dynamics of power in food systems, interventions, and policy. Drawing from ethnographic research in an Australian community that has high levels of socioeconomic disadvantage and obesity, and the Australian Government’s response to the ‘obesity epidemic’, this article examines the processes and tactics of depoliticization that are used to elide political and sociocultural phenomenon. I leverage the work of Brown and Povinelli to argue that liberalism’s hold on universalisms, autonomy, and individual liberty in obesity discourses subjugates a comprehension of political relations, positioning liberal principles and culture as mutually antagonistic. It is precisely this acultural positioning of liberalism that makes it possible to remove recognition of the power that produces and contours the ‘metabolic rift’ between food systems, public health, and equity priorities. In conclusion, I consider how obesity policy might be different if we paid attention to this culturalization of politics.

Surgical Patients' Hospital Experience Scores: Neighborhood Context Conceptual Framework.

Through geocoding the physical residential address included in the electronic medical record to the census tract level, we present a novel model for concomitant examination of individual patient-related and residential context-related factors that are associated with patient-reported experience scores. When assessing patient experience in the surgical setting, researchers need to examine the potential influence of neighborhood-level characteristics on patient experience-of-care ratings. We geocoded the residential address included in the electronic medical record (EMR) from a tertiary care facility to the census tract level of Orange County, CA. We then linked each individual record to the matching census tract and use hierarchical regression analyses to test the impact of distinct neighborhood conditions on patient experience. This approach allows us to estimate how each neighborhood characteristic uniquely influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Individuals residing in communities characterized by high levels of socioeconomic disadvantage have the highest experience ratings. Accounting for individual patient's characteristics such as age, gender, race/ethnicity, primary language spoken at home, length of stay, and average pain levels during their hospital stay, neighborhood-level characteristics such as proportions of people receiving public assistance influence the ratings of hospital experience (0.01, P < 0.05) independent of, and beyond, these individual-level factors. This manuscript is an example of how geocoding could be used to analyze surgical patient experience scores. In this analysis, we have shown that neighborhood-level characteristics influence the ratings of hospital experience independent of, and beyond, individual-level factors.

When Does Verbal Aggression in Relationships Covary With Physical Violence?

Psychological aggression is common in intimate relationships, yet only a subset of psychologically aggressive couples also engage in physical violence. We examine two factors proposed to identify which psychologically aggressive couples display physical violence, emphasizing (a) couples' negative and ineffective communication during relationship-focused conversations and (b) the demands imposed upon couples by chronic social and economic disadvantage. From 862 spouses (431 couples), we collected self-report data on psychological and physical aggression, observational data capturing the quality of their communication, and self-report data assessing established indicators of socioeconomic vulnerability. Tests of moderation were conducted with Structural Equation Modeling (SEM). The association between psychological and physical aggression was stronger among couples who displayed lower-quality communication and among couples facing higher levels of socioeconomic disadvantage. The moderating effect of couple communication remained significant after controlling for socioeconomic disadvantage, and the moderating effect of socioeconomic disadvantage remained significant after controlling for communication. All effects remained after controlling for relationship satisfaction. Specific communication skills and broad indices of socioeconomic vulnerability make independent contributions to acts of physical aggression among psychologically aggressive couples. Conceptual frameworks are needed to integrate these two levels of analysis, and intervention models are needed that identify at-risk couples and that modify the conditions that heighten their likelihood of physical aggression.

11-OR: Youth Empowerment Skills (YES): A Novel Psychosocial Behavioural Intervention for Adolescents with Type 1 Diabetes

Background: The transition from adolescence to young adulthood can be challenging for young people with type 1 diabetes. During this period many young people become disengaged from their health care and can experience increases in adverse diabetes events and diabetes distress. Study Aim: To deliver a novel psychoeducational programme called Youth Empowerment Skills (YES), using simulation based experiential learning and peer learning to increase diabetes knowledge and social confidence in young people with type 1 diabetes. Method: The YES programme was delivered in community settings with a youth worker supporting engagement. HbA1c and admission data were collected 12-months pre and post intervention. Follow-up qualitative questionnaires and semi-structured interviews were conducted 6 weeks post-intervention to elicit participant views of the programme. The study was conducted in a South London boroughs with high levels of socioeconomic disadvantage and ethnic diversity. Results: Data were collected from all participants (n=41), mean age 17.3±2.3 years. Mean HbA1c 12 month prior to attending the programme was (DDCT%) 10.4%±4.8%. There was a reduction of mean HbA1c at 12-months post-intervention to 9.7%± 4.6%m (Δ 0.7%) (p&amp;lt; 0.01). DKA admissions reduced by 55.6% (n=15) over the 12 month follow-up; saving £78,000 in admission avoidance. The programme successfully engaged young people from ethnic minorities (53%) and with high social deprivation (65%). Qualitative data showed perceived improvements in clinical knowledge and psychosocial health. Feedback highlighted active learning sessions and peer support as strengths of the programme. Conclusion: The study showed that the YES programme was beneficial in improving glycaemic control and reducing diabetes related admissions in adolescents with type 1 diabetes; and encouraged a more positive and accepting attitude towards living with diabetes. Disclosure D. Kariyawasam: None. K.A. Saqi: None. F. Dehzad: None. S. Pender: None. M. Jones: None. N. Yemane: None. R.H. Griffiths: None. T. Soukup: None. S.M. Singham: None. A. Forbes: None.

An assets-based intervention before and after birth to improve breastfeeding initiation and continuation: the ABA feasibility RCT

Background The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory. Objective To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial. Design This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group. Setting Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates of breastfeeding. Participants Women aged ≥ 16 years who were pregnant with their first child, irrespective of feeding intention (n = 103), were recruited by researchers in antenatal clinics. Interventions Proactive, woman-centred support, using an assets-based approach and including behaviour change techniques, was provided by an infant-feeding helper (a breastfeeding peer supporter trained in the ABA intervention) and delivered through face-to-face contact, telephone conversations and text messages. The intervention commenced at around 30 weeks’ gestation and could continue until 5 months postnatally. Main outcome measures The main outcome measures were feasibility of intervention delivery with the requisite intensity and duration; acceptability to women, infant-feeding helpers and maternity services; and feasibility of a future randomised controlled trial. Outcomes included recruitment rates and follow-up rates at 3 days, 8 weeks and 6 months postnatally, and outcomes for a future full trial were collected via participant questionnaires. A mixed-methods process evaluation included qualitative interviews with women, infant-feeding helpers and maternity services; infant-feeding helper logs; and audio-recordings of antenatal contacts to check intervention fidelity. Results Of the 135 eligible women approached, 103 (76.3%) agreed to participate. The study was successful in recruiting teenagers (8.7%) and women living in areas of socioeconomic disadvantage (37.3% resided in the most deprived 40% of small areas in England). Postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3 days, 8 weeks and 6 months, respectively. Feeding status at 8 weeks was obtained for 95.1% of participants. Recruitment took place from February 2017 until August 2017. It was possible to recruit and train existing peer supporters to the infant-feeding helper role. The intervention was delivered to most women with relatively high fidelity. Among the 50 women in the intervention group, 39 received antenatal visits and 40 received postnatal support. Qualitative data showed that the intervention was acceptable. There was no evidence of intervention-related harms. Limitations Birth notification delays resulted in delays in the collection of postnatal feeding status data and in the offer of postnatal support. In addition, the intervention needs to better consider all infant-feeding types and did not adequately accommodate women who delivered prematurely. Conclusion It is feasible to deliver the intervention and trial. Future work The intervention should be tested in a fully powered randomised controlled trial. Trial registration Current Controlled Trials ISRCTN14760978. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

Area-Level Variation in Children's Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study.

There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed.

Acute Healthcare Utilization and Predictors of Admission for Sickle Cell Disease in Illinois

Background Sickle cell disease (SCD) is associated with acute healthcare utilization and an estimated annual cost of $2 billion that is primarily covered through public insurance. Understanding factors contributing to acute healthcare utilization among SCD patients is crucial to decrease costs associated with services. Our study describes trends of acute care utilization among Illinois (IL) residents with SCD over a 3 year period and examines factors associated with hospital admissions from the emergency department (ED). Methods We extracted ED visits and hospitalizations associated with an ICD-10 code for SCD from the Illinois Comparative Health Care and Hospital Data Reporting Services, a statewide hospital administrative data source for 154 IL non-federal hospitals. Visits from January 2016 to December 2018 were extracted. Variables of interest included patient sociodemographic variables (age, IL region, insurance, zip code poverty rate and area deprivation index and distance to care). Poverty was categorized based on the percent of residents in a zip code who are at or below the federal poverty level (FPL) as low (&lt;10% of households ≤ FPL), medium (10-20% of households ≤ FPL) or high (&gt;20% households ≤ FPL) using data from the 2017 Community American Survey. Composite socioeconomic opportunity was determined using 2015 state ranked patient zip code area deprivation index (ADI) and categorized as low (ADI&lt;5), medium (ADI=5-7.99), or high (ADI≥8) with higher ADI levels indicating higher levels of socioeconomic disadvantage. For admissions, length of stay (LOS) and intensive care unit (ICU) care were examined. Health care facilities were categorized by number of SCD visits per year into low (&lt; 50), medium (50 to 332) or high (≥333) volume. Poisson regression, adjusted for clustering within hospitals, was used to analyze the likelihood of hospital admission versus discharge from an ED visit. Results Trends of acute care utilization. There were 50,260 hospitalization and ED visits with SCD codes in the 36 month study period, averaging 1396 visits per month. The number of visits per year was stable during the study period (Table 1). Approximately 71% of the visits were associated with SCD as the primary diagnosis. The majority (64%) of visits occurred in Cook County, with 95% occurring within a 30 miles radius from the patient's zip code and 94% in facilities with more than 50 SCD visits annually. Most visits were covered under public insurance (50% Medicaid and 25% Medicare); 20% were covered by private insurance; and less than 5% were uninsured visits. The majority of visits were from patients living in medium (46%) or high (32%) ADI with only 19% from low ADI zip codes. Most (60%) visits were outpatient ED visits (average 832 visits per month) and 40% were hospital admissions (average 564 visits per months) with a mean LOS of 5 days and 12.8% requiring ICU level care. Approximately 80% of the hospital admissions were admissions from the ED. Factors associated with hospital admissions from the ED (Table 2). In the adjusted model, uninsured patients were less likely to be admitted (IRR=0.60; 95% CI 0.50-0.73) and Medicare patients were more likely to be admitted (IRR=1.57; 95% CI 1.38-1.81) compared to patients with private insurance. ED visits with patients travelling &gt;30 miles (IRR=1.52, 95% CI 1.21-1.94) and visits at high volume hospitals (IRR=1.62; 95% CI 1.32-1.99) were more likely to result in admission compared to visits associated with shorter distances and visits at lower volume hospitals, respectively. Visits with patients from medium ADI zip codes (IRR=0.90; 95% CI 0.81-0.99) or high ADI zip codes (IRR=0.90; 95% CI 0.81-0.99) were less likely to result in admission than visits from low ADI zip codes. Biological sex, age, location of care, and zip code poverty level were not significantly associated with hospital admissions from the ED. Conclusions In the most recent 3 year period, SCD acute healthcare utilization in Illinois remained stable without significant reductions. Patients who were uninsured or had higher levels of socioeconomic disadvantage were less likely to be admitted from the ED whereas further distance to care and high SCD volume hospital were associated with higher rates of admission. Further research should explore whether the uninsured and highly disadvantaged were less likely to be admitted due to disease severity or system level factors such as poor access or poor preventative care. Disclosures No relevant conflicts of interest to declare.

The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy

BackgroundMaternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada.MethodsParticipants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons.ResultsMost participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05).ConclusionsThis cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children.Trial registrationRegistered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060. Active not recruiting.

The effect of community-oriented policing on police use of force: does community matter?

Purpose The purpose of this paper is to examine whether community-oriented policing (COP) influences rates of police use of force across communities, and whether the impact of COP varies according to the level of violent crime in communities. Design/methodology/approach A range of data sources including police use of force reports, online surveys of Officers-in-Charge and recorded crime data was used to examine the association between formal and informal community consultation and the frequency of police use of force, across 64 socially challenged communities in Australia. Findings Poisson multilevel modelling indicated no overall association between informal or formal community engagement and rates of police use of force. However, significant interaction terms for both informal and formal community consultation with violent crime rates indicated that higher levels of informal and formal community consultation were associated with lower rates of police use of force in communities with higher levels of violent crime. This relationship was not evident in low violent crime areas. Research limitations/implications Communities were purposively sampled to have a high propensity for police use of force, on the basis that they had high rates of violent crime, or high levels of socio-economic disadvantage, or both. This research should be replicated with a representative sample of communities. Practical implications The findings extend the potential benefits of COP to reducing the use of coercive policing tactics in high violent crime communities. Originality/value This study finds that COP can reduce the frequency of violent encounters between police and community members in high violent crime communities.

Schools as community assets: an exploration of the merits of an Asset-Based Community Development (ABCD) approach

ABSTRACT This paper describes and evaluates the “Asset-Based Community Development (ABCD) in Schools” project; which was designed as a public health intervention to explore the extent to which focusing on schools as community assets can promote well-being for pupils, their school and the local community. The paper reviews the literature in relation to the background and context of the ABCD model within the field of community development, where the focus is identifying and mobilising the positive capabilities, skills, talents and strengths of individuals, associations and communities in order to bring about social change. As such, this project was established using the principles of ABCD. It was designed to ascertain the extent to which ABCD could be feasibly utilised in the school environment and to explore its possibilities in terms of being a force for change. The project piloted two practical pupil-led ABCD initiatives to develop the life skills, resilience, well-being and future employability of the pupils involved. This ABCD project focused on Year 9 pupils in the foundation learning tier in two secondary academies and also involved, as mentors, undergraduate students from two local universities. The location for the project is a city in the North Midlands of England which experiences areas of high levels of socio-economic disadvantage. Following a rationale for the project and description of the two initiatives which evolved, the authors highlight the lessons learned and suggest the ABCD approach can be regarded as promising practice for any (school) community.

RETAIN early career teacher retention programme: evaluating the role of research informed continuing professional development for a high quality, sustainable 21st century teaching profession

ABSTRACTTeacher recruitment and retention is an international challenge. In England the government have reported that more teachers leave before retirement age than five years ago, 30% within five years and schools are finding it difficult to fill posts with quality teachers . This paper evaluates the contribution of the research-informed RETAIN Early Career Teacher (ECT) Continuing Professional Development (CPD) Programme for developing and retaining quality teachers. RETAIN was a yearlong CPD pilot for Early Career Teachers (ECTs) in primary schools in Cornwall, UK (a region with high levels of socio-economic disadvantage). The programme design was informed by research and based on factors shown to support the retention of ECTs. It was contextualised using the precept that teachers should be active researchers, influencing curriculum development as ‘reflective practitioners’, focussed with a Professional Learning Community lens and theorised within a social constructivist frame. In addition, RETAIN utilised robust evidence-informed practice approaches to support teacher development in schools with persistently disadvantaged pupils. The programme was independently evaluated using multiple-methods over the course of the programme to generate data. The theory-based evaluation suggests that the contribution of this intervention to the field is the specific combination of development; taught workshops, coaching and collaborative professional learning, which improved the self-efficacy, confidence and quality of teaching of ECTs in differing but complementary ways. All ECTs who completed the programme have been retained in teaching and all have achieved a leadership role in their school. We argue that these outcomes are of international significance and the promise of the programme can be utilised for developing and retaining high quality teachers in other countries.

Factors predicting out-of-school suspensions for young children

IntroductionDespite limited evidence supporting the effectiveness of out-of-school suspension for rectifying behavioural issues, the practice continues. Certain demographic factors (male, ethnic minority, low SES) predict suspensions; however, developmental and family factors can also play a role. Knowledge of these factors may inform alternative practices aimed at limiting the practice of suspension.&#x0D; Objectives and ApproachThis study investigated the relationship between out-of-school suspensions and demographic, developmental, and family factors. Children suspended in early schooling may be particularly at risk of poor school outcomes; thus, our sample includes children in the first years of school. Linked administrative data were obtained for 14,269 children enrolled in grade 3 at public schools in Western Australia. Multilevel logistic regressions were run, grouped by school, with out-of-school suspensions predicted by: child and parent demographic characteristics; a measure of children’s school-entry development (the Australian Early Development Census); and indicators of family risk (parental psychiatric hospitalizations, parental criminal offending, child maltreatment).&#x0D; ResultsApproximately 2% of children had been suspended at least once by grade 3. Aboriginal children, boys, and children attending schools with high levels of socioeconomic disadvantage had significantly increased odds of being suspended from school (2 times, 6 times, and 3 times increase, respectively). Furthermore, children considered socially and emotionally vulnerable at school-entry were around 3 times more likely than their peers to be suspended in the first few years of school. Parental psychiatric hospitalizations, parental criminal offending, and child maltreatment all significantly predicted out-of-school suspensions. Odds increased exponentially with each additional family risk factor experienced in early childhood. Children experiencing all three family risk factors were almost 7 times more likely than their peers to be suspended at least once by grade 3.&#x0D; Conclusion/ImplicationsOur results provide further justification for the implementation of alternatives to out-of-school suspension, as children who would most likely benefit from a stable, nurturing school environment were significantly more likely to be suspended. Schools need to be better supported by inter-agency collaboration to manage the complex needs of vulnerable children.

The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults.

Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the "Hispanic Paradox". Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially "paradoxical" advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10years (N=8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population.