Higher Risk Of Poor Health Research Articles

The Welsh Health Equity Solutions Platform – a mechanism for health equity solutions

Abstract Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health and wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities, with the rising cost of living amplifying health inequities. Despite their prevalence, health inequities are avoidable. Efforts to reduce health inequities require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem and provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) launched on 22nd June 2023, a collaboration between Public Health Wales, Welsh Government and WHO European Office for Investment in Health and Development. The WHESP is an innovative digital tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. It is a mechanism for health equity solutions and aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap through an online gateway to data, health economics, policies, and innovative health equity tools. Emerging evidence is highlighted to identify solutions for achieving healthy equity, which informs evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all. Collating and sharing health equity solutions, evidence, data and best practice both across Wales and globally supports equitable, long-term action to improve the health and wellbeing of the population. Key messages • Highlighting health equity solutions informs best practice on tackling health inequalities. • WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.

Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes

BackgroundThis study was a two-year follow-up evaluation of health service use and the cost-effectiveness of a multicomponent general practice intervention targeted at people at high risk of poor health outcomes.MethodsA two-year follow-up study of a clustered randomised controlled trial was conducted in South Australia during 2018–19, recruiting 1044 patients from three cohorts: children; adults (aged 18–64 years with two or more chronic diseases); and older adults (aged ≥ 65 years). Intervention group practices (n = 10) provided a multicomponent general practice intervention for 12 months. The intervention comprised patient enrolment to a preferred general practitioner (GP), access to longer GP appointments and timely general practice follow-up after episodes of hospital care. Health service outcomes included hospital use, specialist services and pharmaceuticals. The economic evaluation was based on quality-adjusted life years (QALYs) calculated from EuroQoL 5 dimensions, 5 level utility scores and used an A$50,000 per QALY gained threshold for determining cost-effectiveness.ResultsOver the two years, there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which is lower than the A$50,000 per QALY gained threshold used in Australia. However, the intervention's cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care.ConclusionsThe positive cost-effectiveness results from the 24-month follow-up warrant replication in a study appropriately powered for outcomes such as hospital use, with an intervention period of at least two years, and targeted to older people at high risk of poor health outcomes.

Feasibility and acceptability of collecting biobehavioral data from Latinx transgender and nonbinary people

Background Latinx transgender and nonbinary (TGNB) people are at high risk of poor health compared to cisgender (i.e., non-TGNB) people. Most studies about the health of Latinx TGNB people have collected self-reported data. There is an urgent need for inclusion of biobehavioral measures to better understand and target the underlying mechanisms of health disparities among Latinx TGNB people. We conducted the first study to assess the feasibility and acceptability of collecting biobehavioral data that we are aware of in this population. Methods Participants were recruited from an existing longitudinal study of TGNB individuals and through outreach to the community. Data collection involved structured surveys, saliva samples, actigraphy, sleep dairies, and blood pressure monitoring. We administered a survey with Likert scale items and open-ended questions to assess the acceptability of our study procedures. Results The sample consisted of 41 Latinx TGNB adults with a mean age of 35.7 (+/− 11.9) years. The majority of participants completed all phases of data collection, demonstrating feasibility of study procedures. Acceptability was overall good, but there were a few exceptions; some participants disliked ambulatory blood pressure monitoring or saliva collection. The open-ended responses on the acceptability survey organized around each aspect of the data collection procedures, and the following additional categories were derived: 1) perceived benefits of participating in research, 2) interest in receiving individual data, and 3) the importance of TGNB cultural awareness for study staff. Conclusions This study is one of the first to demonstrate the feasibility and acceptability of collecting biobehavioral data with Latinx TGNB people. Biobehavioral research can help to illuminate mechanisms underlying the substantial health disparities experienced by this multiply minoritized group. Future research with this population should consider augmenting self-reported data by including biobehavioral measures relevant for the research question.

Priority populations’ experiences of the accessibility and inclusion of recreation centres: a qualitative study

BackgroundAlthough the health benefits of physical activity are well documented, certain priority populations are often disproportionately insufficiently active and at higher risk of poor health. Recreation centres have the potential to provide accessible and supportive environments for physical activity for all. However, little is known about priority populations’ experiences of these venues and their views of how accessibility and inclusion can be optimised. This study aimed to gain in-depth insights of recreation centre experiences and potential strategies for improving inclusion and accessibility amongst priority populations (women, older adults, ethnic minorities, persons living with disabilities/additional needs, individuals identifying as LGBTQIA+, low socio-economic position).MethodsThis qualitative study (2021–2022) involved 18 semi-structured individual interviews with adult priority population users of recreation centres (50% 65 + years, 61.2% female) in one Melbourne municipality. Participants were asked to discuss their positive and negative experiences at the centres and to identify strategies for enhancing accessibility and inclusion. Interviews were audio-recorded and transcribed verbatim. Content analysis was performed for data analysis.ResultsWhile many participants had positive views of the facilities and programs at the centres, as they met their needs, they also had suggestions for improving accessibility and inclusion. Similarly, most participants were happy with the communications, felt included, and perceived the culture positively. Those who did not feel included at the centres offered many potential strategies for changing the culture, modifying communications (e.g., signage), and establishing partnerships for better access and inclusion.ConclusionsThe present study adds to essential knowledge concerning priority populations’ experiences of recreation centres. For recreation facilities that were generally perceived as having positive inclusion and accessibility, the findings nonetheless highlighted suggestions for further enhancement. These strategies may be useful more broadly for improving accessibility and inclusion, thereby promoting physical activity and ultimately health for all.

The effect of housing tenure on health status of migrant populations in China: are health service utilization and social integration mediating factors?

BackgroundCurrent research suggests that there is an association between housing tenure and the health status of migrant populations, but the potential mediators of this association remain to be explored. We aimed to examine the effect of housing tenure on migrant populations’ health in China and how this effect is mediated by health service utilization and social integration.MethodsData from the 2017 China Migrants Dynamic Survey of 47,459 participants was used. Logistic regression models were used to explore the effects of housing tenure, health service utilization, and social integration on the health status of migrant populations. Mediated effects models were used to explore the association among them. This study used the bootstrap method and KHB method to test the mediating effect of health service utilization and social integration.ResultsCompared to private renters, owners with mortgages (OR: 0.828, 95% CI: 0.765–0.896) were significantly associated with a higher risk of poor health. Compared with private renters, outright owners were associated with a lower risk of poor health (OR: 1.016, 95% CI: 0.935, 1.104), but the association was not statistically significant (p > 0.05). Moreover, health service utilization (OR: 1.422, 95% CI: 1.268, 1.594) and social integration (OR: 4.357, 95% CI: 3.555, 5.341) were both significantly associated with a higher probability of good health (p < 0.001).ConclusionAmong migrant populations, homeowners with mortgages had a lower likelihood of good health than private renters, while there was no significant difference in the health status between outright owners and private renters. Moreover, health service utilization and social integration mediate the effect of housing tenure on the health status of migrant populations. Policies and interventions can be designed to improve the health service utilization and social inclusion of migrant populations to reduce health disparities across housing tenure types.

Welsh Health Equity Solutions Platform

Abstract Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health&amp; wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities. More recently, the rising cost of living is amplifying health inequities. Despite their prevalence, health inequities are avoidable. Caused by multiple, interlinked factors; efforts to reduce health inequities thus require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem&amp; provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) is a new innovative tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. WHESP aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap. WHESP is an online gateway to data, health economics and modelling, policies, resources and innovative tools on health equity. Emerging evidence is highlighted to identify tools and solutions for achieving healthy prosperous lives for all in Wales and beyond. WHESP will be linked with and feed into a WHO health equity gateway, providing an example and inspiration for countries to learn and follow, as well as to contribute and share. WHESP recognises that there is not a ‘one size fits all’ approach. It provides an extensive body of evidence to inform evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all. Key messages • Efforts to reduce health inequalities require action across all of the social determinants of health. • WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.

P090 How do Australian Shiftworkers and Non-Shiftworkers Prioritise Sleep, Diet, and Physical activity?

Abstract Background Increasing engagement with sleep, diet, and physical activity (PA) is critical for populations who are at higher risk of poor health, such as shiftworkers. To increase engagement in sleep, diet and PA, it is critical to first understand which of these behaviours Australians currently prioritise and whether this prioritisation relates to actual behaviour. Therefore, this study aimed to investigate how Australians prioritise sleep, diet and PA. Methods A cohort of 1151 Australian adults (54% female, aged 18-65 years) completed a phone interview, and a cohort of 588 Australian shiftwork-only adults (76% female, 18-72 years) completed an online survey. All participants were asked which health behaviour (sleep, diet or PA) they prioritised. Behavioural correlates of sleep, diet, and PA, and questions on shiftwork experience were also collected. Results Diet was prioritised by the adults (49%), whereas sleep was prioritised by the shiftwork-only sample (68%). Multinomial logistic regressions revealed that adults who prioritised diet were significantly more likely to report less fast-food consumption (p&amp;lt;0.002) and more fruit consumption (p&amp;lt;0.002) compared to those that prioritised sleep. For the shiftwork-only sample, those with 16-30 years of shiftwork experience were significantly more likely to prioritise sleep compared to diet (p&amp;lt;0.05). Conclusions While prioritising diet was associated with healthier diet behaviour in Australian adults, overall, across both cohorts, behaviour prioritisation did not relate to actual behaviour. This suggests that there are factors other than behaviour prioritisation that influence engagement in healthy behaviours. These factors, such as workplace barriers, should be the focus of future research.

Health and wellbeing impacts of experiences of public spaces for young people from refugee backgrounds in Australia

While there is evidence from the general population that experiences in public spaces can affect health and wellbeing, there is relatively limited research exploring this relationship for young people from refugee backgrounds, who are at higher risk of poor health. This paper draws on interviews, mapping and photovoice with 10 young people from refugee backgrounds and interviews with 16 service providers working with refugee youth, recruited through a survey and community and service networks. All interviews were analysed thematically, with photographs and maps also included in the analysis of interviews with young people. A typology of health-related experiences in public spaces was identified - including socialising and connection, a sense of welcome, a sense of safety, and relaxation and restoration. Each of these aspects of public space experiences could be health promoting. However, cutting across this typology was a theme of racism and discrimination, which affected health and wellbeing directly and indirectly through limiting young people's public space landscape.

Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey.

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.

Intersectionality as a theoretical-analytical tool to study health inequalities in the AmericasA interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas

Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.

Navigating health and well‐being during the COVID‐19 pandemic: Experiences of Latina immigrant mothers in rural Midwestern communities

AbstractObjectiveIn this study, we sought to gain insight into the challenges Latina immigrant mothers in rural Midwest communities encountered during the pandemic, strategies they employed to avoid infection of the virus, and impacts of the pandemic on family health and well‐being.BackgroundIn rural Midwestern communities, the pandemic disproportionately affected immigrants, many of whom are Latino and worked in meatpacking and food processing plants. Latina mothers are commonly viewed as caretakers of the family. This prescribed role placed mothers at the center of safeguarding their families' health during the pandemic.MethodIn this descriptive study, we conducted individual interviews with 124 Latina immigrant mothers across six rural Midwestern communities who participated in one of two previous studies in the communities. Thematic analyses was used to identify themes that aligned with three areas of interest: challenges experienced, strategies employed to avoid virus infection, and impacts of the pandemic on family health and well‐being.ResultsMothers enacted behaviors (e.g., sanitation practices, wore masks, stayed home) to lessen negative impacts of the pandemic on family health and well‐being. Factors beyond their control (e.g., public policies, work policies and practices) placed families at greater risk for poor health and well‐being. Eleven themes were identified that aligned with the three areas of interest.ConclusionFindings build upon and extend prior research that reexposed unjust employment conditions, inadequate health‐care systems, and an anti‐immigrant context during the pandemic that perpetuated health disparities among Latino immigrants and other minoritized populations.ImplicationsEthnographic and longitudinal studies that give voice to populations underrepresented in COVID‐19 research and at high risk for poor health are warranted to inform policies and practices to protect health during public health crises.

Inequitable access to sport in juvenile justice across the USA: findings from a national survey.

The USA incarcerates more young people than any other industrialized nation in the world, and black youth are much more likely to be incarcerated than white youth. Young people who interface with the criminal justice system are at higher risk for poor health upon release and the justice system is believed to be a contributor to racial health disparities. Sport participation during incarceration has the potential to improve health and health equity, but the evidence on the health benefits of youth sport participation has almost exclusively focused on school and community settings in the USA with little attention to non-traditional settings, such as the justice system. Given the poor health consequences of incarceration, the potential of sport to improve health, and the lack of research on this phenomenon in the USA, our objective was to describe the landscape of sport programming in juvenile correctional facilities and provide a baseline understanding upon which future research can build. Through a cross-sectional survey of all long-term secure juvenile correctional facilities in the USA (n = 211), we found 55.1% operate a sport program. Among facilities with programs, there was a range of sport program offerings. Gender disparities in access to various types of programs exist, with girls generally having less opportunity than boys. Most facilities reported a purpose of positive youth development in the operation of their programs. These findings have important implications for health promotion and the further integration of sport and juvenile justice as part of a public health agenda.

"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan.

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

Energy poverty, housing conditions, and self-assessed health: evidence from Poland

Energy poverty, i.e., inefficient heating and insufficient access to energy services, can turn a shelter into a health hazard. We find that substandard housing and ineffective heating is associated with a higher risk of poor health in an urban context. We surveyed people living in two middle-sized cities in a coal-dependent region of Poland and used objective and subjective indicators of energy poverty and self-assessed health status. We demonstrate that people who live in substandard housing are more likely to exhibit poor musculoskeletal and cardiovascular outcomes, by 10 and 6 pp, respectively than otherwise similar people living in suitable housing conditions. We show that energy-poor people who use coal or a wood stove have a 24 pp higher likelihood of respiratory disease than the energy-poor who live in flats connected to district heating. We also find that a significant amount of the explained variance in the probability of respiratory disease is attributable to energy poverty. To improve the housing conditions and reduce the risk of poor health outcomes, we recommend two policy instruments: 1) a full subsidy for thermal retrofits and connecting multi-family buildings to the district heating network and 2) a targeted energy voucher for clean heating.

‘I really want to work for me to feel good myself ‘: Health impacts of employment experiences for women from refugee backgrounds in Australia

Work is an important social determinant of health. However, people from refugee backgrounds face various barriers to employment and women especially have significantly lower levels of employment. Many refugees also work in jobs with poor conditions. Given the higher risk of poor health for refugees more generally, the impact of employment experiences on health is an important area of investigation. Drawing on in-depth interviews with 42 refugee women, this paper explores health effects of job seeking and employment experiences. Interviews were analysed using inductive thematic analysis. Women reported difficulties securing work and most were unemployed, which had a negative effect on mental health. Once in work, employment was found to promote wellbeing through a sense of identity and contribution, as well as extending social networks. However, almost all employed participants were working in precarious employment conditions. In terms of mental health, participants reported negative effects from exploitation and discrimination. Exposure to toxic chemicals and poor working conditions were reported as particularly detrimental to physical health. Women were reluctant to complain about poor working conditions, citing a lack of awareness of procedures, fear of losing employment, and concerns about implications for immigration status. Overall, the study highlighted significant barriers to women securing work generally, particularly work that was health promoting. The paper concludes with a discussion of the implications for policy and practice.

The health of mothers of children with a life-limiting condition: A qualitative interview study

Background: The number of children with a life-limiting condition is increasing. The mothers of these children commonly provide extensive care at home for their child and are at a higher risk of poor health than other mothers. The impact of this is rarely explored from mothers’ perspectives. Aim: To explore mothers’ accounts of their physical and mental health, experiences of accessing healthcare and who they think should support their health. Design: Qualitative semi-structured interviews were conducted and analysed using thematic analysis. Setting/participants: Thirty mothers of children with a life-limiting condition were recruited via three UK children’s hospices and social media. Results: Mothers felt that their health concerns could be misunderstood by professionals, describing untimely and inappropriate support that failed to recognise the nature of caring for a child with a life-limiting condition. This led to mothers’ reluctance in addressing these concerns. Mothers felt unable to prioritise their own needs, relative to those of their child and worried about who would look after their child if they did become unwell. They described stress as a result of battles with services rather than as a result of caregiving. Mothers valued feeling recognised as caregivers, which made it easier to look after their health alongside their child’s. Hospice support was particularly valuable in this respect. Conclusions: A more unified system that recognises not only the unique set of challenges presented to mothers caring for a child with a life-limiting condition, but the value of palliative care services in supporting these mothers, is required.

Body-mass index trajectories from childhood to mid-adulthood and their sociodemographic predictors: Evidence from the International Childhood Cardiovascular Cohort (i3C) Consortium

SummaryBackgroundUnderstanding lifecourse trajectories of body-mass index (BMI) is important for identifying groups at high risk of poor health and potential target points for intervention. This study aimed to describe BMI trajectories from childhood to mid-adulthood in four population-based cohorts established in the 1970s and 1980s and to identify childhood sociodemographic factors related to trajectory membership.MethodsBetween Dec 17, 1970 and Dec 15, 1994, data were collected at the first visit from 9830 participants from the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes participants from Australia (1985), Finland (1980) and the USA (1970–1994). Participants had at least three measures of height and weight, including one in childhood (6–18 years) and one in adulthood (>18 years), and were aged 30–49 years at last measurement. Latent Class Growth Mixture Modelling was used to identify lifecourse BMI trajectory groups and log multinomial regression models were fit to identify their childhood sociodemographic predictors.FindingsFive consistent BMI trajectory groups were identified amongst the four cohorts: persistently low (35.9–58.6%), improving from high (0.7–4.8%), progressing to moderate (9.3–43.7%), progressing to high (1.1–6.0%), and progressing to very high (0.7–1.3%). An additional three BMI trajectory groups were identified in some, but not all, cohorts: adult onset high (three cohorts; 1.8–20.7%), progressing to moderate-high (two cohorts; 5.2–13.8%), and relapsing yo-yoers (alternating upward and downward; one cohort; 1.3%). In pooled analyses, each predictor variable in childhood, including age, gender, parental education and race, was associated with increased likelihood of belonging to the most (e.g., improving from high) and least (e.g., progressing to very high) favourable BMI trajectory groups, suggesting a U-shaped (or inverse U-shaped) pattern of association.InterpretationFive consistent BMI trajectory groups were identified across four cohorts from Australia, Finland, and the USA, mainly across two eras of birth. While most participants remained on a persistently low trajectory (50%), many demonstrated worsening BMI trajectories (47%), with only few demonstrating improving trajectories (<5%). Age, gender, parental education, and race appear to be important predictors of BMI trajectory group membership and need consideration in preventive and management strategies.FundingThis study was supported by funding from the National Institutes of Health, National Heart, Lung and Blood Institute (grant number R01 HL121230).

Multi-level barriers and facilitators to implementing a parenting intervention in prison, perceptions from deliverers and responsible managers: a mixed-methods study

BackgroundChildren of incarcerated parents run a high risk of poor health and own delinquency and positive parenting is vital for their healthy development. Internationally, parenting interventions for incarcerated parents suggest impacts on parenting and child behaviour outcomes. The intervention For Our Children’s Sake (FOCS), was developed for incarcerated parents in Sweden and evaluated in a controlled trial with a parallel process evaluation during 2019–2021. This study constitutes part of the process evaluation and aims to describe barriers and facilitators for the implementation of FOCS, and how the intervention targets parents’ needs, as perceived by delivering group leaders and responsible correctional inspectors.MethodsIn this mixed-methods study, group leaders (n = 23) and correctional inspectors (n = 12) in both intervention and control group of the FOCS trial responded to a quantitative questionnaire regarding factors of importance for intervention implementation. Group leaders (n = 12) and correctional inspectors (n = 6) in the intervention group also participated in qualitative interviews. Quantitative data were analysed using descriptive statistics and comparison of means. Qualitative data were analysed inductively using qualitative content analysis.ResultsA synthesis of the quantitative and qualitative results showed that the topic of parenting and child issues in general was perceived as highly important to work with in prison, and FOCS to be an important programme in specific. At the same time, the implementation of FOCS was perceived as reliant on the individual engagement of group leaders and correctional inspectors and implementation was described as a struggle due to the scarce resources that were allowed for FOCS. Thus, additional resources and support from the Prison and Probation Service’s management were called for to facilitate implementation of FOCS, and to make it an automatic part of prison activities.ConclusionThis study showed that there was high engagement among deliverers and managers for working with parenting in prison, where the need among parents has been described as great. Additional resources and support within the overall Prison and Probation Service, is vital to facilitate implementation of FOCS and make it sustainable within the prisons. The findings can be used to refine an implementations structure for similar interventions in the prison or similar settings.

114. Generational Trauma: Teen Parent Reactions to a Brief Intervention in the Primary Care Clinic

Exposure to adverse childhood experiences (ACEs) has been linked to poor health and developmental outcomes across the lifespan. Adversity experienced by a caregiver in childhood can lead to a generational transfer of trauma, through an impact on caregiver mental health, parenting behaviors, and parent-child relationships. Adolescent parents have disproportionately high rates of exposure to childhood trauma, putting their offspring at high risk of poor health and developmental outcomes, through the intergenerational transfer of trauma.

Chronic Diseases and Associated Risk Factors Among Adults in Puerto Rico After Hurricane Maria

As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017. This cross-sectional study used data from 2 previous cross-sectional studies, including the pre-Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post-Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020. Self-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate. Data were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT. A total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20 001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results. In this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.