Individual-level Determinants Research Articles

Social Genomic Determinants of Health: Understanding the Molecular Pathways by Which Neighborhood Disadvantage Affects Cancer Outcomes.

Neighborhoods represent complex environments with unique social, cultural, physical, and economic attributes that have major impacts on disparities in health, disease, and survival. Neighborhood disadvantage is associated with shorter breast cancer recurrence-free survival (RFS) independent of individual-level (race, ethnicity, socioeconomic status, insurance, tumor characteristics) and health system-level determinants of health (receipt of guideline-concordant treatment). This persistent disparity in RFS suggests unaccounted mechanisms such as more aggressive tumor biology among women living in disadvantaged neighborhoods compared with advantaged neighborhoods. The objective of this article was to provide a clear framework and biological mechanistic explanation for how neighborhood disadvantage affects cancer survival. Development of a translational epidemiological framework that takes a translational disparities approach to study cancer outcome disparities through the lens of social genomics and social epigenomics. The social genomic determinants of health, defined as the physiological gene regulatory pathways (ie, neural/endocrine control of gene expression and epigenetic processes) through which contextual factors, particularly one's neighborhood, can affect activity of the cancer genome and the surrounding tumor microenvironment to alter disease progression and treatment outcomes. We propose a novel, multilevel determinants of health model that takes a translational epidemiological approach to evaluate the interplay between political, health system, social, psychosocial, individual, and social genomic determinants of health to understand social disparities in oncologic outcomes. In doing so, we provide a concrete biological pathway through which the effects of social processes and social epidemiology come to affect the basic biology of cancer and ultimately clinical outcomes and survival.

Prevalence, underlying causes, and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis.

Maternal near miss (MNM) is one of the newly adopted assessment parameters to gauge the quality of maternity care. In Ethiopia, several studies have been conducted to investigate the incidence, underlying causes, and determinants of MNM. However, the findings from those studies vary greatly and are largely inconsistent. Thus, this review aims to more robustly estimate the pooled prevalence, identify underlying causes, and single out determinants of MNM in Ethiopia. Studies were searched from international databases (PubMed/ Medline, Cochrane Library, and Embase databases) and other potential sites. All observational studies were included. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics and small study effects were checked using Egger's statistical test at a 5% significance level. Outcome measures were overall and specific underlying causes (obstetrics hemorrhage, hypertensive disorder pregnancy, pregnancy-related infection) rates of MNMs per 10,000 live births. The meta-analysis included 43 studies consisting of 77240 MNM cases. The pooled prevalence MNM per 1000 live births in Ethiopia was 54.33 (95% CI: 33.93 to 85.89). Between-study heterogeneity was high (I2 = 100%, P < 0.0001), with the highest rate observed in Amhara region (384.54 per 1000). The prevalence of obstetrics hemorrhage (14.56 per 1000) was higher than that of hypertensive disorder pregnancy (12.67 per 1000) and pregnancy-related infections (3.55 per 1000) were identified as underlying causes. Various factors, including socio demographic characteristics, previous medical and obstetrics history as well as access to and quality of care obtained, were associated with MNM. Almost six women encounter near miss among a hundred live births in Ethiopia. Obstetric hemorrhage and hypertensive disorder pregnancy were the most common underlying causes of MNM. Both individual and facility level determinants were found to be associated with MNM. Considering the magnitude and identified factors, tailored measures should be taken at every stage of the continuum of care. https://www.crd.york.ac.uk/prospero/, identifier CRD42023395259.

Abstract C131: Understanding the impact of social risk factors on cancer care delivery: A scoping review

Abstract In recent years, there has been a growing emphasis on understanding the relationship between individual-level social determinants of health, which include social risks and social needs, within the realm of cancer care delivery. Social risks include food insecurity, housing instability, and transportation barriers, leading to adverse health outcomes. These social risks become social needs when patients identify a desire for assistance in addressing them. As the number of cancer survivors increases and disparities in the burden of cancer persist, there is a critical need to focus efforts on ensuring all survivors experience high-quality and equitable care across the cancer continuum, from diagnosis to end-of-life care. To inform research activities and intervention development, we aim to summarize and describe cancer care delivery research focused on three social risk factors: food insecurity, housing insecurity, and transportation barriers. To achieve our research objectives, we conducted a scoping review using Covidence software to examine published research assessing and addressing housing insecurity, food insecurity, and transportation barriers among individuals diagnosed with cancer. Six databases were searched: PubMed, Scopus, Cochrane Library, CINAHL Plus, EMBASE, and PsycINFO. Inclusion criteria for this review included original research in English published between 2010 and 2023 that focused on cancer patients and survivors in the United States and included social risk factors and cancer care delivery data. Data selection and screening were performed in two phases: (1) title and abstract and (2) full text, which required two independent reviewers. Discrepancies and disagreements between the two reviewers for inclusion of studies were resolved through weekly discussions at team meetings. A data abstraction tool that contains nine general variable categories was developed. We identified 10,032 studies, of which 76 were duplicates, and 9,368 were irrelevant at the title and abstract levels. We are currently finishing the full-text screening for the 563 studies deemed potentially eligible for inclusion at the title abstract level. To date, 164 of the 335 studies screened have met our eligibility criteria. We will extract data from all eligible studies once the full-text screening is completed. Across eligible studies, transportation barriers (91.5%) were the most common social risk factor of focus, followed by studies focusing on food insecurity (6.7%) and housing insecurity (3.7%). Our scoping review findings will provide us with a wide spectrum of knowledge regarding the most prominent relationships between social risk factors and cancer care delivery, gaps in current work, and existing interventions targeting these efforts. The results of this work will enhance our understanding of how social-structural disadvantages influence cancer outcomes and inform the development of concerted efforts aimed at addressing the social factors contributing to the unequal burden of cancer among survivors. Citation Format: Carol Y. Ochoa-Dominguez, Victoria M. Telles, Janeth I. Sanchez, Brenda A. Adjei, Avertson Worthy, Daniel Sabater-Minarim, Angel Arizpe, Matthew P. Banegas. Understanding the impact of social risk factors on cancer care delivery: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C131.

Spatial Patterns and Risk Factors of Stunting Among Under-five Children in Kenya: A Multilevel and Spatial Analysis

Stunting remains a significant public health burden in sub-Saharan Africa and has far reaching consequences. Identifying the drivers of stunting and high burden regions is key to developing effective and targeted intervention strategies. The objective of the study was to identify the risk factors and explore spatial patterns of stunting across counties in Kenya. Secondary data from 2022 Kenya Demographic Health Survey (KDHS) was utilized. A total of 13,016 children aged between 0 - 59 months were included in the analysis. A multilevel logistic regression was applied to identify individual, household and community level determinants of stunting, spatial regression models to analyze spatial dependency and geographically weighted regression to explore spatial heterogeneity in the association between childhood stunting and county level determinants. In the multilevel logistic regression, Children from urban residence exhibited a significantly increased odds of stunting compared to those in rural areas (aOR = 1.25, 95% CI: 1.03 - 1.51, p = 0.02). Children from households categorized as poorer, middle, richer, and richest all exhibited significantly reduced odds of stunting compared to those from the poorest households. Children whose mothers had attained secondary education exhibit higher odds of stunting compared to those with no education (aOR = 1.32, 95% CI: 1.01 - 1.72, p = 0.04). Male children show significantly higher odds of stunting compared to females (aOR = 1.50, 95% CI: 1.33 - 1.70, p &amp;lt; 0.001). Children aged 12-23 months exhibit the highest odds of stunting (aOR = 2.65, 95% CI: 2.23 - 3.14, p &amp;lt; 0.001) compared to those aged &amp;lt; 6 months). Spatial analysis indicated that stunting prevalence varies geographically, with some areas exhibiting higher clustering. The geographically weighted regression further revealed that the influence of socioeconomic and climatic factors on stunting prevalence differed across locations highlighting the need for geographically targeted interventions.

Development of a Tool for the Assessment of Job Satisfaction amongst the Community Health Workers

Abstract Introduction: Amongst the various factors influencing the performance of community health workers (CHWs), job satisfaction serves as a potential drive to perform better. This study aimed at developing a tool to measure how well the CHWs are satisfied pertaining to individual, community and health system determinants. Methodology: This cross-sectional study was conducted in a rural block of Madhya Pradesh (Central India). The CHWs were administered a self-reported questionnaire that contained individual, health system and community level determinants of job satisfaction with a 5-point Likert scale to mark their perception. Results: The job satisfaction scale of 15 items was initially administered to the 92 CHWs. Their scale content validity index (average) was 0.83. The finalised tool consisted of 13 items under three factors following the exploratory factor analysis namely, health system, supervision and peer support and intrinsic job satisfaction. Their overall Cronbach’s alpha was 0.81, with the median (interquartile range) score of job satisfaction for both the Relatively Low Performing and Relatively High Performing Community Health Workers being 4 (4–5). Conclusion: The CHWs in this study were satisfied with their performance as voluntary village health workers following the assessment using a complex job satisfaction scale.

Individual-level social determinants of health and disparities in access to kidney transplant and waitlist mortality.

Comprehensive, individual-level social determinants of health (SDOH) are not collected in national transplant registries, limiting research aimed at understanding the relationship between SDOH and waitlist outcomes among kidney transplant candidates. We merged Organ Procurement and Transplantation Network data with individual-level SDOH data from LexisNexis, a commercial data vendor, and conducted a competing risk analysis to determine the association between individual-level SDOH and the cumulative incidence of living donor kidney transplant (LDKT), deceased donor kidney transplant (DDKT), and waitlist mortality. We included adult kidney transplant candidates placed on the waiting list in 2020, followed through December 2023. In multivariable analysis, having public insurance (Medicare or Medicaid), less than a college degree, and any type of derogatory record (liens, history of eviction, bankruptcy and/ felonies) were associated with lower likelihood of LDKT. Compared with patients with estimated individual annual incomes ≤ $30,000, patients with incomes ≥ $120,000 were more likely to receive a LDKT (sub distribution hazard ratio (sHR), 2.52; 95% confidence interval (CI), 2.03-3.12). Being on Medicare (sHR, 1.49; 95% CI, 1.42-1.57), having some college or technical school, or at most a high school diploma were associated with a higher likelihood of DDKT. Compared with patients with incomes ≤ $30,000, patients with incomes ≥ $120,000 were less likely to receive a DDKT (sHR, 0.60; 95% CI, 0.51-0.71). Lower individual annual income, having public insurance, at most a high school diploma, and a record of liens or eviction were associated with higher waitlist mortality. Patients with adverse individual-level SDOH were less likely to receive LDKT, more likely to receive DDKT, and had higher risk of waitlist mortality. Differential relationships between SDOH, access to LDKT, DDKT, and waitlist mortality suggest the need for targeted interventions aimed at decreasing waitlist mortality and increasing access to LDKT among patients with adverse SDOH.

Neighborhood-Level Social Determinants of Health and Adolescent Mental Health

ObjectiveMental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents. MethodsWe used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles. ResultsThe sample included 50,011 adolescents ages 10–19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10–14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level. ConclusionsThere are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study.

Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old. Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts. Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation. Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.

Model-based estimation of individual-level social determinants of health and its applications in All of Us.

We introduce a widely applicable model-based approach for estimating individual-level Social Determinants of Health (SDoH) and evaluate its effectiveness using the All of Us Research Program. Our approach utilizes aggregated SDoH datasets to estimate individual-level SDoH, demonstrated with examples of no high school diploma (NOHSDP) and no health insurance (UNINSUR) variables. Models are estimated using American Community Survey data and applied to derive individual-level estimates for All of Us participants. We assess concordance between model-based SDoH estimates and self-reported SDoHs in All of Usand examine associations with undiagnosed hypertension and diabetes. Compared to self-reported SDoHs, the area under the curve for NOHSDP is 0.727 (95% CI, 0.724-0.730) and for UNINSUR is 0.730 (95% CI, 0.727-0.733) among the 329074 All of Us participants, both significantly higher than aggregated SDoHs. The association between model-based NOHSDP and undiagnosed hypertension is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.649. Similarly, the association between model-based NOHSDP and undiagnosed diabetes is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.900. The model-based SDoH estimation method offers a scalable and easily standardized approach for estimating individual-level SDoHs. Using the All of Us dataset, we demonstrate reasonable concordance between model-based SDoH estimates and self-reported SDoHs, along with consistent associations with health outcomes. Our findings also underscore the critical role of geographic contexts in SDoH estimation and in evaluating the association between SDoHs and health outcomes.

The Individual-Level and Community-Level Social Determinants of Burn Injuries: A Single-Institution Study From the Southwestern United States.

Burn injuries are a significant public health concern, causing life-threatening complications and substantial hospitalization costs for patients. It has been shown that burn injuries may affect individuals differently based on demographic factors and socioeconomic status, among other variables. In the Southwestern United States with high ambient temperatures, specific burn etiologies, such as pavement burns, may pose a disproportionately high risk for disadvantaged communities and homeless individuals. This study uniquely explores burn injuries in relation to patients' socioeconomic status in Las Vegas, Nevada by using the Distressed Community Index to quantify socioeconomic status utilizing individual-level and community-level indicators. This single-institution and retrospective study collected data from all patients admitted to a burn center located in Las Vegas. Data were analyzed through Chi-square, one-way ANOVA, and post-hoc analysis with Tukey's test. Patients residing in distressed communities contributed to the greatest number of burn injuries, however there was a lack of significant association between socioeconomic status and burn injury (p = 202). Additionally, specific burn etiologies and demographic characteristics were associated with variations in burn patient hospital course, complications, resources utilized and outcomes. Distressed patients were significantly associated with public insurance (p < 0.001), and public insurance users were associated with pavement burns-one of the most severe burn injuries (p < 0.001). This study emphasizes the importance of developing comprehensive burn prevention resources tailored to vulnerable populations, especially in regions with increased incidence of severe burn injuries, in order to reduce burn burden and mortality.

Colorectal cancer outcomes among Hispanic/Latino patients in the United States: a scoping review protocol.

This scoping review will identify the patterns of survival, treatment, and recurrence among Hispanic and/or Latino/a/x (H/L) patients with colorectal cancer (CRC) living in the United States (US) and Puerto Rico. Additionally, population- and individual-level determinants of cancer outcomes among H/L CRC patients will be mapped to highlight under-reported/under-investigated research areas. CRC is the third most common cancer excluding skin cancers in the US. Unlike non-Hispanic White populations, cancer is the number one cause of death in H/L populations and currently represents 21% of total deaths. Despite this, a lack of consensus exists on CRC outcomes for H/L patients. Most research on H/L individuals has examined incidence and screening of CRC, with fewer studies focusing on cancer outcomes. All epidemiological study designs and systematic reviews will be considered. The review will only include peer-reviewed studies that report on survival, treatment, and/or recurrence patterns for H/L patients with CRC residing in the US and Puerto Rico. A 3-step search with a 2-stage study selection process will be followed, as recommended by JBI and Arksey and O'Malley. Databases to be searched will include MEDLINE (PubMed), Embase (Ovid), and Scopus. A data extraction tool will be designed based on JBI recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRSIMA-ScR) will be used, with the results presented in a PRISMA diagram. Publications in English from database inception to the present will be considered. Open Science Framework https://osf.io/y6qf5.

Self-care behaviors and their individual-level determinants in Italian adults with Marfan syndrome: A single-center cross-sectional study

AimThis study aimed to describe the levels of self-care behaviors and self-care self-efficacy in patients with Marfan syndrome and to identify the individual-level determinants of self-care behaviors. BackgroundThe behaviors aimed at maintaining health stability (self-care maintenance), monitoring signs and symptoms (self-care monitoring), and taking action when signs and symptoms occur (self-care management) are key aspects of the care for addressing the complexity of care of patients with Marfan syndrome. However, the description of self-care behaviors and their determinants in patients with Marfan syndrome are highly under-described. MethodsThe adopted design was descriptive observational with a cross-sectional data collection on 111 patients with MFS in a single Italian specialized and reference center for this disease between 2020 and 2021. ResultsPerforming healthy activities and managing illness, therapies, and follow-ups to maintain health over time (self-care maintenance) was almost adequate (mean score = 67.87 ± 13.17), as well as the ability to recognize signs and symptoms promptly (self-care monitoring, mean score = 67.95 ± 26.70). The ability to respond to symptoms when they occur (self-care management, mean score = 54.17 ± 19.94) was sub-optimal. The stronger positive predictor of each self-care behavior was self-care self-efficacy. ConclusionsThis study suggested prioritizing educational activities focused on enhancing self-care management in patients with Marfan syndrome and strengthening their self-care self-efficacy. Researchers should develop and validate evidence-based educational approaches to enhance self-care in patients with Marfan syndrome, and clinical nurses should strengthen their focused educational activities to improve the self-care management of these patients.

Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment.

Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities.

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey

BackgroundRepeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women.MethodsWe used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15–49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables.ResultsOf the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25–34 years (AOR:2.16;95%CI = 1.66–2.79) or 35–49 years (AOR:2.95;95%CI:2.18–3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25–12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03–2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33–1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07–1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49–0.93), Northern (AOR:0.46;95%CI:0.24–0.88), Upper West (AOR:0.24; 95%CI: 0.12–0.50) and Upper East (AOR:0.49; 95%CI = 0.24–0.99) regions were less likely to have repeat induced abortion.ConclusionThe study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

Knowledge of fertility period among reproductive age women in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BackgroundKnowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya.MethodsThe 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.ResultsThe overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period.ConclusionAs per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

Socioeconomic inequalities in the uptake of postpartum care at home across Dutch neighbourhoods.

Postpartum care focuses on prevention of health problems by performing medical check-ups and through enhancing maternal empowerment, the parent-infant interaction and knowledge about mother's own health and that of her newborn. We aimed to investigate whether there was significant clustering within neighbourhoods regarding the uptake of postpartum care and to what extent neighbourhood-level differences are explained by individual socio-demographic factors, pregnancy-related factors and neighbourhood-level determinants (i.e. deprivation and urbanization). A nationwide population-based observational study was carried out using linked routinely collected healthcare data from appropriate-for-gestational-age weight live-born term singleton deliveries (2015-18) in the Netherlands. We performed two-level multivariable logistic regression analyses, using three different models. Model 1 contained no explanatory variables and was used to assess clustering of postpartum care uptake within neighbourhoods. In model 2, individual-level determinants were added one by one and in model 3, neighbourhood-level determinants were added. About 520818 births were included. Multilevel modelling showed that 11% of the total variance in postpartum care uptake could be attributed to the neighbourhood of residence. Individual characteristics explained 38% of the neighbourhood variance, of which income and migration background were the most important contributors. An additional 6% of the variation could be explained by neighbourhood-level determinants. We found substantial neighbourhood differences in postpartum care uptake. These differences are influenced by a complex interplay between individual-level and neighbourhood-level determinants, highlighting the importance of addressing both individual and neighbourhood-level determinants to improve the uptake of postpartum care and therewith overall community health.

Assessing associations between individual-level social determinants of health and COVID-19 hospitalizations: Investigating racial/ethnic disparities among people living with human immunodeficiency virus (HIV) in the U.S. National COVID Cohort Collaborative (N3C).

Leveraging the National COVID-19 Cohort Collaborative (N3C), a nationally sampled electronic health records repository, we explored associations between individual-level social determinants of health (SDoH) and COVID-19-related hospitalizations among racialized minority people with human immunodeficiency virus (HIV) (PWH), who have been historically adversely affected by SDoH. We retrospectively studied PWH and people without HIV (PWoH) using N3C data from January 2020 to November 2023. We evaluated SDoH variables across three domains in the Healthy People 2030 framework: (1) healthcare access, (2) economic stability, and (3) social cohesion with our primary outcome, COVID-19-related hospitalization. We conducted hierarchically nested additive and adjusted mixed-effects logistic regression models, stratifying by HIV status and race/ethnicity groups, accounting for age, sex, comorbidities, and data partners. Our analytic sample included 280,441 individuals from 24 data partner sites, where 3,291 (1.17%) were PWH, with racialized minority PWH having higher proportions of adverse SDoH exposures than racialized minority PWoH. COVID-19-related hospitalizations occurred in 11.23% of all individuals (9.17% among PWH, 11.26% among PWoH). In our initial additive modeling, we observed that all three SDoH domains were significantly associated with hospitalizations, even with progressive adjustments (adjusted odds ratios [aOR] range 1.36-1.97). Subsequently, our HIV-stratified analyses indicated economic instability was associated with hospitalization in both PWH and PWoH (aOR range 1.35-1.48). Lastly, our fully adjusted, race/ethnicity-stratified analysis, indicated access to healthcare issues was associated with hospitalization across various racialized groups (aOR range 1.36-2.00). Our study underscores the importance of assessing individual-level SDoH variables to unravel the complex interplay of these factors for racialized minority groups.

Individual and community level determinants of delayed antenatal care initiation in Ethiopia: A multilevel analysis of the 2019 Ethiopian Mini Demographic Health Survey.

Antenatal care (ANC) is essential health care and medical support provided to pregnant women, with the aim of promoting optimal health for both the mother and the developing baby. Pregnant women should initiate ANC within the first trimester of pregnancy to access a wide range of crucial services. Early initiation of ANC significantly reduces adverse pregnancy outcomes, yet many women in Sub-Saharan Africa delay its initiation. The aim of this study was to assess prevalence and determinants of delayed ANC initiation in Ethiopia. We conducted a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The study involved women of reproductive age who had given birth within the five years prior to the survey and had attended ANC for their most recent child. A total weighted sample of 2,895 pregnant women were included in the analysis. Due to the hierarchical nature of the data, we employed a multi-level logistic regression model to examine both individual and community level factors associated with delayed ANC initiation. The findings of the regressions were presented with odds ratios (OR), 95% confidence intervals (CI), and p-values. All the statistical analysis were performed using STATA-14 software. This study showed that 62.3% (95% CI: 60.5, 64.1) of pregnant women in Ethiopia delayed ANC initiation. Participants, on average, began their ANC at 4 months gestational age. Women with no education (AOR = 2.1; 95% CI: 1.4, 3.0), poorest wealth status (AOR = 1.9; 95% CI: 1.3, 2.8), from the Southern Nations, Nationalities, and Peoples (SNNP) region (AOR = 2.1; 95% CI: 1.3, 3.3), and those who gave birth at home (AOR = 1.4; 95% CI: 1.1, 1.7) were more likely to delay ANC initiation. The prevalence of delayed ANC initiation in Ethiopia was high. Enhancing mothers' education, empowering them through economic initiatives, improving their health-seeking behavior towards facility delivery, and universally reinforcing standardized ANC, along with collaborating with the existing local community structure to disseminate health information, are recommended measures to reduce delayed ANC initiation.

What determines public attitudes toward immigration in the Middle East: an analysis at the individual level

PurposeSurveys in Europe show that immigration is more of a challenge than an opportunity for a significant number of people. However, little attention is given to attitudes toward immigration in the Middle East. This paper examines the effects of personal values and religiosity on the anti-immigration attitudes of citizens in the Middle East and North African countries.Design/methodology/approachUtilizing data from the World Values Survey, we analyze how personal values and religiosity affect anti-immigration attitudes in nine Middle Eastern countries. The data covers individual-level data of 9 MENA countries from the WVS Round 7 (2017–2022). Factor analysis is applied as a data reduction method. Afterward, an OLS regression analysis is conducted on the pooled data.FindingsAnti-immigration attitudes increase with age, education, and religiosity. Personal values such as national pride, support for nationals, and belongingness to one’s country significantly affect anti-immigration attitudes. Furthermore, the importance of religion as a measure of religiosity was found to be positively associated with anti-immigration attitudes.Originality/valueThis paper contributes to underexplored literature by investigating how individual-level determinants, such as demographic indicators, personal values, and religious factors, shape anti-immigration attitudes in the MENA context, distinct from European dynamics.

Associations among educators' beliefs, intervention fidelity, and student outcomes in school-wide positive behavior interventions, and supports: A school-level moderated mediation analysis.

Existing literature has established the effectiveness of school-wide positive behavioral interventions and supports (SWPBIS) for improving school-level student behavioral and academic outcomes. Implementation of SWPBIS in uncontrolled settings is often suboptimal, leading to lackluster outcomes. Researchers have developed and validated several implementation strategies to improve individual-level implementation determinants (e.g., educators' supportive beliefs) to promote the successful delivery of universal programs (e.g., SWPBIS). However, empirical studies are needed to explore the mechanisms of change through which school-level educators' beliefs influence their delivery of SWPBIS. This school-level quasi-experimental study tested a mediational mechanism of change where changes in educators' beliefs work through their intervention fidelity of SWPBIS to influence student outcomes. We delivered the Supportive Belief Intervention (a school-wide implementation strategy used before training to promote educators' supportive beliefs about SWPBIS) and then Tier 1 SWPBIS training to 81 elementary schools serving diverse student populations. At the start of the academic year, school-level educators' beliefs were assessed before the Supportive Belief Intervention. At the end of the academic year, educators' beliefs, intervention fidelity, and rates of student reading proficiency and suspension were assessed. Conditional process analyses with nonparametric bootstrapping (mediational and first stage moderated mediational models) revealed that, at the school level, a larger increase in educators' supportive beliefs was associated with enhanced SWPBIS fidelity and better corollary student outcomes (increased reading proficiency and reduced suspension), while student socioeconomic status moderated the size of the mediation effect. Implications for research and practices about the implementation of SWPBIS and school context were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).