Poverty Line Research Articles

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

Individual- and community-level predictors of healthcare-seeking behaviour for acute respiratory tract infections among children under five in 29 low- and middle-income countries: a multilevel analysis

ObjectivesThis study aimed to identify the individual- and community-level determinants of mothers’ healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). Study designNationally representative Demographic and Health Survey datasets from 29 LMICs were used. MethodsThe study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. ResultsThe overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. ConclusionsThis study revealed that mothers’ healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs.

Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 - National Immunization Survey-Child, United States, 2021-2023.

Data from the National Immunization Survey-Child (NIS-Child) were analyzed to estimate coverage with childhood vaccines recommended by the Advisory Committee on Immunization Practices among U.S. children by age 24 months. Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points. Analyses of NIS-Child data for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage. Coverage among children born during 2020-2021 varied by race and ethnicity, health insurance status, poverty status, urbanicity, and jurisdiction. Compared with non-Hispanic White children, coverage with four of the 17 vaccine measures was lower among non-Hispanic Black or African American children as well as Hispanic or Latino (Hispanic) and non-Hispanic American Indian or Alaska Native children. Coverage was also generally lower among those covered by Medicaid or other nonprivate insurance, uninsured children, children living below the federal poverty level, and children living in rural areas. Coverage varied widely by jurisdiction, especially coverage with ≥2 doses of influenza vaccine. Children born during 2020-2021 were born during or after the period of major disruption of primary care from the COVID-19 pandemic. Providers should review children's histories and recommend needed vaccinations during every clinical encounter. Addressing financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation can also help to increase coverage, reduce disparities, and protect all children from vaccine-preventable diseases. Strategies that have been found effective include implementation of standing orders and reminder and recall systems, strong physician recommendations to vaccinate, and use of immunization information systems to identify areas of lower coverage that could benefit from targeted interventions to increase immunization rates.

Clinician Willingness to Prescribe Medications for Opioid Use Disorder to Adolescents in Indiana.

Prescribing medications for opioid use disorders (MOUD), including buprenorphine, naltrexone, and methadone, to adolescents remains an underused evidence-based strategy for reducing harms associated with opioid use. To identify potential associations between clinician- and community-level characteristics regarding clinicians' self-reported willingness to prescribe MOUD to adolescents. This cross-sectional study included a phone survey of Indiana clinicians and spatial analysis of community-level characteristics. Clinicians were eligible for inclusion in analyses if actively providing health care and listed on the Buprenorphine Practitioner Locator website, a publicly available national registry of clinicians possessing a waiver to legally prescribe buprenorphine (ie, waivered clinicians). Community-level characteristics, including total population, rurality or urbanicity, percentage with incomes below the federal poverty line, and racial or ethnic makeup. Clinicians were asked about their willingness to prescribe MOUD to adolescents younger than 18 years if clinically indicated. Responses were recorded as no, yes, or yes with conditions. Among the 871 clinicians listed on the website as of July 2022, 832 were eligible for inclusion and contacted by phone. Among waivered clinicians, 759 (91.2%) reported being unwilling to prescribe MOUD to adolescents, 73 clinicians (8.8%) reported willingness to prescribe MOUD to adolescents, and only 24 (2.9%) would do so without conditions. A multivariable logistic regression model including spatially lagged community-level variables showed that, among areas with waivered clinicians, clinicians practicing in more populated areas were significantly less likely to prescribe to adolescents (β = 0.65; 95% CI, 0.49-0.87; P = .003). Similarly, those in more rural areas were significantly more likely to prescribe to adolescents (β = 1.27; 95% CI, 1.02-1.58; P = .03). Variation in clinician willingness to prescribe was not explained by other community-level characteristics. Among all waivered clinicians, advanced practice clinicians were less likely than physicians to report willingness to prescribe (β = 0.58; 95% CI, 0.35-0.97; P = .04), as were physicians without any specialty training relevant to MOUD prescribing when compared with family medicine clinicians (β = 0.40; 95% CI, 0.18-0.89; P = .03). A small subgroup of waivered clinicians had training in pediatrics (13 clinicians [1.6%]), and none were willing to prescribe MOUD to adolescents. From this cross-sectional study, it appears that Indiana adolescents continued to face gaps in access to MOUD treatment, despite its well-established efficacy. Programs that support primary care practitioners, including family medicine clinicians and pediatricians, in safe and appropriate use of MOUD in adolescents may bridge these gaps.

Measuring Multidimensional Poverty of the Population of the Regions of Russia: A Hybrid Approach

The research paper is devoted to the measurement of poverty (and its depth) of the population of Russian regions on the basis of a hybrid approach. This approach involves both an objective assessment of the phenomenon under study (according to Rosstat data) and taking into account the subjective perception of poverty by the population. In the first case, the index method is used in combination with the method of self-organising maps by T. Kohonen and an ensemble of multilayer perseptrons of various configurations. Artificial intelligence allows not only to deepen the results of retrospective assessment of multidimensional poverty through cluster analysis, but also to realise the predictive function. In the second case, a sociological survey is conducted on the example of a certain region of Russia (the Republic of Bashkortostan). According to the results of the cluster analysis, taking into account the earlier retrospective assessment, we can conclude that there is a high degree of polarisation of Russian regions based on the actual level of ‘multidimensional poverty’. ‘Oases’ (St. Petersburg, Moscow and the Republic of Tatarstan) contrast with “centres” (the Republic of Ingushetia, the Republic of Tyva, the Karachay-Cherkess Republic and the Republic of Altai) of multidimensional poverty. At the same time, the Republic of Bashkortostan (one of the old-industrial regions with a rich mineral and raw material base) in the formed rating regularly occupied the median position among other constituent entities of the Russian Federation. The main (key) problems in the sphere of poverty for this region of Russia are specified based on the results of sociological research. Such a study also makes it possible to deepen the retrospective assessment of ‘multidimensional poverty’, since not all the necessary data for a comprehensive analysis of the phenomenon under study are generated by Rosstat on a regular basis. The results obtained in the framework of the study can be used in the actualisation of the most important direction of the state social policy of modern Russia – the fight against poverty. In the long term, the top management of the country needs to ensure a significant reduction in the poverty level of the population regardless of the territorial factor (constituent entity of the Russian Federation).

Cohort profile: the ADAPT study, a prospective study of pregnancy preferences, pregnancy, and health and well-being in the southwestern USA

PurposeSignificant methodological shortcomings limit the validity of prior research on pregnancy decision-making and the effects of ‘unintended’ pregnancies on people’s health and well-being. The Attitudes and Decisions After Pregnancy Testing...

Advances in Economic Development through Control of the Underground Economy

In an era of ongoing global development and increasing focus on sustainability, the underground economy persistently identifies novel areas for expansion. This dynamic growth compels states to engage in an ongoing search for effective strategies to regulate and mitigate its effects, while simultaneously addressing the broader implications for economic development. Poverty, financial development, income inequality, and legal framework are analyzed in this paper in relation to the underground economy for the European Union member states between 2004 and 2022 by way of a panel model. Our findings reveal a positive relationship between the levels of poverty among individuals and the underground economy. Conversely, the interplay between the underground economy and both financial development and the legal framework exhibits a detrimental effect. In conclusion, our analysis reveals that the three primary variables examined—poverty, financial development, and legal framework—substantially influence the scale of the underground economy, with important implications for overall economic development and sustainable growth.

Impact of Energy Crises on Income Inequality: An Application of Piketty’s Hypothesis to Pakistan

In Pakistan, the majority of people have access to energy supplies. However, people who are underprivileged, below the extreme poverty line, or part of the middle class often spend disproportionate portions of their income on energy supplies and services, to some extent because of higher upfront prices for energy supplies, expensive products, and expensive imported appliances. The nonavailability of low-cost energy supplies is mainly affecting underdeveloped regions that have mostly low-income households. We used the dynamic ordinary least squares method to look at the impact of the energy crisis on income inequality from 1997 to 2021. The results show that the energy crisis exacerbates income inequality as low-income groups end up spending more significant shares of their income on energy products, supplies, and services than higher-income groups. Fair and equal access to energy supplies and services is less likely to reduce income inequality if prices are not cost-efficient. Cautious deliberation regarding the structure of energy tariffs is inevitable; at the same time, safety nets and social security programs for the poorest groups need to be expanded. At this stage, the aim is to target energy prices that will achieve the objectives of reducing polarity and increasing real income.

Heterogeneous effects of Medicaid coverage on cardiovascular risk factors: secondary analysis of randomized controlled trial

ObjectivesTo investigate whether health insurance generated improvements in cardiovascular risk factors (blood pressure and hemoglobin A1c (HbA1c) levels) for identifiable subpopulations, and using machine learning to identify characteristics of people...

Affordable Care Act Medicaid expansion, access to health care, and financial behavior of the United States adults.

The access to care benefits of Affordable Care Act (ACA) Medicaid expansions are important for 45-64-year-old adults who are living below 100% of the Federal Poverty Level, a particularly vulnerable group in the United States (US). Gaining coverage from Medicaid expansions should improve access to healthcare and affect social determinants of health, including financial behavior. We analyzed data from 2009 to 2018 from the National Financial Capability Survey (NFCS) and utilize a difference-in-differences model to compare outcomes changes in states with and without expansion before and after the ACA Medicaid expansions. Overall, Medicaid expansion was associated with increased healthcare access for 45-64-year-olds, potentially resulting in better healthcare experience. Results indicate effects of the Medicaid expansion on the financial behavior of45-64-year-olds, with evidence of credit card bills being paid in full, higher banking activities, and better financial preparedness. These findings have important implications for financial regulators and healthcare policymakers.

Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil.

The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

Abstract A047: Neighborhood disadvantage and multiple myeloma risk among Black women living in the United States

Abstract Introduction: Multiple myeloma (MM) is a rare cancer of the plasma cells. Black men and women are at a greater than 2-fold increased risk of MM as compared to other racial/ethnic groups. In 2021, Black women living in the United States (U.S.) were diagnosed with MM at a rate of 13.9 per 100,000 women, and incidence has increased by more than 30% since 2000. Factors associated with the neighborhood in which Black women live and work may be one area to consider to disentangle this racial disparity in MM incidence and reduce the burden of disease for Black women. Methods: We evaluated the association between two neighborhood-level indices and MM within the Black Women’s Health Study, a longitudinal cohort of 59,000 self- identified Black women ages 21-69 at enrollment in 1995. Participant addresses at baseline were geocoded and linked with U.S. Census Bureau and American Community Survey data. We conducted a factor analysis to a create neighborhood concentrated disadvantage (nDIS) score, which included 6 variables: percentage of individuals below the poverty line, percentage of individuals on public assistance, percentage of female headed households, percentage unemployed, percentage of individuals ≤18 years, and percentage of Black residents. A neighborhood socioeconomic status (nSES) score included median household income, median housing value, percentage of households receiving interest, dividend or net rental income, percentage of adults aged ≥25 years who completed college, percentage of employed persons aged ≥16 years in occupations classified as managerial, executive or professional, and percentage of families with children that are not headed by a single female. We used Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CI) for the association of quartiles of nSES and nDIS in relation to MM risk. Multivariable models were adjusted for age, body mass index, educational attainment, alcohol consumption, physical activity, and cigarette smoking. Results: During follow-up through 2021, we identified 276 incident cases of MM. Multivariable-adjusted HRs were 1.43 (95% CI: 1.00, 2.03) for women living in the highest quartile of neighborhood disadvantage relative to the lowest quartile, and 1.23 (95% CI: 0.86, 1.76) for women living in neighborhoods in the lowest quartiles of nSES compared to the highest. Conclusions: Black women in the U.S. living in neighborhoods of high concentrated disadvantage have an increased risk for MM compared to women who live in more advantaged communities, even after adjustment for individual SES as measured by educational attainment. Future studies to further tease apart specific neighborhood-level factors (e.g., walkability, chronic stress, environmental pollution, opportunities to engage in healthy behaviors) that might influence risk of MM would be beneficial. Ultimately, community reinvestment may offer an opportunity to reduce the increasing burden of MM among Black women. Citation Format: Etienne X. Holder, Julie R. Palmer, Kimberly A. Bertrand. Neighborhood disadvantage and multiple myeloma risk among Black women living in the United States [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 A047.

Abstract B150: Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women

Abstract Introduction: Comorbidities such as obesity, Type-2 diabetes (T2D), and hypertension (HTN) are highly prevalent among under-resourced African Americans (AA) and Latinx, and they are associated with breast cancer (BC) risks and outcomes. Social determinants of health (SDOH) also have been found related to BC incidence, stage, and survival. In addition, elevated inflammatory cytokines may be an underlying factor in comorbidities that contribute to tumorigenesis and adverse cancer outcomes. Limited research has been conducted to explore the process and associations among SDOH, comorbidities, and inflammation cytokines related to BC. The purpose of this study was to fill this research gap using a sample recruited from AA and Latinx communities. Methods: This was a cross-sectional study conducted in South LA. A total of 570 AA and Latinx women with or without BC were recruited. A panel of 19 cytokines from serum samples were measured by Luminex assay. Demographic information, body mass index, comorbidities, and diagnosis/stage of BC were collected from patients’ medical records. SDOH factors were selected from the social vulnerability index (e.g., percentage of persons in poverty, unemployed, with no high school diploma) obtained through Geographic Information Systems. Chi-square tests, independent sample Mann-Whitney U tests, and Cox regression were employed to examine the associations between BC diagnosis/stages, comorbidities, and cytokines. Path analyses were adopted to further explore the associations between SDOH, comorbidities, and cytokines. Results: Among the 570 women, 45.79% had a diagnosis of BC. Over half (50.97%) had ER/PR+, HER2-, and 27.80% had triple negative BC. Results from Chi-square tests showed that a higher percentage of women with obesity (p=.001), HTN (p<.0001), and T2D (p=.024) had a BC diagnosis than those without the comorbidity. Women with obesity had significantly higher levels of Leptin, VEGFα, and MIP1b; women with HTN had significantly higher levels of VEGFα and MIP1b; and women with T2D had significantly higher levels of Leptin and TGFβ1/β2. Leptin was found significantly higher in ER/PR+ BC (p<.0001) and VEGFα was significantly higher in triple negative BC (p=.001). Increasing VEGFα and TGFβ1/β2 reduced BC disease-free survival significantly. The path model showed community poverty and education level did not affect TGFβ1/β2 directly but were indirectly associated with them through obesity and T2D status (p<.01). Community poverty level was indirectly associated with the level of MIP1b through HTN status (p<.01). Conclusions: To eliminate breast cancer disparities, effective interventions are needed that account for the social and community contexts in which women live and are treated. Interventions that target comorbidities of T2D, HTN, and obesity are important to reduce the disparities. Citation Format: Weizhou Tang, Yanyuan Wu, Jaydutt Vadgama. Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women [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 B150.

Abstract A100: Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico

Abstract Introduction: Cancer is one of the most expensive medical conditions to treat due to the cost and duration of treatment. Financial toxicity (FT) describes the problems that a cancer patient has related to the cost of medical care, including subjective financial concerns. Despite the high burden of cancer, significant levels of poverty, and a fragile healthcare system in Puerto Rico (PR), no previous studies have evaluated FT among cancer patients in PR. Thus, we aimed to assess FT and associated social determinants among Hispanic cancer patients in PR. Methods: We are conducting a cross-sectional study through an online survey among cancer patients aged 21+ years who have received active cancer treatment over the last year. We use the COST-FACIT questionnaire, a validated survey composed of 12 questions; to measure low (score ≥ 21) and high (score < 21) FT. We also collect information on social determinants, including demographics, clinical characteristics, access to healthcare services, quality of life, social support, and patient navigation services, among others. Cronbach's alpha was used to assess the internal consistency of the FT score. Univariate (ULRM) and multivariate logistic regression models (MLRM) were used to determine the social determinants associated with FT. MLRM included significant variables in the ULRM (p < 0.10) and predictors supported by scientific literature. Results: As of April 8th, 2024, 387 people accessed the survey, with 294 (80.0%) completing it, including the FT section. The final sample size for this preliminary data analysis included 226 participants due to the exclusion of missing information on important covariates. Most of the participants were 51 to 64 years of age (46.9%), female (72.6%), had annual income < $25,000 (59.7%), and had a bachelor’s degree or higher (51.8%). COST-FACIT demonstrated good internal consistency (alpha=0.83). Approximately 46.0% of the participants had a high FT (overall FT mean score = 21.0±8.9). MLRM show that retired participants (OR: 0.22, 95%CI: 0.22-0.59) had less odds of high FT, while those who have public health insurance (OR: 2.38, 95%CI: 1.02-5.54), have comorbidities (OR: 2.27, 95%CI: 1.08-4.79), and have had a cancer diagnosis for more than 1 year (OR: 1.90, 95%CI: 1.02-3.53) have significantly higher odds of experiencing high FT. Conclusion: FT is higher among cancer patients with public health insurance, comorbidities, and more than one year since cancer diagnosis, but FT is lower in retired cancer patients. More research is needed to identify and evaluate interventions to address the FT of cancer treatment and the social determinants associated among Hispanic/Latino patients. IRB: This project was approved by the Institutional Review Board of the University of Puerto Rico Comprehensive Cancer Center (IRB # 2023-11-123). Citation Format: Marievelisse Soto-Salgado, Sofía Contreras-Fernández, Lorena González-Sepúlveda, Karina Torres-Mojica, Rocío Avilés-Mercado, Juan Paulo González-Mayoral, Nancy Cardona-Cordero. Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico [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 A100.

Abstract B116: Overcoming barriers in recruiting medically underserved patients with lung cancer: The NutriCare study, a "Food is Medicine" intervention

Abstract Despite recent efforts to expand clinical trial eligibility criteria to involve traditionally underserved patient populations, less than 5% of patients diagnosed with cancer choose to participate in clinical trials (lifestyle, behavioral or pharmaceutical), of which only a small fraction represents underserved or vulnerable populations. The barriers that contribute to these trends are multifactorial. Examining sociodemographic and clinical characteristics may provide insight into successful participant recruitment and retention of underrepresented groups in clinical trials. The NutriCare study (NCT04986670) is a national, multisite, randomized controlled trial evaluating the impact of medically tailored meals plus weekly nutritional counseling on the outcomes of vulnerable patients with treatment-naïve lung cancer initiating treatment. Eligibility criteria defining vulnerability included: ≥65 years of age; underrepresented minority; rural resident; no health insurance; or income ≤130% of federal poverty line. To remain on study, eligible participants also completed a 90-minute baseline assessment within 8 weeks of study consent. A comprehensive list of screened patients was maintained throughout the course of the study, including approach attempts and refusal reasons for participation. Strategies to improve recruitment included obtaining referrals from the treating physician and inclusion of the study dietitian during the informed consent process. Descriptive statistics were used to summarize the recruitment and retention of vulnerable patients. Overall, 438 participants were screened in Phase I of this study at The Ohio State University and MD Anderson (Nov, 2020 – Aug, 2022), of which 116 (26%) participants consented to the study. Of these 116 participants, 76 (66%) were 65 years of age or older, 42 (36%) lived in a rural area, 21 (18%) identified as a racial or ethnic minority, and 27 (23%) met federal poverty levels. As the study progressed, 44 (38%) patients withdrew between baseline to 3-months,18 (16%) patients withdrew between the 3-month to 8-month timepoints, and a total of 54 (47%) participants completed the study. The highest retention rates were identified among those <65 years (58%), males (52%), early-stage lung cancer (69%), racial or ethnic minorities (62%), non-rural residents (50%) and those above the federal poverty line (48%). Barriers to completing the study included rapid decline in performance status among those diagnosed with late/extensive stage lung cancers (16%), treatment impacting taste and appetite (8%), and logistical complications with the meal intervention (3%). Barriers to recruitment and willingness to participate during the NutriCare trial were similar across recruiting sites. Future trials should consider implementation of a crossover study design, local and customized food delivery services, and measurements of time toxicity related to survey completion as an outcome. These efforts may improve clinical trial participation and provide more supportive care needs for vulnerable patients with lung cancer. Citation Format: Hazel M. Antao, Kenneth Kwan Ho Chui, Jade Smith, Pooja Vibhakar, Mary Kathryn Cohen, Jessica Bauman, Saumil Gandhi, Joya Chandra, Lori Pai, Fang Fang Zhang, Colleen Spees, Carolyn Presley. Overcoming barriers in recruiting medically underserved patients with lung cancer: The NutriCare study, a "Food is Medicine" intervention [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 B116.

Effect of Flood on Poverty Status: Evidence from Sugar cane Farmers in Kwara State and Osun State of Nigeria

In Nigeria, sugarcane is a prominent crop and the primary crop used to produce sugar. However, floods have been a major tragedy that has troubled Nigeria's small-scale farmers. The bulk of rural poor people are these small-scale farmers, and as poverty rates have been rising over time, corrective action is required. This study was therefore carried out to assess the poverty status of sugar cane farming households (affected by flood, and unaffected by flood) in Kwara/Osun State of Nigeria. The study employed two-stage sampling technique to select 120 sugarcane farming households in the study area. Descriptive statistics, the Flood Loss Estimation, Logit Regression and Foster Greer Thorbecke (FGT) are the empirical analytical tools employed to analyze the data collected for the study. The results of the poverty index analysis revealed that 46 percent of the respondents are relatively poor, the poverty depth was 0.16 which implies that 16 percent were below the poverty line and the poverty severity was 0.07 which implies that 7 percent of the respondents were severely poor. Also, it revealed that flood shocks, gender, household size, household income, access to credit and membership to social organization were significant determinants of poverty. The study then came to the conclusion that many coping mechanisms people employ are corrosive because they have detrimental long-term implications on the sustainability of household subsistence. For future risk assessments and flood mitigation, the study advises using a holistic strategy and adept models. The remedies outlined in this paper would help the government, private sector, and sugar cane farmers economically.

Interwoven relationships between inequality, poverty, thuggery, and terrorism

This article aims to justify the relationship between inequality, poverty, thuggery, and terrorism, mainly in third-world countries. The primary issue is the incessant growth of inequality that leads to chronic poverty, which gives way to political thuggery and, consequently, terrorism in weak democracies or developing countries. In this particular context, the social disorganization theory was selected to elucidate the correlation between inequality, poverty, criminality, and terrorism in the top ten poorest countries in the world. The relationship between the stated societal negative factors could be mutualistic or commensalism, or both depending on the scenario and political cum economic idiosyncrasies of the affected society or community. In order to provide additional support for the arguments, data from various sources such as the Gini coefficient, per capita national income, crime, conflict, and terrorist indexes were utilized. The article justified that the higher the level of inequality, the higher the level of poverty, which have a mutually beneficial relationship with the pockets of criminality and terrorism in a given society.

Agricultural and rural development interventions and poverty reduction: Global evidence from 16 impact assessment studies

Agricultural and rural development interventions can reduce global poverty by providing growth-oriented tools, including access to finance, training, and markets. While such interventions effectively reduce monetary poverty (e.g., $1 a day poverty line), there is increasing interest in incorporating non-monetary poverty indicators, such as education, health, and living standards, to capture inherent multidimensionality in poverty. This study analyzes data from 16 impact evaluation studies conducted between 2019 and 2023 to examine whether and to what extent agricultural and rural development interventions affect multidimensional poverty of small-scale producers. Our analysis shows a 4 percent reduction in multidimensional poverty for treatment households compared to comparison households. Our findings suggest that agricultural and rural development interventions play a positive role in reducing poverty and have the potential to improve the long-term well-being of poor households.

Mental health services in rural India: a big challenge still to be met

There has been a decline in the rural population of India from nearly 82% to about 65% over the past six decades. The National Mental Health Survey of India (2015–2016) reported a lower prevalence of mental disorders in rural areas compared with urban ones. Mental health services in the country are skewed towards the urban areas, and more families are pushed below the poverty line while getting treatment for a member with mental illness. India has expanded its District Mental Health Programme over the past two decades, and it now covers nearly all the districts in the country. Despite that, significant numbers of people with mental disorders, ranging from 70–90%, do not receive adequate treatment. This paper discusses the rural–urban divide in the mental health services, examining the problem and need, and the initiatives taken by the government of India in this direction.

Changes in the medical admissions and mortality amongst children in four South African hospitals following the COVID-19 pandemic: A five-year review.

Vulnerable children from poor communities with high HIV and Tuberculosis(TB) burdens were impacted by COVID-19 lockdowns. Concern was raised about the extent of this impact and anticipated post-pandemic surges in mortality. Interrupted time series segmented regression analyses were done using routinely collected facility-level data of children admitted for medical conditions at four South African referral hospitals. Monthly admission and mortality data over 60 months from 01 April 2018 to 31 January 2023 was analysed using models which included dummy lockdown level variables, a dummy post-COVID period variable, Fourier terms to account for seasonality, and excess mortality as a proxy for healthcare burden. Of the 45 015 admissions analysed, 1237(2·75%) demised with significant decreases in admissions during all the lockdown levels, with the most significant mean monthly decrease of 450(95%, CI = 657·3, -244·3) p<0·001 in level 5 (the most severe) lockdown. There was evidence of loss of seasonality on a six-month scale during the COVID periods for all admissions (p = 0·002), including under-one-year-olds (p = 0·034) and under-five-year-olds (p = 0·004). No decreases in mortality accompanied decreased admissions. Post-pandemic surges in admissions or mortality were not identified in children with acute gastroenteritis, acute pneumonia and severe acute malnutrition.During the COVID-19 pandemic, paediatric admissions in 4 hospitals serving communities with high levels of HIV, TB and poverty decreased, similar to global experiences; however, there was no change in in-hospital mortality. No post-pandemic surge in admissions or mortality was documented. Differences in the impact of pandemic control measures on the transmission of childhood infections and access to health care may account for differing outcomes seen in our setting compared to the global experiences. Further studies are needed to understand the impact of pandemic control measures on healthcare provision and transmission dynamics and to better inform future responses amongst vulnerable child populations.