Low Education Research Articles

Trends in Sexual Orientation and Gender Identity Data Collection.

The aim of this study was to determine response patterns to sexual orientation and gender identity (SOGI) questions in the Behavioral Risk Factor Surveillance System (BRFSS) over time and to assess nonresponse and indeterminate responses by demographic characteristics. This is a secondary data analysis of the SOGI module of the BRFSS. We used data from 46 states and Guam that implemented SOGI questions between 2014 and 2022. We used weighted analyses that accounted for the sampling design, determined SOGI response patterns by year, and assessed nonresponse and indeterminate responses by demographic characteristics. Over time, increasing numbers self-reported as sexual and gender minority respondents, while heterosexual identity declined. Sexual orientation nonresponse and indeterminate responses increased with time, while respondents' reports of not knowing gender identity declined. Hispanic, older, respondents, those with lower education, and those who completed the questionnaire in Spanish had higher SOGI nonresponse and indeterminate responses. The low amount of SOGI nonresponse and indeterminate responses in the BRFSS can be instructive for the implementation of SOGI questions in medical settings. SOGI data collection in all settings requires improving procedures for the groups that have been shown to have elevated nonresponse and indeterminate response.

P192 PREVALENCE OF HYPERTENSION AND ITS ASSOCIATED FACTORS AMONG PUBLIC VEHICLE DRIVERS IN POKHARA, NEPAL

Introduction: Hypertension, defined as >=140/90 mm Hg or currently taking antihypertensive medicine, is a major public health concern globally, affecting individuals of all ages, backgrounds, and lifestyles. Occupational risk factors associated with hypertension are poorly studied in the context of Nepal, drivers could be at a higher risk of hypertension because of multiple shift work, stress, inactivity, and poor diet. Methodology This cross-sectional study recruited 358 public vehicle drivers from Pokhara Metropolitan City of Nepal. The WHO STEPS questionnaire was used to assess the prevalence of hypertension. Data were entered into REDCap software and analyzed by using SPSS. The chi-square test and binary logistic regression were applied to identify hypertension-related factors. Results: The mean age of the participants was 37.3 ±8.5 years, and all of them were male. The prevalence of hypertension was found to be 41.9%. Using the chi-square test, hypertension was found to be associated with age, lower education, being married, tobacco consumption, age of smoking initiation, alcohol consumption, binge alcohol intake, lower physical activity, obesity, duration of driving, and service. However, when using binary logistic regression, the association was found only with age (OR=0.353; 95% CI: 0.183 to 0.680) and obesity (OR=0.429; 95% CI: 0.234 to 0.783). Conclusion: This study concludes that nearly two-fifths of drivers had hypertension, which is higher than the prevalence in the general population. The research highlights the need to focus on risk factors associated with hypertension among public vehicle drivers in Pokhara, Nepal.

Hypertension knowledge and its associated factors among hypertensive patients in primary care settings in Central Vietnam: A cross-sectional study

Context: Hypertension is highly prevalent in Vietnam, yet the rate of controlled hypertension remains low. Knowledge about hypertension is linked to patient beliefs and medication adherence. However, there's limited data on hypertension knowledge among primary care patients in Vietnam. Aims: To evaluate the knowledge of hypertension among hypertensive patients in primary care settings in Central Vietnam and identify factors affecting their knowledge. Methods: A cross-sectional study was conducted, and a thorough examination was performed to assess hypertension knowledge and its related factors. Utilizing the Hypertension Knowledge Level Scale and Medication Adherence Report Scale, hypertension knowledge and medication adherence were evaluated. Additionally, demographic, clinical, lifestyle, and patient belief data were gathered. Statistical analyses and logistic regression models were applied to pinpoint key factors associated with hypertension knowledge. Results: In the study involving 761 participants (55.7% male), the average hypertension knowledge score was 15.0 (SD = 4.6), with only 45.3% demonstrating a high level of knowledge. Significant correlations were observed between hypertension knowledge and variables such as education level, ethnicity, home blood pressure monitoring, patient beliefs, and medication adherence. Logistic regression analysis indicated that higher education levels and belonging to the majority ethnicity were linked to enhanced hypertension knowledge. Notably, individuals with better hypertension knowledge tended to recognize the necessity of their prescribed medications. Conclusions: Hypertension knowledge among primary care patients in Central Vietnam is suboptimal, with approximately half having a high knowledge level. These findings emphasize the importance of hypertension knowledge in shaping patient beliefs, perceptions, and medication adherence. Tailored educational interventions are crucial, especially for those with lower education and minority backgrounds, to enhance hypertension management.

Prevalence and Associated Risk Factors with Unawareness of Folic Acid Benefits Prior to Pregnancy: Results From Canadian Community Health Survey

Recent national studies on awareness of folic acid (FA) prior to pregnancy among Canadian women are lacking. Using the 2017–2018 Canadian Community Health Survey, we aimed to estimate prevalence and risk factors associated with Canadian women who reported they were unaware of the benefits of FA supplementation before pregnancy. Prevalence of unawareness of FA was 22.1%. Lower education, lack of a health care provider, low household income, and an immigrant background were associated with greater odds of unawareness of the benefits of FA supplementation. Persistent associations with measures of social disadvantage and social determinants of health emphasize the need for new targeted public health campaigns.

Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients' Expectations of Antibiotics for Common Symptoms.

Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use. We conducted a survey (n = 564) between January 2020 to June 2021 in public and private primary care clinics in Texas to study the prevalence and predictors of patients' antibiotic expectations for common symptoms/illnesses. We surveyed Black patients (33%) and Hispanic/Latine patients (47%), and over 93% expected to receive an antibiotic for at least 1 of the 5 pre-defined symptoms/illnesses. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu than private clinic patients. Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (odds ratio [OR] = 1.6; 95% CI, 1.1-2.4) and cold/flu symptoms (OR = 2.9; 95% CI, 2.0-4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. Future antibiotic stewardship interventions should tailor patient education materials to include information on antibiotic risks and guidance on appropriate antibiotic indications.

Hispanic Thrifty Food Plan (H-TFP): Healthy, Affordable, and Culturally Relevant.

The USDA Thrifty Food Plan (TFP) is a federal estimate of a healthy diet at lowest cost for US population groups defined by gender and age. The present goal was to develop a version of the TFP that was more tailored to the observed dietary patterns of self-identified Hispanic participants in NHANES 2013-16. Analyses used the same national food prices and nutrient composition data as the TFP 2021. Diet quality was measured using the Healthy Eating Index 2015. The new Hispanic TFP (H-TFP) was cost-neutral with respect to TFP 2021 and fixed at $186/week for a family of four. Two H-TFP models were created using a quadratic programming (QP) algorithm. Fresh pork was modeled separately from other red meats. Hispanic NHANES participants were younger, had lower education and incomes, but had similar or higher HEI 2015 scores than non-Hispanics. Their diet included more pulses, beans, fruit, 100% juice, grain-based dishes, and soups, but less pizza, coffee, candy, and desserts. The H-TFP market basket featured more pork, whole grains, 100% fruit juice, and cheese. The second TFP model showed that pork could replace both poultry and red meat, while satisfying all nutrient needs. A vegetarian H-TFP proved infeasible for most age-gender groups. Healthy, affordable, and culturally relevant food plans can be developed for US population subgroups.

A Study To Assess The Level Of Anxiety, Coping Strategies And Financial Burden Among The Spouses Of Alcoholics Attending De-Addiction Centre At Selected Hospital In Kolkata, West Bengal

Background: Alcoholism is one of the significant problems in India. It is a chronic progressive and often fatal disease but it has not a symptom like other diseases or emotional problems. Prolonged heavy use of alcohol is the cause of addiction. For this addiction higher anxiety level, depression, low self-esteem and communication apprehension have been reported in spouses of alcoholics and attributed to intense, stress and traumas experiences. [1] The World Health Organization (WHO) estimates (9th May 2022) that there are about Worldwide, 3 million deaths every year result from harmful use of alcohol. This represents 5.3% of all deaths. The excessive use of alcohol is one of the main causes of more than 200 disease and injury conditions. Overall, 5.1% of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). A cause of death and disability relatively early in life is alcohol consumption. In people aged 20–39 years, approximately 13.5% of total deaths are attributable to alcohol. [9] Materials and Methods: A descriptive survey research design was adopted in this study. Non-probability Convenience sampling technique was used to select 100 spouses of alcoholics attending de-addiction centre of R. G. Kar M. C. H. Kolkata and de-addiction centre of N. R. S. M. C. H., Kolkata. Result: The findings revealed that majority of the subject 70% experiencing moderate level of anxiety, majority of the subject 76% adapted moderate coping strategies and majority of the subject 87% experiencing moderate financial burden. There was no relation between the level of anxiety and coping strategies among the spouses of alcoholics. There was a statistical significant association between anxiety with the selected socio demographic variables as educational qualification (χ2= 4.842 df =1, p>0.05), duration of marriage (χ2=4.762, df=1, p>0.05). Conclusion: Alcoholism had the negative effects towards the individual, family and also the nations. Lower education, loss of job, unemployment, unsocial behaves were also the effect of alcoholism. Awareness about the adverse effect of alcohol can prevent the alcoholism, thus reduce the level of anxiety of the spouses

Tobacco control policies and the multidimensional context of tobacco use by gender: The case of Türkiye.

This study aims to determine the indicators of tobacco use in Türkiye within a multidimensional context as socio-demographic, physical, behavioural, and psychological as a response to the tobacco control policies. The Turkish Health Survey data in 2014 and 2019 are employed within a probit model approach and the differences in tobacco are decomposed use by gender in order to reveal the gender differences. The samples in 2014 (total n=19,129; males=8 721, females=10,408) and 2019 (total n=17,084; males=7 784, females=9300) were restricted to 15-year-old and above. The findings indicate that being in the 30-49 age cohort, having lower education, and being married increase the likelihood of tobacco use. Future policies and campaigns should specifically target the single, pre-obese, employed males who consume alcohol. For females, the gender-specific policies should aim to reduce the prevalence of smoking, especially among separated or widows, obese, and out of the labour force. The contribution of mental health indicators on tobacco use has declined over the 5years, which could be a result of the supportive free health services in Türkiye. The findings provide evidence for a significant and increasing gender difference in tobacco use in Türkiye along with reporting that the most significant contributors to gender differences in tobacco use are alcohol consumption and education level. Even though the Ministry of Health and the government have been implementing anti-tobacco policies, legislations, and campaigns for years, the tobacco use prevalence has remained high and even increased in Türkiye.

Socioeconomic Risk Factors in Neurocysticercosis.

NCC is responsible for around 30% of active epilepsy in endemic countries such as India. Knowing socioeconomic factors associated with NCC can help in decreasing the incidence of this disease. We intend to study socioeconomic risk factors in NCC patients and how these factors are different from patients without NCC. Consecutive 100 adult patients of NCC presenting to neurology services with probable NCC (symptomatic or asymptomatic) along with age- and sex-matched controls were interviewed with preset proforma and then data was compiled and analyzed statistically. The NCC group had significantly more people with lesser education level (53%) as compared to control group (42%) (P = 0.002), lower socioeconomic status, poor hand hygiene practices, and use of contaminated vegetables (40% NCC group, 1% control group, P < 0.0001). Open defecation practice was also more among NCC cases. Lower education and socioeconomic status, poor hand hygiene, and eating undercooked contaminated vegetables are modifiable factors that are more prevalent in patients of NCC compared to controls. Social interventions aiming at these will help to reduce NCC patients in our country.

Socio-demographic and other factors contributing to excessive leisure screen time in preadolescent children.

Excessive screen use in early school age is associated with worsened health habits and negative child development in later age. We aimed to assess the time spent on modern and traditional screen-based devices and examine its associations with socio-demographic characteristics. This population-based cross-sectional observation study was conducted in Czechia, Slovakia and Finland between April and June 2021. Participants (N = 1,915) were parents/caregivers of children attending elementary school grades 1 to 3, selected by stratified random sampling. Children's daily leisure screen time (LST) based on parental reports was the main outcome. Descriptive statistics, mean comparison and linear regression analysis were used for the analysis. The average daily LST was found to be as high as 3.5 hours and significantly associated with most socio-demographic variables. Eighty percent of children exceeded the threshold of two hours of LST per day, which was formerly introduced by the American Academy of Pediatrics. The most important predictor of LST in children was having their screen-based device(s) for their exclusive personal use (EPU). Linear regression with all predictors assessed together confirmed the significant effect of the screen-based devices' EPU, the child's sex and grade, the child's birth order and the parent's education, even when controlled for media parenting practices. Given the widespread availability of smartphones for exclusive personal use among young children, the regulation of EPU and the reinforcement of effective media parenting practices, particularly in families with lower education and income, are critical public health strategies to mitigate the negative impact of excessive screen time on child development and overall well-being.

Risk Factors Associated with Cervical Cancer: A Matched Case-control Study

Background: One of the most effective ways to prevent cervical cancer is to identify the risk factors for the disease. Objective: The purpose of this research was to determine the risk factors for cervical cancer in women in Iran. Methods: This was a matched case-control study. 105 participants (35 patients with cervical cancer and 70 healthy women) were selected from the registered patients and women attending a women’s specialized hospital in Hamadan, Iran. One case was matched to 2 controls by age (±3 years). Demographic and clinical data were collected using a semi-structured questionnaire. Conditional multivariate logistic regression model and STATA 11 software were used for data analysis. Results: The mean age of women in the case and control group were 58.02(12.32) and 58.11(12.25) years (P = 0.486), respectively. Patients had lower education levels (P = 0.037), lower economic status (P˂0.001), and lower spouse education levels (P = 0.009). The results showed OCP users were 8.79 times more likely to develop cervical cancer than women who do not use OCP (P = 0.007), and the probability of cervical cancer in women increased by 8.33 times (&lt;0.001) with decreasing each level of socio-economic status. Conclusion: The results of the present study showed low economic status, and a history of using oral contraceptive pills are risk factors for cervical cancer.

Children's toothbrushing: a population survey on behaviours, attitudes, and knowledge in parents of Callao, Peru.

To determine the factors associated with behaviours, attitudes and knowledge of parents about children's toothbrushing (CTB). This is a cross-sectional analytical study of a calculated sample of 3,534 parents/guardians (92.6% female; 7.4% male; average age = 34 years [29-37]) of schoolchildren aged 3 to 8 years in 19 public schools in the province of Callao (Peru). A 31-item face-to-face/virtual questionnaire was divided into: 5 behavioural (18 (IQR)=3]; good 76%), 5 attitudes (13 [IQR=4]; negative 74.2%) and 10 knowledge (12 [IQR=4]; low 92.8%) (KMO≥0.537, Bartlett<0,001) and reliability (ω≥0.537) and 11 demographic domains. Bivariate and multivariate linear Poisson models were used with a P<0.05. Children of parents with a higher education showed good behaviours related to CTB. Negative parental attitudes and low knowledge about CTB were associated with a lower parental education and toothbrushing frequency.

Attitudes Toward Mathematics of Lower Secondary Education Students in Korca Region

Attitudes Toward Mathematics of Lower Secondary Education Students in Korca Region

Exploring the Relationship Between Education, Living Environment, and Anxiety/Depression Among Stable Patients: Insights from the COPD-AD China Registry Study.

Education and living environment are related to mental health. But the independent and combined effects of them on mental health among patients with chronic obstructive pulmonary disease (COPD) are uncertain. The independent and combined effects of education and living environment on mental health were assessed by binary logistic regression in 1064 COPD patients. Additive interaction was assessed with the relative excess risk ratio (RERI), attribution percentage (AP), and synergy index (SI). Our results shown that low education level and urban living environment were independently associated with higher risks for anxiety (odds ratio [OR]: 1.56, 95% confidence interval [CI] 1.06-2.29 and OR:2.15, 95% CI 1.51-2.05) or depression (OR:1.62, 95% CI 1.17-2.27 and OR: 2.01, 95% CI 1.46-2.75) among COPD patients. The combination effect of them was also associated with higher risks for anxiety (OR: 7.90, 95% CI 3.83-16.29, P < 0.001) or depression (OR: 11.79, 95% CI 5.77-24.10, P < 0.001) among these patients. Furthermore, we observed strong synergistic additive interactions between them for anxiety (SI: 11.57, 95% CI 1.41-95.27; RERI: 6.31, 95% CI 1.60-11.01; AP: 0.8, 95% CI 0.66-0.94) and depression (SI: 31.31, 95% CI 1.59-617.04; RERI: 10.44, 95% CI 2.66-18.23; AP: 0.89, 95% CI 0.8-0.97). Low education levels and living in urban areas had an independent and synergistic effects on mental health among COPD patients.

Prevalence of Food Insecurity during Pregnancy in Latin American and the Caribbean Countries: A Systematic Review

In Latin American and Caribbean (LAC) countries, women are particularly affected by food insecurity (FI). This gender gap can be amplified at certain key periods in life, particularly during pregnancy, with negative consequences on maternal and infant health. In the current geopolitical and health context, it is essential to take stock of the prevalence of FI among pregnant women in this region and the associated economic and psychosocial determinants. From 168 publications identified on Pubmed and Scopus, this systematic review selected 13 publications in 7 LAC countries. Although the published data only described the situation before the COVID-19 pandemic (2009–2019), the prevalence of FI in this population was already worrying, ranging from 28.2% to 64.9%. Only 4 of 13 studies investigated socioeconomic and psychosocial determinants among mothers in this region. Thus, the factors most frequently reported concerned mothers’ demographic characteristics (advanced age and ethnic minority), household socioeconomic characteristics (low income, poorest wealth quartile, precarious housing, and welfare recipients), the absence of a stable partner, and a low education level. High prevalences of FI have also been associated with mental distress during pregnancy. In conclusion, few recent studies (notably none since the COVID-19 pandemic) have been published in this region on the issue of FI among women during pregnancy. Yet, this knowledge is essential to the development of a logical framework for the implementation and evaluation of public health programs aimed at women and children. By reducing the FI of mothers in the LAC region, we will contribute to reducing the social inequalities in health that often manifest themselves very early in life.This study was registered at PROSPERO as CRD42024513321 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=513321).

The ADNI4 Digital Study: A novel approach to recruitment, screening, and assessment of participants for AD clinical research.

We evaluated preliminary feasibility of a digital, culturally-informed approach to recruit and screen participants for the Alzheimer's Disease Neuroimaging Initiative (ADNI4). Participants were recruited using digital advertising and completed digital surveys (e.g., demographics, medical exclusion criteria, 12-item Everyday Cognition Scale [ECog-12]), Novoic Storyteller speech-based cognitive test). Completion rates and assessment performance were compared between underrepresented populations (URPs: individuals from ethnoculturally minoritized or low education backgrounds) and non-URPs. Of 3099 participants who provided contact information, 654 enrolled in the cohort, and 595 completed at least one assessment. Two hundred forty-seven participants were from URPs. Of those enrolled, 465 met ADNI4 inclusion criteria and 237 evidenced possible cognitive impairment from ECog-12 or Storyteller performance. URPs had lower ECog and Storyteller completion rates. Scores varied by ethnocultural group and educational level. Preliminary results demonstrate digital recruitment and screening assessment of an older diverse cohort, including those with possible cognitive impairment, are feasible. Improving engagement and achieving educational diversity are key challenges. A total of 654 participants enrolled in a digital cohort to facilitate ADNI4 recruitment. Culturally-informed digital ads aided enrollment of underrepresented populations. From those enrolled, 42% were from underrepresented ethnocultural and educational groups. Digital screening tools indicate>50% of participants likely cognitively impaired. Completion rates and assessment performance vary by ethnocultural group and education.

AWARENESS AND ATTITUDE REGARDING EYE SCREENING PROGRAMS IN THE POPULATION OF SELANGOR, MALAYSIA BASED ON A CROSS-SECTIONAL STUDY

Introduction: Visual impairment significantly impacts individuals, causing functional and psychological challenges. Effective health promotion strategies require a robust foundation, necessitating an assessment of the awareness toward eye screening programs. This study aims to evaluate the awareness and attitudes of the public towards eye screening programs in Selangor, Malaysia. Methods: A cross-sectional study involved 388 adults aged 18 years and above. Data were collected using a self-administered questionnaire. Chi-square analysis assessed associations between knowledge and attitudes regarding screening programs for various eye diseases among adults. Results: A significant correlation was found between knowledge and attitudes toward different eye disease screening programs among adults in Selangor (p = 0.00). Additionally, associations were observed between age, marital status, residence area, education level, and knowledge of screening programs for different eye diseases (p &lt; 0.05). Age, gender, residential area, and education significantly correlated with attitudes toward screening programs (p = 0.00). Conclusion: This study underscores the need for targeted initiatives to raise awareness of visual impairment and the importance of routine eye exams. Particularly, efforts should be directed toward the elderly and individuals with lower education levels.

Tooth Loss and Systemic Diseases in the Slovenian Elderly Population: A Cross-Sectional Study of the Associaton Between Oral and Systemic Health.

This study aimed to assess the prevalence of edentulism and tooth loss in the Slovenian elderly population, along with the associated risk factors, and investigate the association between systemic and oral health. The study included 445 individuals aged 65 or older (average age: 79.7±8.9 years). Data on preserved teeth, dental history, chronic diseases, and medications were collected through clinical examinations. Height and weight were recorded in order to calculate body mass index (BMI), and the education level was also collected. Chronic systemic diseases and medications were categorized. Statistical analysis was conducted using linear regression and nonparametric tests. Participants had an average of 4.7±7.7 teeth, with no significant gender differences. Higher age (β=-0.185, p<0.001) and lower education level (p<0.001) were associated with fewer teeth, while higher BMI showed no correlation (β=-0.085, p=0.325). Diabetes mellitus (p=0.031), cardiovascular diseases (p=0.025), and thyroid diseases (p=0.043) were inversely related to retained teeth. This inverse relationship also applied to individuals who recovered from malignancies, not including head and neck malignancies (p=0.019). No significant relationship was found between osteoporosis and the number of teeth (p=0.573). Notably, antidiabetic drug use was inversely related to the number of teeth (p=0.004), while analgesics showed a positive relationship (p=0.022). This study highlights the association between specific sociodemographic factors, chronic diseases, and retained teeth among elderly individuals in Slovenia. High edentulism rates among the elderly emphasize the need for enhanced preventive measures and risk factor management, particularly for high-risk groups like the elderly.

Knowledge and Awareness of Type 2 Diabetes Complications in Conflict-Affected Regions: A Cross-Sectional Study in Homs, Syria.

Background Diabetes mellitus is a significant global health problem characterized by high blood sugar levels due to either a lack of insulin or insensitivity to it. Concerns about diabetes complications are growing both globally and locally, making effective preventive measures crucial to tackle these complications. This research aimed to determine the level of knowledge and awareness regarding type 2 diabetes complications among patients in Homs, Syria, during the ongoing conflict. Methods A cross-sectional study was conducted among 1016 diabetic patients aged 16 years and above attending internal medicine and diabetes clinics in Homs City through a structured questionnaire administered via social media, telephone interviews, and paper forms. The data collected were analyzed using SPSS version 23.0 (IBM Corp., Armonk, USA). Descriptive statistics were used to summarize the demographic characteristics. In contrast, inferential statistics such as the chi-square test were used to test for associations between different variables with p-value < 0.05 as the significance level. Results The study found that 478 (47.1%) of participants were male, and 538 (53%) were female. The majority 652 (64.2%) were between 46 and 70 years old, and 422 (41.5%) had primary-level education. Most were married 750 (73.8%) and lived in urban areas 856 (84.2%). Diabetes knowledge varied significantly by age, education, occupation, and residence. Housewives and those with lower education levels had the least knowledge, while urban residents and those with 1-5 years since diagnosis had better awareness. Individuals with relatives in the medical field had higher knowledge levels.Results indicate that gender did not significantly influence diabetes knowledge (p = 0.19), while younger adults showed poorer awareness compared to older age groups (p < 0.05). Higher education levels were associated with better knowledge (p < 0.05), and a family history of diabetes correlated with greater awareness of complications. Occupation significantly impacted knowledge, with employed individuals and urban residents demonstrating higher awareness levels (p < 0.05). Diabetes knowledge peaked during the 6-10 year disease duration (p < 0.05). Conclusion This study assesses diabetes knowledge and management practices among 1016 participants in Homs, Syria, focusing on demographic and socioeconomic factors. Our findings underscore the need for targeted educational initiatives to improve diabetes management, particularly among younger, less educated, and rural populations in Homs.The analysis reveals significant knowledge gaps about diabetes across different demographics in Homs, highlighting the need for targeted educational programs, especially for younger individuals, the less educated, and rural residents. The study emphasizes the importance of education and medical practice in understanding diabetes, particularly in conflict-affected areas.

Impact of Warehouse Expansion on Ambient PM2.5 and Elemental Carbon Levels in Southern California's Disadvantaged Communities: A Two‐Decade Analysis

AbstractOver the past two decades, the surge in warehouse construction near seaports and in economically lower‐cost land areas has intensified product transportation and e‐commerce activities, particularly affecting air quality and health in nearby socially disadvantaged communities. This study, spanning from 2000 to 2019 in Southern California, investigated the relationship between ambient concentrations of PM2.5 and elemental carbon (EC) and the proliferation of warehouses. Utilizing satellite‐driven estimates of annual mean ambient pollution levels at the ZIP code level and linear mixed effect models, positive associations were found between warehouse characteristics such as rentable building area (RBA), number of loading docks (LD), and parking spaces (PS), and increases in PM2.5 and EC concentrations. After adjusting for demographic covariates, an Interquartile Range increase of the RBA, LD, and PS were associated with a 0.16 μg/m³ (95% CI = [0.13, 0.19], p &lt; 0.001), 0.10 μg/m³ (95% CI = [0.08, 0.12], p &lt; 0.001), and 0.21 μg/m³ (95% CI = [0.18, 0.24], p &lt; 0.001) increase in PM2.5, respectively. For EC concentrations, an IQR increase of RBA, LD, and PS were each associated with a 0.021 μg/m³ (95% CI = [0.019, 0.024], p &lt; 0.001), 0.014 μg/m³ (95% CI = [0.012, 0.015], p &lt; 0.001), and 0.021 μg/m³ (95% CI = [0.019, 0.024], p &lt; 0.001) increase. The study also highlighted that disadvantaged populations, including racial/ethnic minorities, individuals with lower education levels, and lower‐income earners, were disproportionately affected by higher pollution levels.