Low-income Neighborhoods Research Articles

Association between forced displacement and cigarette smoking among Colombian adolescents

ABSTRACT Objective To establish the relationship between forced displacement and cigarette consumption among high-school students in Colombia. Methods A cross-sectional study was designed with the participation of high-school students (10th and 11th grade in Colombia) under 18 years of age. The crude and adjusted relationship (odds ratios) between internal forced displacement and cigarette consumption during the last month was established. It was adjusted for covariates (age, gender, educational level, and income) and confounding variables (depression and family dysfunction). Results 1,462 students between the ages of 13 and 17 participated (M = 15.98; SD = 0.83); 60.33% were women, 55.34% were in tenth grade, and 49.59% lived in low-income neighborhoods. A total of 113 (7.73%) students reported forced displacement, 103 (7.05%) reported depression, 1,112 (76.06%) scored for family dysfunction, and 149 (10.19%) students reported last-month cigarette consumption. After adjusting for covariates and confounding variables, forced internal displacement and cigarette smoking showed a statistically significant association (OR = 2.48, 95%CI 1.47–4.21). Conclusions A statistically significant relationship between forced displacement and last-month cigarette smoking among Colombian adolescents is observed. It is necessary to investigate other social determinants related to adolescent cigarette smoking.

The influence of neighborhood income on healthcare utilization in pediatric liver transplant.

Neighborhood contextual factors are associated with liver transplant outcomes. We analyzed associations between neighborhood-level socioeconomic status and healthcare utilization for pediatric liver transplant recipients. We merged the Pediatric Health Information System and Scientific Registry of Transplant Recipients databases and included liver transplant recipients ≤21 years hospitalized between January 2004 and May 2022. Outcomes were annual inpatient bed-days, risk of hospitalizations, and risk of liver biopsies. The primary exposure was zip code-based neighborhood income at transplant. We applied causal inference for variable selection in multivariable analysis. We modeled annual inpatient bed-days with mixed-effect zero-inflated Poisson regression, and rates of hospitalization and liver biopsy with a Cox-type proportional rate model. We included 1006 participants from 29 institutions. Children from low-income neighborhoods were more likely to be publicly insured (67% vs. 46%), Black (20% vs. 12%), Hispanic (30% vs. 17%), and have higher model for end-stage liver disease/pediatric end-stage liver disease model scores at transplant (17 vs. 13) than the remaining cohort. We found no differences in inpatient bed-days or rates of hospitalization across neighborhood groups. In univariable analysis, low-income neighborhoods were associated with increased rates of liver biopsy (rate ratio [RR]: 1.57, 95% confidence interval [CI]: 1.04-2.34, p = 0.03). These findings persisted after adjusting for insurance, race, and ethnicity (RR: 1.86, 95% CI:1.23-2.83, p < 0.01). Children from low-income neighborhoods undergo more liver biopsies than other children. These procedures are invasive and potentially preventable. In addition to improving outcomes, interventions to mitigate health inequities among liver transplant recipients may reduce resource utilization.

Factors Associated with Non-Completion of a Pediatric Metabolic and Bariatric Surgery Program

BackgroundChildhood obesity is a devastating disease process disproportionately affecting minority and low-income populations. Though bariatric surgery leads to durable weight loss and reversal of multiple obesity-related comorbidities, only a small fraction of pediatric patients undergoes the procedure. We sought to identify factors associated with non-completion in a pediatric bariatric surgery program. MethodsRetrospective review of consecutive patients ≤18-years-old referred to an academic adolescent bariatric surgery program between 2017 and 2022 (n = 20 completers, 40 non-completers) was completed. Demographics and medical and psychosocial histories were summarized by completion status. ResultsOf the 33% (20/60; 85% female, 30% racial minorities) who successfully completed the program, the median age was 16 years [IQR 16, 17]. The median age of non-completers was 16 years [IQR 15, 17] (55% female, 56% racial minorities). Non-completion was associated with male gender (15% of completers vs 45% of non-completers, p = 0.022), neighborhood income <150% poverty level (0 completers vs 17.5% of non-completers, p = 0.047), and presence of environmental or family stressors (22% of completers vs 65% of non-completers, p = 0.008). Though not statistically significant, non-completers tended to be racial minorities (p = 0.054). ConclusionsNon-completion of the bariatric surgery pathway was more prevalent among male patients from lower-income neighborhoods with significant environmental or family stressors. These patients also tended to be racial and ethnic minorities. The findings underscore the need for further investigation into barriers to pediatric bariatric surgery. Level of EvidenceLevel III.

Factors Associated With Negative Life Changes due to COVID-19 Among Older Adults Residing in an Urban Low-Income Neighborhood in Korea: Focused on Gendered Differences.

This study examined negative life changes due to coronavirus disease of 2019 (COVID-19) and its correlates in a sample of community-dwelling older adults from a low-income urban city in Korea, focusing on gendered differences. Negative life changes due to COVID-19 were categorized into four domains: behavioral/physical, psychosocial, goal-seeking, and control/freedom. Being female, not receiving basic livelihood security, and dissatisfaction with housing situation were significantly associated with negative life changes during the pandemic. Gender-stratified analyses revealed that most within-gender social disparities associated with changes due to COVID-19 occurred in older women. The odds of experiencing negative changes were higher among working women and those receiving security income aid. In low-income urban communities, those who were previously socially and economically active perceived more negative changes owing to the pandemic. The contribution of gender to negative life changes should be considered to effectively alleviate concerns among older adults during pandemics.

Geographic variation in breast reconstruction surgery after mastectomy for females with breast cancer in Alberta, Canada.

Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada. Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction. A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively. We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.

Narrowing inequity gap: ERAS home delivery kit

ObjectiveTo enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients. BackgroundThis retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design. MethodsThe study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates. ResultsPost-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation. ConclusionMailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Examining the Relationship Between Immigrant Residential Segregation and Access to Healthcare

ABSTRACT As a result of recent immigration, the United States is becoming more racially and ethnically diverse. Since immigrants have added some new dimensions to the segregation picture within their ethnic/immigrant communities, it is important to understand their travel behaviour. Despite the recent research studies examining access to job opportunities in foreign-born neighborhoods versus U.S.-born neighborhoods, little has been done regarding spatial disparities in access to healthcare facilities. Accordingly, the present study investigates the disparities in the accessibility of Minnesota immigrant neighborhoods to healthcare facilities. Different neighborhoods are therefore distinguished according to their immigrant composition and median household income. The results reveal that compared to White neighborhoods, ethnic/immigrant neighborhoods are more physically accessible. Even so, low-income immigrant neighborhoods tend to have maximum access to healthcare facilities.

Association of Park Renovation With Park Use in New York City

Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities. To evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods. The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement preintervention-postintervention study design with matched control parks. Thirty-three intervention and 21 control neighborhood parks were selected based on specific criteria related to poverty rates, population growth, and population density in park neighborhoods and not having received more than $250 000 in investment in the past 2 decades. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1 year post renovation) between June 5 and December 4 from 2016 to 2022. Participants were individuals observed as users of study parks. The CPI, which involved the redesign and renovation of neighborhood parks by the municipal government of New York City. Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation. A total of 28 322 park users were observed across 1458 scans. At baseline, 6343 of 10 633 users (59.7%) were 20 years or younger, 4927 of 10 632 (46.3%) were female and 5705 (53.7%) were male, and 4641 of 10 605 (43.8%) were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan; P = .002). The association was driven by a significant increase in adult users at intervention parks and overall decrease in all users at control parks. Park users engaging in sitting or standing at intervention parks increased (difference, 4.68 [95% CI, 1.71-7.62] users/scan; P = .002) and park users engaging in walking or vigorous physical activity at control parks decreased (difference, -7.30 [95% CI, -10.80 to -4.26] users/scan; P < .001) over time. In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.

Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents

BackgroundThe BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.MethodsWe first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method.ResultsThirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals.ConclusionsResidents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention.Trial registration#NCT03052959, 10/02/2017.

Estimating Community Disruption from Nighttime Gunshots in 6 U.S. Cities, 2015 to 2021.

Gunshots affect those directly involved in an incident and those in the surrounding community. The community-level impact of nighttime gunshots, which may be particularly disruptive to the sleep of nearby community members, is unknown. Our aim is to estimate the number of people potentially affected by nighttime gunshots and the relationship between nighttime gunshots and median household income in the USA. We collected publicly available data on the timing and location of gunshots in six U.S. cities (Baltimore, MD; Boston, MA; Washington, D.C.; New York, NY; Philadelphia, PA; and Portland, OR) from 2015 to 2021. We then analyzed the data by computing rate ratios (RRs) to compare the frequency of gunshots during nighttime hours (6:00pm to 5:59 am) versus daytime hours (6:00 am to 5:59pm). Additionally, we used geospatial mapping to create choropleth maps to visualize the variation in nighttime gunshot density across cities. We estimated, using city-wide population, person-nights potentially impacted by the sound of gunshots within areas of 0.2- (low) and 0.5-mile (high) radius. Finally, for five of six cities where data on median household income were available by census tract, we built nonlinear regression models to estimate the relationship between the number of nighttime gunshots and median household income. We analyzed 72,236 gunshots. Gunshots were more common during the nighttime than daytime (overall RR = 2.5). Analyses demonstrated that the low estimates for the mean annual number of person-nights impacted by nighttime gunshots were 0.4 million in Baltimore and Portland, 1.3 million in Philadelphia, 1.6 million in Boston, 2.9 million in New York City, and 5.9 million in Washington. The number of nighttime gunshots was inversely related to median household income. Nighttime gunshots are prevalent, particularly in low-income neighborhoods, and may have under-recognized effects on the surrounding community.

A study on analysing sociospatial distribution and equity in access to urban parks in Bengaluru, India

BackgroundGiven the effect of urbanisation on land use, allocation, and implementation of urban green spaces, we attempt to analyse the sociospatial distribution and equity in access to urban parks in Bengaluru, India, also known as the garden city of India. MethodsGeospatial method was used for mapping the park's distribution and measuring the accessibility using road network data. To understand equitable access to the parks, four socioeconomic parameters from 2011 census (ie, population density, children aged 6 years or younger, proxy wealth index, and the Scheduled Caste population) were correlated with the parks' accessibility. FindingsThe spatial distribution revealed that 19 of 198 wards did not have a single park and 36 wards only had one park. About 25–29% of wards did not have accessibility to neighbourhood-level and community-level parks within a 400–800 m distance. These parks must be accessible within walking distance of 400–800 m but were found to most likely be inaccessible in the periphery where population density was low and children population was high in comparison to the central part of the city. Similarly, parks found inaccessible in the eastern part of the city where the scheduled caste population is high, and also found inaccessible to the low-income neighbourhoods residing in the western part and southern periphery of the city, indicating the uneven distribution and inequitable access to public parks. InterpretationOur study proposes reshaping of both neighbourhood parks and community parks, an attempt to look beyond biodiversity. The affirmative actions in terms of availability of public parks with adequate area requirement and essential services at a neighbourhood scale is required to redress the inequity of access. In addition, accessibility to parks must be considered important in urban planning. FundingNone.

Reframing the method: Report on the adaptation of an ethnographic study to virtual collaborative research on mental health in a low-income neighbourhood during the COVID-19 pandemic in Sao Paulo, Brazil

Reframing the method: Report on the adaptation of an ethnographic study to virtual collaborative research on mental health in a low-income neighbourhood during the COVID-19 pandemic in Sao Paulo, Brazil

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

"I Would Have My Children Participate IF …": Perceptions of Canadian Caregivers Towards School Food Programs.

Purpose: The Canadian federal government has expressed an intention to work with provinces and territories to develop a national school food program (SFP). This study aimed to explore caregivers' perception of attributes important to include in a future SFP.Methods: An online cross-sectional survey was conducted. Fifteen elementary schools from high, medium, or low median income neighbourhoods in Saskatoon were invited to participate. School principals sent a survey link to students' caregivers. The 37-item survey included an item with 15 statements asking caregivers to rate the importance of various components of a SFP. Descriptive statistics and exploratory factor analysis were conducted.Results: A total of 510 caregivers completed the survey (response rate of 52%). The factor analysis indicated four key components of a future SFP: (1) learning opportunities on growing and preparing food, (2) offering healthy food following Canada's Food Guide, (3) affordability of the meals offered, and (4) cultural adaptability of the meal program. Over 90% of caregivers thought providing healthy meals and ample time to eat meals to be very important.Conclusion: Our results indicate caregivers support multicomponent meal programs that, along with providing nutritious food, help children build healthy habits and sustainable food systems. These findings will help dietitians understand caregivers' perspectives to inform the design of a national SFP.

Closing the Cycling Gap: Examining Equity Implications of Montreal’s Bikesharing Network Growth

The worldwide growth of bike-sharing systems demonstrates their mass appeal and success. Montreal’s bike-sharing system, BIXI, opened in 2009, is now one of the largest in the world, and has drastically expanded since being taken over by the City of Montreal in 2014. The system now has over 750 stations up from 459 in 2014. This paper analyzes BIXI’s expansion through the lens of equity, revealing how factors including race and income can explain its growth. First, we mapped high-need equity areas that BIXI could have plausibly expanded to, and those that BIXI actually expanded to. We then created a logistic regression model with dissemination areas that gained new access to BIXI as the dependent variable, and income, race, the number of nearby trips, the population count, and the number of bus stops as independent explanatory variables, and controlled for distance from existing stations. Our regression findings demonstrated that race and income were statistically significant in explaining BIXI’s expansion, with a general trend that BIXI was expanding into lower-income neighborhoods and neighborhoods with a greater proportion of visible minorities, as defined by Statistics Canada. Finally, we compared the same explanatory variables in areas that had gained access to BIXI stations, and those in areas that had not but plausibly could have to show the socioeconomic differences in areas gaining new access to service.

Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis

Cognitive decline in people experiencing homelessness is an increasingly recognised issue. We compared the prevalence of dementia among people experiencing homelessness to housed individuals in the general population and those living in low-income neighbourhoods. We conducted a population-based, cross-sectional, comparative analysis using linked health-care administrative data from Ontario, Canada. We included individuals aged 45 years or older on Jan 1, 2019, who visited hospital-based ambulatory care (eg, emergency department), were hospitalised, or visited a community health centre in 2019; and identified people experiencing homelessness if they had one or more health-care records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained as of Dec 31, 2019, using a validated case definition for Alzheimer's disease and related dementia that was modified to include diagnoses made at a community health centre. Poisson models were used to generate estimates of prevalence. Estimates were compared with Ontarians that accessed any of the same health-care services over the same time, overall (general population group), and among those who were in the lowest quintile of area-based neighbourhood income (low-income group). 12 863 people experiencing homelessness, 475 544 people in the low-income comparator group, and 2 273 068 people in the general population comparator group were included in the study. Dementia prevalence was 68·7 per 1000 population among people experiencing homelessness, 62·6 per 1000 population in the low-income group, and 51·0 per 1000 population in the general population group. Descriptively, prevalence ratios between people experiencing homelessness and the comparator groups were highest within the ages of 55-64 years and 65-74 years in both sexes, ranging from 2·98 to 5·00. After adjusting for age, sex, geographical location of residence (urban vs rural), and health conditions associated with dementia, the prevalence ratio of dementia among people experiencing homelessness was 1·71 (95% CI 1·60-1·82) compared with the low-income group and 1·90 (1·79-2·03) compared with the general population group. People experiencing homelessness experience a high burden of dementia compared with housed populations in Ontario. Findings suggest that people experiencing homelessness might experience dementia at younger ages and could benefit from the development of proactive screening and housing interventions. The Public Health Agency of Canada.

Under the banner of heritage conservation: The gentrification of dilapidated low-income neighborhoods in the Daming Palace Protection and Renovation Project

Understanding the dynamics and implications of urban redevelopment projects, particularly in the context of China's rapid urbanization, could inform sustainable and inclusive urban development strategies. This abstract provides an overview of the Daming Palace Protection and Renovation Project (DPPRP). Unlike other redevelopment projects that prioritize economic benefits, the DPPRP is predominantly driven by political interests, with cultural and economic factors playing supporting roles. As part of the broader integrated conservation and redevelopment program, the DPPRP holds political significance, and its implementation demonstrates clear state involvement, led by the local government. The response from residents reflects the failure of China's attempts to promote citizen participation in local governance, suggesting challenges even for participatory authoritarianism. These developments have negative implications for Chinese citizens' pursuit of their right to the city, hindering their ability to shape urban spaces and participate meaningfully in decision-making processes. The purpose of this study is to analyze the Daming Palace Protection and Renovation Project (DPPRP) in China, providing insights for policymakers and urban planners to enhance the effectiveness and inclusivity of urban redevelopment projects.

Defensive Development Against Disinvestment: Early Black Gentrification in the History of Fort Greene, Brooklyn

Studies of early gentrification have largely focused on cases of White gentrifiers in predominately White and Latinx low-income neighborhoods, which has overlooked the role of the Black middle-class and the presence of Black gentrifiers in early gentrification. In this article, we document the role of the Black middle-class in early gentrification in 1970s Fort Greene, Brooklyn, demonstrating their role in a “defensive development” strategy to protect the neighborhood from state-led demolition-style urban renewal. The Fort Greene Landmarks Preservation Committee, a Black, middle-class led coalition of multi-racial, middle-class residents pursued historic designation to preserve the multi-racial and predominately Black, mixed-income neighborhood from further demolition from urban renewal and disinvestment from redlining. Our findings confirm that early Black gentrification, like tract contemporary Black gentrification can both provide temporary protections for the Black community and lead to further gentrification.

Community testing practices for autism within the autism and developmental disabilities monitoring network.

No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. Data are from the Autism and Developmental Disabilities Monitoring Network, a multi-site surveillance system reporting prevalence estimates and characteristics of 8-year-old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. Of 5058 8-year-old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI-R test. Overall, 115 children (2.3%) had both the ADOS and ADI-R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4-66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6-43.2%). Children in low-income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co-occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices.

Accessibility and the ‘everyday mobility–work–household’ triad: an exploration during the COVID-19 crisis in low-income peripheries of Lima and Bogotá

ABSTRACT How do people make decisions on where, when, and how to commute? And how did the pandemic crisis affect their commuting patterns? Based on exploratory interviews in Lima and family chronicles collected in Bogotá during 2020; and a second round of interviews in six low-income areas in the peripheries of these two cities during 2021, this article offers a panoramic view of the changes experienced in low-income neighbourhoods and their families during these recent years of pandemic. These changes bring to light the role of intra-household arrangements regarding mobility and accessibility. We suggest that mobility and accessibility can better be understood on a more systemic level (influenced by intra-household arrangements), as a collective phenomenon (based on the household’s resources and the household’s needs), and even as a collective decision-making process.