Low Socioeconomic Status Neighborhoods Research Articles

Lung Cancer Screening Penetration in an Urban Underserved County

To compare residential geography, sex, socioeconomic status (SES), and race/ethnicity of patients screened at Montefiore's Lung Cancer Screening Program with those of patients diagnosed with lung cancer, assessing whether screening efforts are appropriately focused. This retrospective cohort study involved patients within a multisite urban medical center undergoing lung cancer screening or diagnosed with lung cancer from January 1, 2015 to December 31, 2019. Inclusion criteria were residence within the Bronx, NY and age between 55 and 80years. Institutional review board approval was obtained. Data were analyzed using the Wilcoxon two-sample t test and χ2. The cohorts comprised 1568 (50.3%) women and 1551 (49.7%) men (mean age 65.6 ± 6.16). The Southeast Bronx had the most diagnosed lung cancers (29.96%) and screenings (31.22%). Sex did not significantly differ (p = 0.053). Cancer and screening cohorts were from impoverished neighborhoods with mean SES of -3.11 ± 2.78 and -3.44 ± 2.80 (p < 0.01). The lower tier SES neighborhoods demonstrated more patients in the screening cohort than cancer cohort (p = 0.01). Both cohorts included a majority of Hispanic patients, although race/ethnicity differed significantly (p = 0.01). Lower SES neighborhoods showed no significant difference in race/ethnicity between cancer and screening cohorts (p = 0.262). Though statistically significant differences were found between cohorts, likely due to sample size, few clinically meaningful differences were found, implying our lung cancer screening program was effective in reaching the desired population. Demographics-based programs should be considered in global efforts to screen vulnerable populations.

First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods

Introduction First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. Methods We linked the 2014–2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. Results We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22–0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65–0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61–0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17–0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10–0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. Conclusion While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.

Abstract PD1-03: Neighborhood deprivation and breast cancer mortality among Black and White women

Abstract Background: Neighborhood deprivation is hypothesized as a potential driver of racial disparities in breast cancer mortality. However, research shows that neighborhood deprivation is associated with increased breast cancer mortality among White women, but has little to no association among Black women. No study has previously considered the intersections of race, social cohesion, or urban/rural status in the association between neighborhood deprivation and breast cancer mortality. Methods: Neighborhood deprivation was examined in relation to breast cancer mortality among 31,358 non-Hispanic Black and non-Hispanic White women diagnosed with invasive breast cancer (stage I-IIIA) between 2010-2017, followed through 2019, and identified by the Georgia Cancer Registry. Two composite scores, the Area Deprivation Index (ADI) and neighborhood deprivation index (NDI), were used to characterize neighborhood deprivation. A third composite score, the Yost index, was assessed as a measure of neighborhood socioeconomic status (SES). Each composite score was composed of factors representing six domains: poverty, income, occupation, housing, employment, and education. Data on ADI were obtained from the Neighborhood Atlas and was assessed in deciles. American Community Survey data from 2011-2015 and principal components analysis were used to derive the NDI and Yost index. Both measures were assessed in quartiles. Each composite variable was measured at the block group level and linked to patient data. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between each composite variable and breast cancer mortality, overall and by race/ethnicity. Intersectionality will be examined by considering the joint effects of race/ethnicity, social cohesion, and urban/rural status. Results: During the 9-year follow-up period, 2,353 (1,347 non-Hispanic White, 1,006 non-Hispanic Black) women died from breast cancer. Regardless of which composite score was assessed, living in the most deprived or lowest SES neighborhoods was associated with an increased risk of breast cancer mortality in models adjusted for age and race (ADI decile 10 vs. 1: HR=1.57, 95% CI 1.26-1.96; NDI quartile 4 vs. 1: HR=1.43, 95% CI 1.26-1.63; Yost index quartile 1 vs 4: HR= 1.34, 95% CI 1.18-1.51). Stratification by race/ethnicity showed associations were slightly stronger among non-Hispanic White women but null among non-Hispanic Black women. Results from analyses examining the joint effects of race/ethnicity, social cohesion, and urban/rural status are forthcoming and will be presented in December. Conclusions: Consistent with previous studies, our study found that living in a deprived neighborhood may increase breast cancer mortality among non-Hispanic White women, but not non-Hispanic Black women. Investigating the association with an intersectionality framework may help identify subgroups of women who are particularly susceptible to the adverse impact of neighborhood deprivation on breast cancer mortality. Citation Format: Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Maret L. Maliniak, Leah Moubadder, Jeffrey Switchenko, Lauren E. McCullough. Neighborhood deprivation and breast cancer mortality among Black and White women [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-03.

Abstract P236: Neighborhood Socioeconomic Status and Functional Status Impairment in Late-Life: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity. Hypothesis: Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity. Methods: We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score&lt;4) during the 2016 annual telephone interview. Multivariable logistic regression was used to examine the association between NSES tertiles and functional status impairment adjusting for age, race, ARIC center, and sex. We tested for effect modification by AHA-defined physical activity (categorized as poor, intermediate, ideal based on weekly minutes of moderate-to-vigorous physical activity). We also tested for effect modification by sex, race, and age. Results: Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65). Conclusions: Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.

Abstract P253: Neighborhood Socioeconomic Status and Psychosocial Health Among Asian Americans Adults in New York City

Introduction: Social determinants of health, including one’s neighborhood environment, are a fundamental cause of health inequities. Low neighborhood socioeconomic status (NSES) is associated with adverse psychosocial and physical health profiles, yet limited data exists among Asian Americans. Our study aim was to determine the association between NSES with depressive symptoms and psychological distress among Asian American adults in New York City (NYC). Methods: The NYC Community Health Survey (CHS) is a population based annual telephone survey used to track the health of NYC residents. It is conducted in five languages including Mandarin and Cantonese. Data are weighted to be representative of NYC as a whole. Our sample included data from 4,557 Asian American participants of the 2017-2020 CHS cycles who were geolinked to their respective neighborhoods, conceptualized as the community district (CD). From publically available CD profiles, we constructed a NSES factor score from four indicators: proportion of the CD unemployed, in poverty, with a high rent burden, and with less than a high school education. Psychosocial health was measured using the Kessler-6 (K6) for nonspecific psychological distress and the 8-item Patient Health Questionnaire (PHQ8) for depressive symptoms, with higher scores indicating worse psychosocial health. We used hierarchical linear models to determine the association between NSES tertile with outcomes stratified by Asian sub-group or region (Chinese, Indian subcontinent, or other Asian). Models were adjusted for individual level age, sex, income, and education. All analyses accounted for the complex survey design of the CHS. Results: Among NYC Asian American residents, 52.1% were women, 45% were age 25-44 years, 25% had less than a high school education, and 56% lived below 200% of the federal poverty level. Among Chinese residents of NYC, living in a neighborhood of low compared with high NSES, was associated with lower PH8 score (beta: -0.65, 95% CI: -1.10, -0.19). Among residents of NYC with heritage from the Indian subcontinent, living in a neighborhood of low compared with high NSES, was associated with a higher K6 score (beta: 1.27, 95% CI: 0.59, 1.95). Associations were not significant among other Asians or for other outcomes. Conclusion: Our results indicate a heterogeneous association between NSES with psychosocial health among Asian Americans of NYC, persisting beyond individual-level SES. Low NSES was associated with adverse psychosocial health among Asians from the Indian subcontinent but better psychosocial health among Chinese Americans. Further examination into potential sources of resilience such as social cohesion, for Chinese American residents residing in low resourced neighborhoods, is warranted.

Neighborhood Socioeconomic Status and Racial and Ethnic Survival Disparities in Oral Cavity and Laryngeal Cancer.

Oral cavity cancer (OCC) and laryngeal cancer are among the most common cancers worldwide. This study investigated survival in non-Hispanic (NH) Black, NH White, Asian, and Hispanic patients with OCC and laryngeal cancer of low, intermediate, and high neighborhood socioeconomic status (nSES). We used data from the SEER 18 Census Tract-level SES and Rurality Database of the National Cancer Institute to create cohorts of OCC and laryngeal cancer patients from 2013 to 2018. Univariate survival analysis was performed with Kaplan-Meier curves and log-rank P values by nSES and then the cross-classification of race, ethnicity, and nSES. We used Cox proportional hazards regression model for multivariable analysis. Higher nSES was associated with better OCC survival for NH White, NH Black, and Asian patients, and better laryngeal cancer survival for NH White, NH Black, Hispanic, and Asian patients. In the multivariable analyses of both OCC and laryngeal cancer survival, NH Black patients had worse survival than NH White patients in the high nSES tertile. NH Black patients with OCC were at higher risk of death than NH White patients at all nSES levels. Conversely, Asian patients with laryngeal cancer demonstrated better survival than other races within the high nSES. Overall survival differs between racial and ethnic groups of similar nSESs. These health disparities in patients with OCC and laryngeal cancer reflect broader inequities in the cancer control continuum. The cross-classification of race, ethnicity, and nSES revealed disparities in the 5-year overall survival of patients with OCC and laryngeal cancer and highlights the importance of intersectionality in the discussion of health equity.

Does Neighborhood Crime Mediate the Relationship Between Neighborhood Socioeconomic Status and Birth Outcomes? An Application of the Mediational G-Formula.

While the link between living in a low-socioeconomic status (SES) neighborhood and higher risk of adverse birth outcomes has been well established, the underlying mechanisms remain poorly understood. Using the parametric g-formula, we assessed the role of neighborhood crime as a potential mediator of the relationship between neighborhood SES and birth outcomes using data on singleton births occurring in the Netherlands between 2010 and 2017 (n=1,219,470). We estimated total and mediated effects of neighborhood SES on small-for-gestational-age (SGA) birth, low birth weight (LBW), and preterm birth (PTB) for 3 types of crime (violent crimes, crimes against property, and crimes against public order). The g-formula intervention settings corresponded to a hypothetical improvement in neighborhood SES. A hypothetical improvement in neighborhood SES resulted in a 6.6% (95% CI: 5.6, 7.5) reduction in the proportion of SGA birth, a 9.1% (95% CI: 7.6, 10.6) reduction in LBW, and a 5.8% (95% CI: 5.7, 6.2) decrease in PTB. Neighborhood crime jointly accounted for 28.1% and 8.6% of the total effects on SGA birth and LBW, respectively. For PTB, we found no evidence of mediation. The most relevant pathways were crimes against property and crimes against public order. The results indicate that neighborhood crime mediates a meaningful share of the relationship between neighborhood SES and birth outcomes.

Association Between Neighborhood Socioeconomic Status and 30-Day Mortality and Readmission for Patients With Common Neurologic Conditions.

Patients of low individual socioeconomic status (SES) are at a greater risk of unfavorable health outcomes. However, the association between neighborhood socioeconomic deprivation and health outcomes for patients with neurologic disorders has not been studied at the population level. Our objective was to determine the association between neighborhood socioeconomic deprivation and 30-day mortality and readmission after hospitalization for various neurologic conditions. This was a retrospective study of nationwide Medicare claims from 2017 to 2019. We included patients older than 65 years hospitalized for the following broad categories based on diagnosis-related groups (DRGs): multiple sclerosis and cerebellar ataxia (DRG 058-060); stroke (061-072); degenerative nervous system disorders (056-057); epilepsy (100-101); traumatic coma (082-087), and nontraumatic coma (080-081). The exposure of interest was neighborhood SES, measured by the area deprivation index (ADI), which uses socioeconomic indicators, such as educational attainment, unemployment, infrastructure access, and income, to estimate area-level socioeconomic deprivation at the level of census block groups. Patients were grouped into high, middle, and low neighborhood-level SES based on ADI percentiles. Adjustment covariates included age, comorbidity burden, race/ethnicity, individual SES, and sex. After exclusions, 905,784 patients were included in the mortality analysis and 915,993 were included in the readmission analysis. After adjustment for age, sex, race/ethnicity, comorbidity burden, and individual SES, patients from low SES neighborhoods had higher 30-day mortality rates compared with patients from high SES neighborhoods for all disease categories except for multiple sclerosis: magnitudes of the effect ranged from an adjusted odds ratio of 2.46 (95% CI 1.60-3.78) for the nontraumatic coma group to 1.23 (95% CI 1.19-1.28) for the stroke group. After adjustment, no significant differences in readmission rates were observed for any of the groups. Neighborhood SES is strongly associated with 30-day mortality for many common neurologic conditions even after accounting for baseline comorbidity burden and individual SES. Strategies to improve health equity should explicitly consider the effect of neighborhood environments on health outcomes.

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1- to 2-Level Lumbar Fusion.

Retrospective Case-Control Study. The objectives were to determine whether patients from poor social determinants of health, undergoing primary 1- to 2-level lumbar fusion, demonstrate differences in (1) medical complications, (2) emergency department (ED) utilizations, (3) readmission rates, and (4) costs of care. Measures of socioeconomic disadvantage may enable improved targeting and prevention of potentially increased health care utilization. The Area Deprivation Index (ADI) is a validated index of 17 census-based markers of material deprivation and poverty. A retrospective query of the 2010-2020 PearlDiver database was performed for primary 1- to 2-level lumbar fusions for degenerative lumbar pathology. High ADI (scale: 0-100) is associated with a greater disadvantage. Patients with high ADI (90%+) were 1:1 propensity score matched to controls (ADI: 0-89%) by age, sex, and Elixhauser Comorbidity Index. This yielded 34,442 patients, evenly matched between cohorts. Primary outcomes were to compare 90-day complications, ED utilizations, readmissions, and costs of care. Multivariable logistic regression models computed the odds ratios (OR) of ADI on complications, ED utilizations, and readmissions. P -values <0.05 were significant. Patients with a high ADI incurred higher rates and odds of developing respiratory failures (1.17% vs. 0.87%; OR: 1.35, P =0.005). Acute kidney injuries (2.61% vs. 2.29%; OR: 1.14, P =0.056), deep venous thromboses (0.19% vs. 0.17%; OR: 1.14, P =0.611), cerebrovascular accidents (1.29% vs. 1.31%; OR: 0.99, P =0.886), and total medical complications (23.35% vs. 22.93%; OR: 1.02, P =0.441) were similar between groups. High ADI patients experienced higher rates and odds of ED visits within 90 days (9.67% vs. 8.91%; OR: 1.10, P =0.014) and overall 90-day expenditures ($54,459 vs. $47,044; P <0.001). Socioeconomically disadvantaged patients have increased rates and odds of respiratory failure within 90 days. ED utilization within 90 days of surgery was higher in socioeconomically disadvantaged patients. Social determinants of health could be used to inform health care policy and improve postdischarge care. Level III.

A longitudinal study of protective factors against substance use in early adolescence. An ecological approach.

Adolescent substance use has been widely related to different individual, school, family and community factors. Yet, the number of studies with all these variables together in a model from an ecological perspective is still low, and they rarely used a longitudinal design. The aim of this study was to explore, from an ecological perspective, the prospective impact of different individual, school, family and neighbourhood factors on adolescent substance use. This was a longitudinal study with a one-year follow up. There were 881 participants (Mage=12.57; 48.1% females) at wave 1, of which 686 (Mage=13.51; 51.8% females) were followed-up at wave 2. Validated questionnaires were used for data collection. Regression analyses showed that higher substance use was predicted by high family socio-economic status cross-sectionally and longitudinally, and it was related to low neighbourhood socio-economic status cross-sectionally only. Participants who disliked school and had a poor academic performance were more likely to use substances, both cross-sectionally and longitudinally. The inclusion of families in substance use prevention programmes could be a key component in these interventions. Moreover, promotion of a positive school climate could protect adolescents from using substances.

Does the Internet Moderate the Neighborhood Effect? Internet Use, Neighborhoods, and Mental Health among Older Adults in Shanghai.

Internet use may reduce the impact of the neighborhood on residents' well-being by helping people utilize resources beyond their immediate neighborhoods or strengthen neighborhood influences by widening the digital divide across neighborhoods. This study investigates how internet use moderates neighborhood effects on mental health among older adults in Shanghai. Using data from the Shanghai Urban Neighborhood Survey (SUNS) and population census, hierarchical linear models reveal that older adults who more frequently use the internet report lower levels of mental distress. Internet use attenuates the negative effects of living in low-socioeconomic status (SES) neighborhoods. We also examine the roles of three types of internet use: social networking, leisure, and information seeking. The results show that only social networking and leisure internet use are significantly associated with improved mental health among older adults. The results suggest that social programs are needed to increase internet literacy among older adults to promote active aging, and priority should be given to relatively disadvantaged neighborhoods.

"Hard-To-Reach" or Hardly Reaching? Critical Reflections on Engaging Diverse Residents From Low Socio-Economic Status Neighborhoods in Public Health Research.

HINTS AND KINKS Int J Public Health, 05 January 2023 https://doi.org/10.3389/ijph.2022.1605296

Neighborhood socioeconomic differences in BMI: The role of fast-food outlets and physical activity facilities.

The goal of this study was to investigate the association between neighborhood socioeconomic status (NSES) and BMI and to what extent this association is moderated by availability of fast-food (FF) outlets and pay-for-use physical activity (PA) facilities. Baseline data of adults in Lifelines (N=146,629) were linked to Statistics Netherlands and a register using geocoding to compute, respectively, NSES (i.e., low, middle, high) and the number of FF outlets and PA facilities within 1km of the residential address. Multivariable multilevel linear regression analyses were performed to examine the association between NSES and BMI. Two-way and three-way interaction terms were tested to examine moderation by FF outlets and PA facilities. Participants living in low NSES areas had a higher BMI than participants living in high (B [95% CI]: 0.76 [0.65 to 0.87]) or middle NSES areas (B [95% CI]: 0.40 [0.28 to 0.51]), independent of individual socioeconomic status. Although two- and three-way interactions between NSES, FF outlets, and PA facilities were significant, stratified analyses did not show consistent moderation patterns. People living in lower NSES areas had a higher BMI, independent of their individual socioeconomic status. The study found no clear moderation of FF outlets and PA facilities. Environmental factors that may mitigate NSES differences in BMI should be the subject of future research.

RESILIENCY AMONG WHI WOMEN IN THE 80+ COHORT BY RACE AND NEIGHBORHOOD SOCIOECONOMIC STATUS

Abstract Resilience, an individual’s ability to successfully adapt to adversity, is a multifaceted outcome that may be affected by individual and community factors. A comprehensive examination of resilience by race and neighborhood socioeconomic status (NSES) among women aged 80+ is needed to better understand longevity in diverse populations. Women aged 80+ in 2011, in the Women’s Health Initiative (WHI) study were included. Resilience was measured using the 3-item Brief Resilience Scale, with higher scores indicating better resiliency. Descriptive statistics and multivariable linear regression examined the association of demographic, psychosocial, and health variables with resilience by race (White, Black, Asian) and NSES. The majority of participants (n=29,367, median age=84.0) were non-Hispanic White (91.4%), and had multimorbidities (66%). There were no significant differences by race on mean resiliency scores (p=0.06). Mean resilience was higher among women with higher NSES (low NSES=3.94±0.83, moderate NSES=3.95±0.82, high NSES=4.00±0.81; p&amp;lt; 0.001). Optimism (p&amp;lt; 0.001), social support (p&amp;lt; 0.01), and physical/mental symptom burden (p&amp;lt; 0.05) were significant correlates of resilience among Asian, Black, and White women. Self-rated health (p&amp;lt; 0.001), depressive symptoms (p&amp;lt; 0.001), optimism (p&amp;lt; 0.001), social support (p&amp;lt; 0.001), physical/mental symptom burden (p&amp;lt; 0.001), and body mass index (p&amp;lt; 0.001) were significant correlates of resilience across women with low, moderate, and high NSES. Age was significantly associated with resilience among women with moderate (β=-0.004, p=0.019) and high NSES (β=-0.005, p=0.045). This study found several common correlates of resilience across race and NSES among women aged 80+ in the WHI. Future research to enhance resilience, such as through psychosocial and behavioral interventions, is warranted.

Analysis of secondary school students’ academic performance and parental involvement in children education at home

Introduction. Parental involvement in children’s education means engagement and participation of parents in the educational activities of their children. The existing body of empirical research shows that parental involvement can influence academic performance of their children in two distinct ways, i.e. parental involvement in children education at home (helping children in homework and other academic discussions, etc.) and parental involvement in children education at school (participation in school function and meetings, etc.). Active involvement of parents in children’s education may even counterbalance the unfavourable effects of low socioeconomic status and underprivileged neighborhood. The overall effect of parental involvement in child education both at home and at school is a worthy source of improving the academic performance of children through securing higher grades at school.Aim. This research aimed to examine the effects of parental involvement in children education at home on academic performance of secondary schools students and to identify the difference of the effects of parental involvement on students of different gender, parent literacy status and parent importance to children education.Methodology and research methods. Cross sectional and a multistage stratified sampling technique was adopted to portray information from sample of 448 students on Likert scale. Chi square, Kendall’s Tau-c tests and Logistic regression analyses were used to determine the level, direction and strength of association among variables.Results. The results showed that the association of children academic performance was significant and positive when parents helped children with their homework (P = 0.000, Tc = 0.231), discussed school progress with children (P = 0.002, Tc = 0.122) and motivated children to work harder when they make a poor grade (P = 0.015, Tc = 0.133). Moreover, the results highlighted variation in the academic performance of children with respect to their gender, parental literacy status, parental importance to children education and parental involvement in children education at home. It was concluded that boys, children of literate parents, children whose parents give more importance to their education and their parents remain involved in their educational activities at home secured higher grades.Scientific novelty. The present study is distinctive in that it examined variations in children’s academic performance with respect to student gender, parental literacy status, and parental importance to their education in addition to focusing on the relationship between parental involvement in their children education at home and academic performance.Practical significance. The analysis of the research outcomes leads to several interesting results and proposes helpful suggestions for important stakeholders. The main study recommendations that will enable parents to promptly meet the educational demands of their children in order to aid them in getting better grades include awareness-raising campaigns for parents, income creation chances for disadvantaged families, and adult literacy initiatives.

Does neighbourhood crime mediate the relationship between neighbourhood SES and birth outcomes?

Abstract Background Previous studies have consistently found that women living in low socioeconomic status (SES) neighbourhoods are at higher risk of experiencing adverse birth outcomes compared to women from high SES areas. However, the mechanisms through which neighbourhood SES might influence health at birth remain poorly understood. One of the proposed pathways is the exposure to higher crime rates. The aim of this study is to investigate whether neighbourhood crime mediates the relationship between neighbourhood SES and birth outcomes. Methods A retrospective cohort study including over 1.3 million singleton births occurred in the Netherlands between 2010 and 2017. Individual-level data from the Dutch perinatal registry was linked to quintiles of neighbourhood SES scores and neighbourhood-level crime rates. Using the mediational g-formula, we estimated the total effect, natural direct effect, and natural indirect effect of neighbourhood SES on birth outcomes: small-for-gestational-age (SGA), low birth weight, and preterm birth. The neighbourhood SES intervention settings correspond with a hypothetical improvement in neighbourhood SES from the lowest to the highest quintile. Results The hypothetical improvement in neighbourhood SES resulted in a 6.6% (CI = 5.6%; 7.5%) relative reduction in the proportion of SGA births, an 8.9% (CI = 7.6%; 10.3%) reduction in the proportion of low birth weight, and a 5.1% (CI = 4.0%; 6.1%) decrease of preterm birth. Neighbourhood crime accounted for 29.0% (CI = 25.1%; 32.8%) of the total effect of neighbourhood SES on SGA, and for 8.6% (CI = 5.1%; 11.6%) of the total effect on low birth weight. For preterm birth, we found no evidence of mediation by neighbourhood crime. Conclusions Neighbourhood crime mediates the association between neighbourhood SES and key adverse birth outcomes. Interventions targeted at lowering neighbourhood crime rates could improve birth outcomes in disadvantaged areas. Key messages

Policies to reduce availability of tobacco products in the retail environment

Abstract Background After implementation of a tobacco vending machine ban in 2022 and a supermarket sales ban in 2024, the Dutch government intends to further phase out tobacco sales after 2030 by prohibiting sales in petrol stations and small outlets. This study aims to understand 1) the impact of these policies on tobacco outlet availability, and 2) differences in tobacco outlet availability by area socioeconomic status (SES) in the Netherlands. Methods Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) were visited and mapped using Global Positioning System (GPS). Expected reductions in tobacco outlet availability were calculated per policy measure. Tobacco outlet density was calculated using ESRI ArcMap version 10.4.1. The association between neighbourhood SES and tobacco outlet availability was estimated with linear and logistic regression model. Results We identified 870 tobacco outlets and an outlet density of 6.2/10.000 capita. The potential sales bans in petrol stations and small outlets would reduce the number of outlets (resp. -7% and -43%) and the outlet density (resp. -0.4 and -2.7). In Eindhoven, Haarlem, and Zwolle, neighbourhoods with high-SES compared to low-SES were less likely to contain a tobacco outlet (OR:0.71, 95%CI:0.59-0.85) and had a lower outlet density (ß:-1.20, 95%CI:-2.20;-0.20). In Amsterdam, the associations were inverse (OR:1.22, 95%CI:1.05-1.40; ß:3.50, 95%CI:0.81;6.20). Conclusions The availability of tobacco outlets varies within and between cities depending on the distribution of the built environment. Future tobacco control policies targeting the retail environment should focus on limiting the overall number tobacco outlets and especially small outlets, which may benefit low SES neighbourhoods in mid-sized cities most.

Resident racial and ethnic composition, neighborhood-level socioeconomic status, and COVID-19 infections in California SNFs.

In California, >29,000 residents in skilled nursing facility (SNFs) were diagnosed with novel coronavirus disease 2019 (COVID-19) between March 2020 and November 2020. Prior research suggests that SNFs serving racially and ethnically minoritized residents often have fewer resources and lower quality of care. We performed a cross-sectional analysis of COVID-19 incidence among residents in California SNFs, assessing the association of SNF-level racial and ethnic compositions and facility- and neighborhood-level (census tract- and county-level) indicators of socioeconomic status (SES). SNFs were grouped based on racial and ethnic composition using data from the Centers for Medicare and Medicaid Services; categories included SNFs with ≥88% White residents, SNFs with ≥32% Black or Latinx residents, SNFs with ≥32% Asian residents, or SNFs not serving a high proportion of any racial and ethnic composition (mixed). SNF resident-level COVID-19 infection data were obtained from the National Healthcare Safety Network from May 25, 2020 to August 16, 2020. Multilevel mixed-effects negative binomial regressions were used to estimate incidence rate ratios (IRR) for confirmed COVID-19 infections among residents. Among 971 SNFs included in our sample, 119 (12.3%) had ≥88% White residents; 215 (22.1%) had ≥32% Black or Latinx residents; 78 (8.0%) had ≥32% Asian residents; and 559 (57.6%) were racially and ethnically mixed. After adjusting for confounders, SNFs with ≥32% Black or Latinx residents (IRR=2.40 [95% CI=1.56, 3.68]) and SNFs with mixed racial and ethnic composition (IRR=2.12 [95% CI=1.49, 3.03]) both had higher COVID-19 incidence rates than SNFs with ≥88% White residents. COVID-19 incidence rates were also found to be higher in SNFs with low SES neighborhoods compared to those in high SES neighborhoods. Public health personnel should consider SNF- and neighborhood-level factors when identifying facilities to prioritize for COVID-19 outbreak prevention and control.

Associations of greenness, public parks, and blue space with cardiovascular and respiratory disease hospitalization in the US Medicare cohort

Background and Aim: Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. Our aim was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (~63 million individuals). Methods: Our open cohort included all fee-for-service Medicare beneficiaries (2000-2016), aged &amp;#x2265;65, living in the contiguous U.S. We assessed zip code-level average greenness (Normalized Difference Vegetation Index, NDVI), public park cover based on the United States Geological Survey Protected Areas Database, and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (&amp;#x2265;1000 persons/mile2). Results: NDVI was weakly negatively correlated with percent public park cover (Spearman ρ = -0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, an IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). Percent public park cover was not associated with CVD or RSD hospitalization in the full or urban population. In stratified analyses, percent public park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. Conclusions: This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.

Individual and neighborhood socioeconomic status and long-term individual trajectories of sleep duration among Black and White adults: the Southern Community Cohort Study.

Sleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults. This study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression. Both Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups. Lower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns.