low-SES Areas Research Articles

Estimated daily intake and health risk assessment of total and organic selenium in crops across areas with different selenium levels

BackgroundThe health risk of Se has gained significant attention. Previous studies mainly focused on the health risk of total Se in high-Se area. Less attention has been paid to the health risk of organic selenium in areas with varying selenium levels. MethodsA total number of 109 crop samples (edible parts) were collected in Langao County, Shannxi Province, China from 2018 to 2020, including 42 corn, 18 rice, 9 sweet potato, 25 potato, 12 radish, and 3 eggplant samples. The hydride generation atomic fluorescence spectrometry (HG-AFS) method was used to determine the total and organic Se contents. Result and conclusion(1) Corn (2.82 mg/kg), rice (0.44 mg/kg), potato (6.56 mg/kg), and eggplant (0.77 mg/kg) in high-Se area, as well as sweet potato (1.07 mg/kg) and radish (4.28 mg/kg) in medium-Se area, exhibited the highest total Se content among all crops in this county, and 5–328 times higher than the values of Se-enriched standard (2) The average daily intake of total/organic Se of residents in high-Se area reached 676/449 μg/day, which was 1–4 times higher than levels observed in medium-Se area (419/257 μg/day) and low-Se area (196/128 μg/day). The organic Se daily intakes from dietary combinations of rice + radish and rice + eggplant in high-Se area lower than 400 μg/day, which could be safely consumed. The organic Se daily intakes from dietary combinations of sweet potato + radish and sweet + eggplant in medium-Se area higher than 400 μg/day, which could not be safely consumed. The total / organic Se daily intakes of all dietary combinations in low-Se area lower than 400 μg/day, which could be safely consumed. (3) The health risk associated with crops might be overestimated due to the higher non-carcinogenic risk attributed to total Se compared to organic Se. The present study demonstrated that daily intake and health risk of total and organic Se in crops across areas with different Se levels varied significantly.

Socioeconomic disparities and green space associated with myopia among Chinese school-aged students: A population-based cohort study.

There is increasing evidence on the link between environmental factors and myopia in children and adolescents, yet with inconsistent conclusions. We investigated the associations between socioeconomic inequalities and green space with myopia in school-aged students participating in the Tianjin Child and Adolescent Research of Eye (TCARE) study. We obtained data from a population-based dynamic cohort study conducted in Tianjin, China, in 2021 and followed up in 2022. We included 1 245 271 participants from 16 districts with an average age of 11.6 years (standard deviation = 3.3) in our analysis. We synthesized their area-level SES through a prediction model that combined economic, educational, and health care variables and assessed the greenness levels surrounding the school using the Normalized Difference Vegetation Index (NDVI) based on data obtained through satellite remote sensing. We performed generalised linear mixed effects analyses for each myopia outcome separately, with adjustments for students' sex, years of education completed, and the school's geographical location. We observed that students living in low SES areas had the highest prevalence of myopia (60.7%) in the last screening in 2022, as well as a higher incidence of one-year myopia (26.4%) compared to those residing in middle SES areas (22.7%). With a 0.1 increase in the 250, 500, and 1000 m buffer NDVI, the prevalence of myopia dropped by 6.3% (odds ratio (OR) = 0.937; 95% confidence interval (CI) = 0.915, 0.960), 7.7% (OR = 0.923; 95% CI = 0.900, 0.946), and 8.7% (OR = 0.913; 95% CI = 0.889, 0.937), respectively. The interaction analysis showed that low SES and low greenness exacerbate the prevalence of myopia. Findings from longitudinal analyses consistently demonstrated a correlation between higher values of NDVI and a slower progression of myopia. These findings remained robust across sensitivity analyses, including for variables on parental myopia and students' behaviors. Exposure to green spaces could play a crucial role in slowing the progression of myopia among school-aged students. Myopia control policies should prioritise young populations residing in low SES areas with limited access to green spaces, as they face the highest potential risks.

Early environments and exploration in the preschool years.

A great deal of research has demonstrated how children's exploration is driven by opportunities for learning. However, less work has investigated how individual differences across children and their environmental contexts relate to patterns in playful exploration. We performed a "mega-analysis" in which we pooled preschool-aged children's play data from four past experiments in our lab (N = 278; M(age) = 56 months) and correlated play behaviors with age and socioeconomic status (median income, modal education in children's home zip codes). We found that, with age, children performed more unique actions during play. Additionally, children from lower SES areas explored more variably; the link between this play and tendencies to focus on pedagogically demonstrated features traded off differently than it did for higher SES children. This work lays critical groundwork for understanding exploration across developmental contexts.

Impact of Socioeconomic Factors on Time to Surgery for Distal Radius Fractures.

Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius fracture (DRF) fixation may improve outcomes while reducing cost. The purpose of this study is to investigate the effect of SES on time to surgery in our study population. Patients undergoing outpatient DRF surgery within an academic healthcare system during a 4-year period were reviewed. Time to surgery and demographic factors were analyzed. The US Census Bureau was used to determine median household income (MHI) for a patient's ZIP code; patients were stratified into three groups based on MHI. A total of 413 patients met inclusion criteria. SES (14.7 d in the low-SES group, 14.0 d in the mid-SES group, and 11.1 d in the high-SES group, P = 0.00063), insurance (11.7 d for insured versus 16.3 d for Medicaid/uninsured, P < 0.0001), race (non-White group: 15.2 d versus White group: 10.9 d, P < 0.0001), and treatment facility (16.2 d at county hospital versus 10.9 d at university hospital, P < 0.0001) were associated with time to surgery in univariate analysis. Multivariate analysis found that only treatment facility was associated with time to surgery. Non-White, uninsured/Medicaid individuals residing in low-SES areas may be more likely to receive care at a safety-net facility and are at greatest risk for delay in time to surgery. Measures aimed to reduce barriers to care, increase healthcare coverage, and improve patient education should be initiated to mitigate these disparities.

Longitudinal gambling risk transitions: evidence from a nationally representative Australian sample

Aims Problem gambling has downstream consequences on individuals, families and the community. While a strong research base now exists on predictors and outcomes of problem gambling risk and severity, few studies have examined the transitions in gambling risk status over time, and factors associated with these transitions. Methods The current study addresses this knowledge gap by examining gambling transitions using two waves of longitudinal, population-representative Australian data (N = 12,364) collected in 2015 and 2018. Focal to our approach is the assessment of predictors of gambling risk status including demographics, and key psychosocial factors that might attenuate the risk of transition into more severe gambling. Results The results show significant stability in gambling risk over time, particularly among individuals who reported no or low gambling risk. Gambling risk transitions were more likely to occur toward less severe than more severe levels of gambling. Furthermore, gambling problems tended to persist in more severe levels of gambling risk. Financial hardship, younger age, male gender, experience of hardship, lower levels of educational attainment, chronic health conditions, risky levels of alcohol consumption, living in low SES areas, and low sense of mastery were associated with transitions from low to more severe gambling over the three-year period. There were no significant predictors of transitions to lower levels of gambling risk in the current data. Conclusions Our findings can help inform public health interventions by better targeting individuals at elevated risk for more severe gambling over time, and we outline a method for analyzing transitions in longitudinal datasets that can be applied in future studies in addiction.

Evaluation of an early childhood caries preventive programme starting during pregnancy-Results after 3 and 6 years.

Early childhood caries (ECC) has been found to be up to five times more common among children living in areas of low socio-economic status (SES) than among children in areas of higher SES. To evaluate an ECC prevention programme from pregnancy to 3 and 6 years of age. A prospective, controlled, intervention cohort study was initiated in 2013 in a low-SES area in Sweden. The intervention group received an individual interdisciplinary ECC prevention programme starting pre-birth, consisting of supportive oral health-promoting talks using motivational interviewing techniques and individual ECC preventive actions. A control group, consisting of pregnant women living in a comparable area, received ordinary routines. Of the 336 pregnant women, 64 mothers (with 64 children) completed the programme, and 394 children were born in the control group. At the sixth year examination, the proportion of children with no caries was similar between the groups (53% resp. 52%, p = .976), whereas the proportion with decayed, missed, filled primary teeth (dmft = 1-5) was slightly lower (23% resp. 36%, p = .063), and the proportion with severe caries disease (dmft > 5) was higher (p = .013) in the intervention group (25%) than in the control group (12%). No preventive effect regarding caries can be demonstrated at sixth year of age. Maternal behavioural change in dental care was not sufficient to even out inequalities in oral health in children, eventually due to difficulties in reaching the target group and the lack of effects among the families reached.

Ambient air pollutants and breast cancer stage in Tehran, Iran

This study aimed to examine the impacts of single and multiple air pollutants (AP) on the severity of breast cancer (BC). Data of 1148 diagnosed BC cases (2008–2016) were obtained from the Cancer Research Center and private oncologist offices in Tehran, Iran. Ambient PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene, and BTEX data were obtained from previously developed land use regression models. Associations between pollutants and stage of BC were assessed by multinomial logistic regression models. An increase of 10 μg/m3 in ethylbenzene, o-xylene, m-xylene, and 10 ppb of NO corresponded to 10.41 (95% CI 1.32–82.41), 4.07 (1.46–11.33), 2.89 (1.08–7.73) and 1.08 (1.00–1.15) increase in the odds of stage I versus non-invasive BC, respectively. Benzene (OR, odds ratio = 1.16, 95% CI 1.01–1.33) and o-xylene (OR = 1.18, 1.02–1.38) were associated with increased odds of incidence of BC stages III & IV versus non-invasive stages. BC stage I and stage III&IV in women living in low SES areas was associated with significantly higher levels of benzene, ethylbenzene, o-xylene, and m-xylene. The highest multiple-air-pollutants quartile was associated with a higher odds of stage I BC (OR = 3.16) in patients under 50 years old. This study provides evidence that exposure to AP is associated with increased BC stage at diagnosis, especially under premenopause age.

Sociodemographic Inequities in Telemedicine Use Among US Patients Initiating Treatment in Community Cancer Centers During the Ongoing COVID-19 Pandemic, 2020-2022.

Although telemedicine was seen as a way to improve cancer care during the coronavirus disease (COVID-19) pandemic, there is limited information regarding inequities in its uptake. This study assessed sociodemographic factors associated with telemedicine use among patients initiating treatment for 20 common cancers. This retrospective cohort study used deidentified electronic health record-derived patient data from a nationwide network of community cancer practices, linked to area-level Census information. We included adults (age 18 years and older) who initiated first-line systemic cancer treatment between March 2020 and December 2022 (follow-up through March 2023). Exposures include race/ethnicity, insurance status, and area-level social determinants of health (eg, block group socioeconomic status [SES]). The outcome was telemedicine use within 90 days after treatment initiation. Associations were examined using logistic regression models adjusted for age, sex, performance status, stage, and cancer type. This study included 36,993 patients (48.6% women; median age, 69 years), of whom 15.1% used telemedicine services. Black (12.2%; odds ratio [OR], 0.78 [95% CI, 0.70 to 0.88]) and uninsured (9.2%; OR, 0.59 [95% CI, 0.48 to 0.73]) patients were less likely to use telemedicine services than their White and well-insured counterparts (14.5% and 15.0%, respectively). Patients in rural (9.7%; OR, 0.54 [95% CI, 0.46 to 0.57]), suburban (11.8%; OR, 0.67 [95% CI, 0.61 to 0.74]), and low SES areas (9.9%; OR, 0.39 [95% CI, 0.35 to 0.43]) were less also likely to use telemedicine than their counterparts in urban (16.6%) or high SES (21.6%) areas. Nearly one sixth of patients initiating cancer treatment during the pandemic used telemedicine, but there were substantial inequities. The proliferation of telemedicine may perpetuate cancer care inequities if marginalized populations do not have equitable access.

Poor Diet and Lower Neuropsychological Performance in a rural setting: The Bogalusa Heart Study

AbstractBackgroundPoor diet has been associated with insidious onset dementia. The Alternate Healthy Eating Index (AHEI) can capture overall nutrient quality and individual/population eating behaviors. Higher adherence to AHEI has been associated with a lower risk of incident dementia and better cognitive function in late life. However, most evidence comes from high‐income populations from urban areas. Here, we examined the adherence to AHEI and its association with cognitive function in midlife among Black and White individuals from a community cohort in the rural, low SES area of Bogalusa, Louisiana.MethodThis cross‐sectional analysis considered 1,040 participants from the Bogalusa Heart Study (mean age 48.1 ± 61% female, 31% Black) with a complete neuropsychological (NP) assessment and food frequency questionnaires. (AHEI‐2010 score, range 0‐110). Regression models using GEE accounted for clustering effects of neighborhood factors/SES using census‐track level codes and estimated the association between quintiles (Q1‐Q5) of AHEI‐2010 and a global cognitive z‐score (GCS) and cognitive domains.ResultIndividuals in Q5 (healthiest) tended to be female (68%, p = 0.03), significantly older (49.3 ± 5, p&lt;0.001), with higher education (³ college 56%, p&lt;0.001), and AHEI‐2010 scores from 53.38‐79.2. Compared with participants in Q1. Those in Q5 had higher GCS [ß (95% CI):1.71 (0.85, 2.57); p&lt;0.001] after adjusting for age, sex, race, and the ACS‐Index of concentration at the extremes (to account for neighborhood‐level SES). Similarly, those with the healthiest diet had higher NP z‐scores within the domains of executive function, attention and speed processing information, and episodic memory. However, these associations were not significant after adjusting for education. (Table 1) For episodic memory, individuals in quintile 4 had higher NP z‐scores after adjusting for education [0.36 (0.07, 0.65); p = 0.01], and the trend across quintiles was also significant in all models and after adjusting for education [p = 0.03].ConclusionAs early as midlife, Black and White individuals from rural settings with greater adherence to healthy dietary patterns have better NP performance across different neurocognitive domains. These results strengthen previous evidence suggesting that diet quality may be a potential avenue of intervention to prevent cognitive decline and aid health disparities.

A preliminary predictive model for selenium nutritional status in residents based on three selenium biomarkers

BackgroundSelenium (Se) is an essential nutrient and an important component of many selenoproteins that possess fundamental importance to human health. Selenium deficiency and excess will cause corresponding diseases in the human body. The nutritional health of Se in the human body mainly depends on the daily dietary Se intake of the human body, which in turn depends to a certain extent on the content of Se transmitted along the food chain. This study aims to research the transport of Se through the soil-crop-human chain in regions with different Se levels, and to establish the model between the residents' dietary Se intake and the three Se biomarkers (hair, nails, and plasma), to predict the nutritional health status of Se in residents through Se biomarkers. MethodCarry out field and cross-sectional surveys of populations in Loujiaba Village and Longshui Village. Samples were collected from soil, crops, drinking water, residents' hair, nails, plasma, and diet. The concentration of available Se fractions was extracted from soil samples using 0.1 mol/L K2HPO4. The concentration of total Se for all samples was determined by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS), and the relative standard deviation was less than 5%. In this study, hair, nails, and blood samples were collected from volunteers according to the Declaration of Helsinki and the Ethics Committee of Soochow University. The dietary nutritional structure and dietary Se intake of the population were randomly selected by 12 volunteers using the duplicate portion method. Data were described using mean ± standard deviation. We performed saliency analysis and correlation analysis (with Pearson correlation coefficient), and fitted a regression to evaluate the associations between these variables. ResultsThe soil total Se (5201 ± 609.2 μg/kg) and available Se (307.7 ± 83.5 μg/kg) in Luojiaba Village (LJB) were significantly higher than the soil total Se (229.2 ± 32.5 μg/kg) and available Se (21.9 ± 4.0 μg/kg) in Longshui Village (LS). The residents' dietary Se intake of LJB (150.3 ± 2.2 μg/d) was within the World Health Organization (WHO) recommended intake range, while LS (16.0 ± 0.4 μg/d) was close to the range of Keshan disease occurrence, and there was a risk of insufficient Se intake. The correlation analysis found significant positive correlations between residents' dietary Se intake and the three Se biomarkers. According to the preliminary model established in this study, if the daily dietary Se intake of residents reaches the WHO recommended value of 55–400 μg, the hair, nails, and plasma of Se concentration will be 522.1–2850.5 μg/kg, 1069.0–6147.4 μg/kg, and 128.3–661.36 μg/L, respectively. ConclusionSelenium is transmitted through the soil-crop-human chain, and the Se concentration that enters the human body through the food chain in high-Se areas is significantly higher than that in low-Se areas. The nutritional health status of Se in the human body depends on the daily dietary intake of the human body, and there is a significant correlation between the daily dietary Se intake of the human body and the three biomarkers of Se levels in the human body, so the three biomarkers can be used to evaluate the Se nutritional health of the human.

Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022.

Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.

Availability and accessibility of HIV self-tests and self-sample kits at community pharmacies in the Netherlands

BackgroundIn 2016 the WHO declared HIV self-testing and self-sampling an effective and safe test option that can reduce testing barriers. HIV self-tests and self-sampling kits (HIVST/HIVSS) are available for purchase at Dutch community pharmacies since 2019. We investigated the availability and accessibility of HIVST/HIVSS in community pharmacies, and factors associated with test availability.MethodsAn online survey among all Dutch community pharmacies (n = 1,987) was conducted between April and June 2021. Availability of HIVST/HIVSS and experiences of pharmacists with the test offer were analyzed with descriptive statistics. The association of pharmacy and pharmacists’ characteristics with HIVST/HIVSS availability was explored by logistic regression analysis.ResultsIn total, 465 pharmacists completed the questionnaire. Of the responding pharmacists, 6.2% (n = 29) offered HIVST/HIVSS. The majority (82.8%) sold between 0 and 20 tests per year. In total, pharmacies sold an estimated 370 HIVST/HIVSS per year. Pharmacies having HIVST/HIVSS available were less often located in moderately-urbanized to rural neighborhoods (OR 0.35, 95%CI 0.16–0.77 versus highly-urbanized), and were less often located in moderate-to-low SES neighborhoods (OR 0.40, 95%CI 0.18–0.88 versus high-SES). Reasons for not offering HIVST/HIVSS by pharmacists were no or little demand (69.3%), and not being familiar with these tests (17.4%). 52% of the pharmacists provided information about testing to test buyers. Reported options to improve the test offer were giving advice about (performing) the test to test buyers (72.4%), placing tests visible on the counter (51.7%), and advertisement (37.9%).ConclusionHIVST/HIVSS have a limited practical availability in Dutch community pharmacies since their introduction in 2019, especially in lower-urbanized and lower-SES areas. Further research is needed to explore how to expand access to HIVST/HIVSS through community pharmacies in the Netherlands, and how to tailor it to the needs of pharmacy clients.

A-26 Area Deprivation Index and Clinical Outcome Following Concussion in Adolescents

Abstract Purpose The purpose of this study was to assess whether socioeconomic status is associated with clinical recovery time following concussion in adolescents. Methods Participants included adolescent student athletes (N=130; age M=16.6, SD=1.2; 60.8% boys, 39.2% girls) who attended one of nine selected high schools in Maine, USA. Schools were identified as either higher or lower SES based on the Area of Deprivation Index (ADI), and indicator of neighborhood disadvantage, associated with their address and the percent of students receiving free and reduced lunches. Athletic trainers entered injury and recovery dates into an online surveillance application between September 2014 and January 2020. Chi-square analyses and Kaplan-Meier survival analyses were used to compare the groups on two clinical outcomes: time to return to school and sports. Results Results of chi-square tests did not reveal between group differences in time to return to school at 21 or 28 days; however, groups differed in the percentage of adolescents who had returned to sports by 21 days (lower SES, 62.5%, higher SES 82.0%, χ2=4.96, p=.03, OR=2.73, 95% CI, 1.11-6.74) and 28 days (lower SES, 78.6%, higher SES 94.0%, χ2=5.18, p=.02, OR=4.27, 95% CI, 1.13-16.16) following concussion. Conclusions The adolescents attending lower SES schools took longer to reach medical clearance for return to sports. Further research is needed to better characterize factors underlying group differences in time to return to sports and examine a broader array of SES indicators. These results may reflect disparities in health care resources between schools serving higher versus lower SES areas.

Comparing the sociodemographic characteristics of participants and non-participants in the population-based Tromsø Study

BackgroundDifferences in the sociodemographic characteristics of participants and non-participants in population-based studies may introduce bias and reduce the generalizability of research findings. This study aimed to compare the sociodemographic characteristics of participants and non-participants of the seventh survey of the Tromsø Study (Tromsø7, 2015–16), a population-based health survey.MethodsA total of 32,591 individuals were invited to Tromsø7. We compared the sociodemographic characteristics of participants and non-participants by linking the Tromsø7 invitation file to Statistics Norway, and explored the association between these characteristics and participation using logistic regression. Furthermore, we created a geographical socioeconomic status (area SES) index (low-SES, medium-SES, and high-SES area) based on individual educational level, individual income, total household income, and residential ownership status. We then mapped the relationship between area SES and participation in Tromsø7.ResultsMen, people aged 40–49 and 80–89 years, those who were unmarried, widowed, separated/divorced, born outside of Norway, had lower education, had lower income, were residential renters, and lived in a low-SES area had a lower probability of participation in Tromsø7.ConclusionsSociodemographic differences in participation must be considered to avoid biased estimates in research based on population-based studies, especially when the relationship between SES and health is being explored. Particular attention should be paid to the recruitment of groups with lower SES to population-based studies.

Macro-structural predictors of Australian family day care quality.

This study explores the predictive power of macro-structural characteristics on quality rating and improvement system (QRIS) outcomes of Family Day Care (FDC) services in Australia. The dataset consisted of 441 FDC National Quality Standard (NQS) ratings from all Australian states and territories, with overall ratings of Exceeding NQS, Meeting NQS, Working Towards NQS, or Significant Improvement Required. Multinomial logistic regressions confirmed that management type, community socioeconomic status (SES), level of urbanization, and government jurisdiction explained 6.9 to 19.3% of the variation in QRIS outcomes. Results indicated that lower FDC NQS ratings were more likely for (1) private for-profit vs. not-for-profit; (2) low-SES vs. high-SES area; and (3) regional or remote area vs. metropolitan. State/territory jurisdiction also influenced NQS ratings. These findings imply the need for policy attention to inequalities in FDC quality associated with systemic and organizational differences. Greater effort is needed to promote equality and equity in FDC services.

Powerful promotions: An investigation of the teen-directed marketing power of outdoor food advertisements located near schools in Australia.

Adolescents are heavily exposed to unhealthy outdoor food advertisements near schools, however, the marketing power of these advertisements among adolescents has not yet been explored. This study aimed to investigate the teen-directed marketing features present and quantify the overall marketing power of outdoor food advertisements located near schools to explore any differences by content (ie, alcohol, discretionary, core and miscellaneous foods) school type (ie, primary, secondary, K-12) and area-level socio-economic status (SES; ie, low vs high). This cross-sectional study audited every outdoor food advertisement (n = 1518) within 500m of 64 randomly selected schools in Perth, Western Australia, using a teen-informed coding tool to score the marketing power of each advertisement. Outdoor alcohol advertisements around schools had the highest average marketing power score and number of advertising features present. Outdoor advertisements for alcohol and discretionary foods scored significantly higher in marketing power than core food advertisements (P < .001). Outdoor alcohol advertisements around secondary schools scored significantly higher in marketing power than around primary and K-12 schools (P < .001); and outdoor advertisements for discretionary foods in low SES areas scored significantly higher in marketing power than those in high SES areas (P < .001). This study found outdoor advertisements for unhealthy products, such as alcohol and discretionary foods, were more powerful than advertisements for core foods around schools. SO WHAT?: These findings strengthen the need for policies which restrict outdoor advertisements for non-core foods near schools, to reduce adolescents' exposure to powerful alcohol and discretionary food advertisements.

Facilitating conditions for staff’s confidence to enforce school tobacco policies: qualitative analysis from seven European cities

BackgroundSchool staff members’ consistent enforcement of school tobacco policies (STPs) is needed to decrease adolescent smoking and exposure to tobacco smoke. Staff’s confidence, indicating their perceived ability to cope with students’ negative responses, explains variations in staff’s STPs enforcement, yet understanding of the determinants for confidence is lacking. We analyzed the conditions in which the staff feel confident in addressing students who violate STPs to support staff’s enforcement. MethodsData consists of 81 semi-structured interviews with the staff members from 26 secondary schools in seven European cities in Belgium, Finland, Germany, Ireland, Italy, The Netherlands, and Portugal. In every city, 3–4 staff members (senior management, teachers, supportive staff) in 3–4 schools (academic–vocational, high–low SES area) were interviewed. Transcripts were analyzed with thematic analysis.ResultsWhen staff felt confident in their ability to prevent, diminish, or handle students’ negative responses, they were more likely to address students on STP violations. The staff was more confident (1) when consistent policy enforcement within school and regarding the wider society ensured staff legitimacy for STPs enforcement, (2) when dialog and mutual familiarity with students allowed the staff to facilitate constructive interaction with STP violators, and (3) when organizational backup structures provided staff collegial support to overcome challenges in the enforcement. These conditions would support consistent enforcement, especially with persistent misbehavers and among the more uncertain staff members.ConclusionsOur study stresses the need to implement strategies at multiple levels to strengthen staff’s confidence for STP enforcement. To support staff’s legitimacy for enforcement, we suggest reinforcing structures and practices that facilitate consistency in STP enforcement; to support staff’s ability for constructive interaction with STP violators, we suggest strengthening staff’s social and emotional learning; and to support staff’s experience of collegial support, we suggest reinforcing staff’s collective ability to cope with students’ negative responses.

The Longitudinal Effect of Area Socioeconomic Changes on Obesity: a Longitudinal Cohort Study in the USA from 2003 to 2017.

Despite several dimensions of area socioeconomic status (SES), past literature has been dominated by the use of area socioeconomic position. We examined the longitudinal effect of three area SES measures (i.e., socioeconomic position, inequality, and segregation) on obesity. Using longitudinal data from the Fragile Families & Child Wellbeing Study (N = 1493), we estimated a linear mixed model to examine the effect of three time-varying area SES measures on time-varying measures of objectively measured body mass index z-score (BMIz) from ages 5years to 15years. Findings showed that BMIz increased steadily over time (B = 0.02, 95% CI = 0.02, 0.03). A significant interaction between time and area socioeconomic position indicates that children in areas with higher socioeconomic position had a smaller increase in BMIz than those in low socioeconomic areas (B = - 0.02, 95% CI = - 0.02, - 0.01). A non-linear relationship of area income inequality with BMIz such that BMIz was higher as area income inequality was greater, but the effect diminishes in magnitude with a higher level of area income inequality (linear term: B = 0.07; quadratic term: B = - 0.03). Area income segregation was associated with greater BMIz (B = 0.08, 95% CI = 0.03, 0.12). No time interaction effect was found for area income inequality and segregation. Results highlight a need for community health policy efforts and evidence-based interventions to address childhood obesity issues in low-SES areas.

Developing and testing the senior park environment assessment in Korea (SPEAK) audit tool

Given the rapidly aging population in Korea and the critical role of neighborhood parks in the health of seniors, it is essential to understand how park environments impact physical activity in this age group. This study outlines the development and testing of an audit tool, Senior Park Environment Assessment in Korea (SPEAK), to assess park characteristics and culture-specific features that may promote physical activity in Korean seniors. Additionally, it investigated disparities in park quality and characteristics in high- and low socioeconomic status (SES) neighborhoods. The 36-item, single-page audit tool was developed and field-tested in 42 parks in four districts of two Korean cities, purposely selected for their differences in SES. Cohen’s kappa and percent agreement assessed the inter-rater reliability of each item. The Kruskal–Wallis test and a Mann–Whitney test evaluated differences in the percent scores among five domains (Access, Amenities, Safety, Aesthetics, and Recreation) and compared scores between the two SES areas. SPEAK was generally reliable: 72% of the items had over 75% agreement, and 70.4% had kappa coefficients between 0.4 and 1. Access to parks had the lowest scores among the five domains. Results indicated a significant disparity in three domains (Access, Amenities, and Safety) regarding parks between the two SES areas, suggesting that parks in low-SES areas are of lower quality and less safe than high-SES park areas. SPEAK would provide Korean municipalities with a feasible park assessment of factors impacting physical activity in the elderly.

Reflecting on teaching in low SES areas during COVID-19: an Australian experience

ABSTRACT School closures and the move to remote learning during the COVID-19 pandemic transformed teaching and learning in Australian schools. Educators experienced personal and professional challenges as they rapidly responded to the needs of their school communities and managed their own emotional reactions. Eleven educators at two Victorian schools in areas of low socioeconomic status discussed in focus groups the impact of school closures and explored their perceptions of responses from leaders and colleagues who supported their wellbeing. While naming the significance of uncertainty, constant change and increased workloads, these educators acted creatively to ensure their students had access to specifically developed learning materials to suit their needs. Educators demonstrated that they could use existing reflective structures that fostered mutual support to sustain their wellbeing and create supportive environments for themselves and their wider school communities in times of crisis, as well as remain open to sometimes-surprising learning opportunities.