low-SES Communities Research Articles

The Effect of Volunteering for Community Activity on the Social Resources of Low-SES Residents: Differences Between Volunteer Community Activists and Other Residents

Community interventions seek to increase volunteer activists’ social resources in order to further the establishment of social networks and better enable volunteers to promote the development of their community and answer its social needs, while also enhancing their own well-being. The current study investigated whether this goal is indeed achieved. Two hundred residents of low-SES (socioeconomic status) communities who volunteer to take an active part in community interventions (volunteer activists) and 200 other residents of these communities completed questionnaires measuring the levels of five social resources (community belonging, community commitment, knowledge of local services, social competence, community leadership). Variance analyses (MANCOVA) revealed significantly higher levels of almost all resources among the volunteer activists. Furthermore, regression analyses found significant effect of the activists’ years of involvement in community activity and the centrality of the role they perform on their social resources, suggesting that their resources are indeed strengthened by their community work. The implications for researchers and professionals are discussed, and practical recommendations are offered.

Do rewards reinforce the growth mindset?: Joint effects of the growth mindset and incentive schemes in a field intervention.

The current study draws on the motivational model of achievement which has been guiding research on the growth mindset intervention (Dweck & Leggett, 1988) and examines how this intervention interacts with incentive systems to differentially influence performance for high- and low-achieving students in Indian schools that serve low-SES communities. Although, as expected, the growth mindset intervention did interact with incentive systems and prior achievement to influence subsequent academic performance, the existing growth mindset framework cannot fully account for the observed effects. Specifically, we found that the growth mindset intervention did facilitate performance through persistence, but only when the incentive system imparted individuals with a sense of autonomy. Such a facilitation effect was only found among those students who had high prior achievement, but not among those who had underperformed. When the incentive did not impart a sense of autonomy, the growth mindset intervention undermined the performance of those who had high initial achievement. To reconcile these discrepancies and to advance understanding of the impacts of psychological interventions on achievement outcomes, we discuss how the existing theory can be extended and integrated with an identity-based motivation framework (Oyserman & Destin, 2010). We also discuss the implications of our work for future research and practice. (PsycINFO Database Record

Impact of respiratory infections, outdoor pollen, and socioeconomic status on associations between air pollutants and pediatric asthma hospital admissions.

BackgroundEpidemiology studies have shown that ambient concentrations of ozone and fine particulate matter (PM2.5) are associated with increased emergency department (ED) visits and hospital admissions (HAs) for asthma.ObjectiveEvaluate the impact of outdoor pollen, respiratory infections, and socioeconomic status (SES) on the associations between ambient ozone and PM2.5 and asthma HAs in New York City.MethodsDaily ozone, PM2.5, meteorological factors, pollen, and hospitalization records during 1999 to 2009 were obtained for New York City residents. Daily counts of HAs for asthma and respiratory infections were calculated for all-age and specific age groups, and for high- and low-SES communities. Generalized additive models were used to examine ambient concentrations of ozone and PM2.5 and asthma HAs, potential confounding effects of outdoor pollen and HAs for respiratory infections, and potential effect modification by neighborhood SES.ResultsBoth ozone and PM2.5 were statistically significantly associated with increased asthma HAs in children aged 6–18 years (per 10 ppb increase in ozone: RR = 1.0203, 95% CI: 1.0028–1.0382; per 10 μg/m3 increase in PM2.5: RR = 1.0218, 95% CI: 1.0007–1.0434), but not with total asthma HAs, or asthma HAs in other age groups. These associations were stronger for children living in the high-SES areas. Adjustment for respiratory infection HAs at various lags did not result in changes greater than 10% in the risk estimates for either ozone or PM2.5. In contrast, adjustment for outdoor pollen generally attenuated the estimated RRs for both ozone and PM2.5.ConclusionsAmbient ozone and PM2.5 are associated with asthma HAs in school-age children, and these associations are not modified by SES. HAs for respiratory infections do not appear to be a confounder for observed ozone- and PM2.5-asthma HAs associations, but pollen may be a weak confounder.

Emotional alienation as a mediator of the relationship between perceived discrimination and alcohol use among immigrant adolescents in Israel

ABSTRACTPerceived discrimination has been found to be a predictor of immigrant adolescent involvement in alcohol use, yet the psychological mechanism behind this relationship has not been well explored. Drawing on strain theory and the motivational model of alcohol use, the current study aimed to develop and test a concept of emotional alienation. In the proposed model, it is when experiences of discrimination are internalized into painful feelings of detachment, anger, rejection, and failure that the immigrant adolescent may turn to alcohol use. The study involved 365 at-risk immigrant adolescents, aged 15–19 (62% male, mean age 17.1) from the Former Soviet Union and Ethiopia in Israel, from low SES neighborhoods and community centers for youth at risk. The young people self-reported on experiences of discrimination, daily alcohol use, heavy episodic drinking (HED), and drunkenness, together with a new questionnaire examining emotional alienation developed for the study. Findings showed that experiences of alienation fully mediated the relationship between discrimination and problematic alcohol use (drunkenness and HED). In particular, feelings of self-detachment, failure, and rejection were strongly related to alcohol use. Results suggest an importance of understanding the way in which negative reactions from the host society may be internalized into destructive feelings of failure, shame, and rejection, which may lead a young person to involvement in alcohol use.

Addressing the Math-Practice Gap in Elementary School: Are Tablets a Feasible Tool for Informal Math Practice?

Students rarely practice math outside of school requirements, which we refer to as the “math-practice gap”. This gap might be the reason why students struggle with math, making it urgent to develop means by which to address it. In the current paper, we propose that math apps offer a viable solution to the math-practice gap: Online apps can provide access to a large number of problems, tied to immediate feedback, and delivered in an engaging way. To substantiate this conversation, we looked at whether tablets are sufficiently engaging to motivate children’s informal math practice. Our approach was to partner with education agencies via a community-based participatory research design. The three participating education agencies serve elementary-school students from low-SES communities, allowing us to look at tablet use by children who are unlikely to have extensive access to online math enrichment programs. At the same time, the agencies differed in several structural details, including whether our intervention took place during school time, after school, or during the summer. This allowed us to shed light on tablet feasibility under different organizational constraints. Our findings show that tablet-based math practice is engaging for young children, independent of the setting, the student’s age, or the math concept that was tackled. At the same time, we found that student engagement was a function of the presence of caring adults to facilitate their online math practice.

Comparison of trace elements in size-fractionated particles in two communities with contrasting socioeconomic status in Houston, TX.

Levels of ambient air pollutants, including particulate matter (PM), are often higher in low-socioeconomic status (SES) communities than in high-SES communities. Houston is the fourth largest city in the USA and is home to a large petrochemical industry, an active port, and congested roadways, which represent significant emission sources of air pollution in the region. To compare levels of air pollution between a low-SES and a high-SES community, we simultaneously collected a 7-day integrated size-fractionated PM between June 2013 and November 2013. We analyzed PM mass and elements for three particle size modes: quasi-ultrafine particles (quasi-UFP) (aerodynamic diameter <0.25μm), accumulation mode particles (0.25-2.5μm), and coarse mode particles (>2.5μm). Concentrations of vanadium, nickel, manganese, and iron in the quasi-UFP mode were significantly higher in the low-SES community than in the high-SES community. In the accumulation and coarse modes, concentrations of crustal elements and barium were also significantly higher in the low-SES community compared to the high-SES community. These findings suggest that people living in the low-SES community may experience higher exposures to some toxic elements as compared to people in the high-SES community.

The Effect of Socio-economic status on the Oral Hygiene of Elementary School Children in the City of Dammam, Saudi Arabia

The purpose of this paper was to determine the status of the oral health of children compared to the socioeconomic status (SES) of the parents in the city of Dammam, Saudi Arabia. Three schools were targeted based on the SES levels; two private schools and one governmental school. The sample size was 40 boys from each school all of them 5 th grade students. The dependent variable was the oral hygiene status of the children and the independent variables were the school type (governmental or private), parents’ education and socioeconomic status. Community SES was significantly related to oral hygiene status. Overall, oral health was significantly worse for low SES communities. There is a direct relationship between SES and oral hygiene status of children in elementary schools in the community of Dammam, Saudi Arabia. In which high caries prevalence was seen with children attending public school. KeywordsOral Hygiene, Dental, Socio-economic. INTRODUCTION Good oral health is a goal that is only achieved by having all the “correct” items to fulfill that goal. These items that are highly related to having a good oral health are proper oral hygiene practice, welleducated people and neighborhood of residency. Moreover, Socio-economic status (SES) is a description of a person’s societal status using factors or measurements such as income level, relationship to the national poverty line, educational achievement and neighborhood of residency. 1 Poor SES has been a known risk factor to poor oral health. Numerous studies were conducted, In which Gillcrist, Brumley and Blackford concluded that community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for mediumand high-SES communities. 2 Also, Reisine and Poster said that underlying mechanisms may not be well understood, low SES may serve clinicians as a marker for increased risk of caries. 3 In addition, Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviors and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care. 4 Moreover, Rosa said that the higher SES receives more dental care than the low SES. www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i6.65

Investigating the real-world emission characteristics of light-duty gasoline vehicles and their relationship to local socioeconomic conditions in three communities in Los Angeles, California

ABSTRACTThis paper discusses results from a vehicular emissions research study of over 350 vehicles conducted in three communities in Los Angeles, CA, in 2010 using vehicle chase measurements. The study explores the real-world emission behavior of light-duty gasoline vehicles, characterizes real-world super-emitters in the different regions, and investigates the relationship of on-road vehicle emissions with the socioeconomic status (SES) of the region. The study found that in comparison to a 2007 earlier study in a neighboring community, vehicle emissions for all measured pollutants had experienced a significant reduction over the years, with oxides of nitrogen (NOX) and black carbon (BC) emissions showing the largest reductions. Mean emission factors of the sampled vehicles in low-SES communities were roughly 2–3 times higher for NOX, BC, carbon monoxide, and ultrafine particles, and 4–11 times greater for fine particulate matter (PM2.5) than for vehicles in the high-SES neighborhood. Further analysis indicated that the emission factors of vehicles within a technology group were also higher in low-SES communities compared to similar vehicles in the high-SES community, suggesting that vehicle age alone did not explain the higher vehicular emission in low-SES communities.Evaluation of the emission factor distribution found that emissions from 12% of the sampled vehicles were greater than five times the mean from all of the sampled fleet, and these vehicles were consequently categorized as “real-world super-emitters.” Low-SES communities had approximately twice as many super-emitters for most of the pollutants as compared to the high-SES community. Vehicle emissions calculated using model-year-specific average fuel consumption assumptions suggested that approximately 5% of the sampled vehicles accounted for nearly half of the total CO, PM2.5, and UFP emissions, and 15% of the vehicles were responsible for more than half of the total NOX and BC emissions from the vehicles sampled during the study.Implications: This study evaluated the real-world emission behavior and super-emitter distribution of light-duty gasoline vehicles in California, and investigated the relationship of on-road vehicle emissions with local socioeconomic conditions. The study observed a significant reduction in vehicle emissions for all measured pollutants when compared to an earlier study in Wilmington, CA, and found a higher prevalence of high-emitting vehicles in low-socioeconomic-status communities. As overall fleet emissions decrease from stringent vehicle emission regulations, a small fraction of the fleet may contribute to a disproportionate share of the overall on-road vehicle emissions. Therefore, this work will have important implications for improving air quality and public health, especially in low-SES communities.

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study.

BackgroundIn Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.MethodsFrom 2009–2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.ResultsIn the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10–3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82–47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17–0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment.ConclusionsRegular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0411-5) contains supplementary material, which is available to authorized users.

Social disparities in dietary habits among women: Geographic Research on Wellbeing (GROW) Study.

Relationships among race/ethnicity, individual socio-economic status (SES), neighbourhood SES and acculturation are complex. We sought to answer whether: (i) race/ethnicity, individual SES and neighbourhood SES have independent effects on women's fruit and vegetable consumption (FVC); (ii) SES modifies the effects of race/ethnicity on FVC; and (iii) nativity modifies the effect of Latina ethnicity on FVC. Cross-sectional surveys from the population-based Geographic Research on Wellbeing (GROW) Study were linked with census-tract level data. FVC was indicated by (i) consuming fruits and vegetables less often than daily (LOWFV) and (ii) not having fruits and vegetables in the home very often. Other variables included age, marital status, race/ethnicity, country of birth, educational attainment, family income and longitudinal neighbourhood poverty (based on latent class growth models). Weighted logistic regression models accounting for the complex sample design were constructed. California, USA, 2012-2013. Women (n 2669). In adjusted models, race/ethnicity, education and income were independently associated with FVC, but not neighbourhood poverty. Women of colour, high-school graduates and women with incomes at 301-400 % of the federal poverty level were at higher odds of LOWFV compared with non-Hispanic Whites, college graduates and those with incomes >400 % of the federal poverty level. Little evidence for interactions between race/ethnicity and individual or neighbourhood SES was found; similar patterns were observed for immigrant and US-born Latinas. Addressing the dietary needs of lower-SES communities requires multilevel interventions that simultaneously provide culturally tailored nutrition education and address the physical and economic accessibility of culturally acceptable fruits and vegetables.

Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial.

BackgroundAdoptions of health behaviors are crucial for maintaining good health after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to glucoregulating behaviors like regular exercise and balanced diet can be challenging, especially for people living in lower-socioeconomic status (SES) communities. Providing cost-effective interventions that improve self-management is important for improving quality of life and the sustainability of health care systems.ObjectiveTo evaluate a health coach intervention with and without the use of mobile phones to support health behavior change in patients with type 2 diabetes.MethodsIn this noninferiority, pragmatic randomized controlled trial (RCT), patients from two primary care health centers in Toronto, Canada, with type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of ≥7.3% (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or without mobile phone monitoring support. We hypothesized that both approaches would result in significant HbA1c reductions, although health coaching with mobile phone monitoring would result in significantly larger effects. Participants were evaluated at baseline, 3 months, and 6 months. The primary outcome was the change in HbA1c from baseline to 6 months (difference between and within groups). Other outcomes included weight, waist circumference, body mass index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), positive and negative affect (Positive and Negative Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 [SF-12]).ResultsA total of 138 patients were randomized and 7 were excluded for a substudy; of the remaining 131, 67 were allocated to the intervention group and 64 to the control group. Primary outcome data were available for 97 participants (74.0%). While both groups reduced their HbA1c levels, there were no significant between-group differences in change of HbA1c at 6 months using intention-to-treat (last observation carried forward [LOCF]) (P=.48) or per-protocol (P=.83) principles. However, the intervention group did achieve an accelerated HbA1c reduction, leading to a significant between-group difference at 3 months (P=.03). This difference was reduced at the 6-month follow-up as the control group continued to improve, achieving a reduction of 0.81% (8.9 mmol/mol) (P=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(P=.001) in the intervention group. Intervention group participants also had significant decreases in weight (P=.006) and waist circumference (P=.01) while controls did not. Both groups reported improvements in mood, satisfaction with life, and quality of life.ConclusionsHealth coaching with and without access to mobile technology appeared to improve glucoregulation and mental health in a lower-SES, T2DM population. The accelerated improvement in the mobile phone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to lead to significant benefits for patients from lower-SES communities with poorly controlled type 2 diabetes.Trial RegistrationClinicalTrials.gov NCT02036892; http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at http://www.webcitation.org/6b3cJYJOD)

Mental health in the foreclosure crisis

Current evidence suggests that the rise in home foreclosures that began in 2007 created feelings of stress, vulnerability, and sapped communities of social and economic resources. Minority and low SES communities were more likely to be exposed to predatory lending and hold subprime mortgages, and were the hardest hit by the foreclosure crisis. Little research has examined whether and how the foreclosure crisis has undermined population mental health. I use data from 2245 counties in 50 U.S. states to examine whether living in high foreclosure areas is associated with residents' mental health and whether the foreclosure crisis has the potential to exacerbate existing disparities in mental health during the recessionary period. I use county-level data from RealtyTrac and other data sources, and individual-level data from the Behavioral Risk Factor Surveillance Survey from 2006 to 2011. I find that – net of time invariant unobserved between-county differences, national time trends, and observed confounders – a rise in a county's foreclosure rate is associated with a decline in residents' mental health. This association is especially pronounced in counties with a high concentration of low SES and minority residents, which supports the perspective that the foreclosure crisis has the potential to exacerbate existing social disparities in mental health.

Interactive hazards education program for youth in a low SES community: a quasi-experimental pilot study.

A pilot study of an interactive hazards education program was carried out in Canberra (Australia), with direct input from youth participants. Effects were evaluated in relation to youths' interest in disasters, motivation to prepare, risk awareness, knowledge indicators, perceived preparedness levels, planning and practice for emergencies, and fear and anxiety indicators. Parents also provided ratings, including of actual home-based preparedness activities. Using a single group pretest-posttest with benchmarking design, a sample of 20 youths and their parents from a low SES community participated. Findings indicated beneficial changes on a number of indicators. Preparedness indicators increased significantly from pre- to posttest on both youth (p < 0.01) and parent ratings (p < 0.01). Parent ratings reflected an increase of just under six home-based preparedness activities. Youth knowledge about disaster mitigation also was seen to increase significantly (p < 0.001), increasing 39% from pretest levels. While personalized risk perceptions significantly increased (p < 0.01), anxiety and worry levels were seen either not to change (generalized anxiety, p > 0.05) or to reduce between pre- and posttest (hazards-specific fears, worry, and distress, ps ranged from p < 0.05 to < 0.001). In terms of predictors of preparedness, a number of variables were found to predict posttest preparedness levels, including information searching done by participants between education sessions. These pilot findings are the first to reflect quasi-experimental outcomes for a youth hazards education program carried out in a setting other than a school that focused on a sample of youth from a low SES community.

Community Characteristics Associated With Smokefree Park Policies in the United States

Outdoor smokefree (SF) policies have the potential to decrease secondhand smoke exposure and denormalize smoking. In order to inform dissemination and evaluation of this emergent tobacco control strategy, this study examined the prevalence of SF park policies in the United States and the community-level characteristics associated with enactment of such policies. Counties with existing SF park policies in one or more jurisdictions were identified using passive surveillance data from the American Nonsmokers' Rights Foundation (ANR). ANR data were validated in a random subsample of counties. County-level characteristics were obtained from public data sources and included population demographics, socioeconomic status (SES), urbanicity, and voter affiliation. State-level tobacco control variables included presence of indoor SF policies and adult smoking prevalence. General estimating equations were used to identify predictors of having a SF park policy while accounting for clustering of counties within states. Eleven percent (n = 355) of counties in the United States (n = 3,143) had at least 1 jurisdiction with a SF park policy. The odds of a county having a SF park policy decreased as the percentage of older residents, recent movers, and smokers increased, and the odds increased as the percentage of Democratic voters increased. Odds were higher for counties with higher SES versus low-SES counties and urban/suburban versus rural counties. SF park policies are currently limited to relatively few jurisdictions, and there is evidence of disparities in adoption of these policies. Public health practitioners should focus promotion of SF park policies on low-SES communities with children and youth and rural areas.

Out of View but in Plain Sight: The Illegal Sale of Single Cigarettes

The practice of selling single cigarettes (loosies) through an informal economy is prevalent in urban, low socioeconomic (low SES) communities. Although US state and federal laws make this practice illegal, it may be occurring more frequently with the recent increase in taxes on cigarettes. This investigation provides information concerning the illegal practice of selling single cigarettes to better understand this behavior and to inform intervention programs and policymakers. A total of 488 African American young adults were recruited and surveyed at two education and employment training programs in Baltimore City from 2005 to 2008. Fifty-one percent of the sample reported smoking cigarettes in the past month; only 3.7% of the sample were former smokers. Approximately 65% of respondents reported seeing single cigarettes sold daily on the street. Multivariate logistic regression modeling found that respondents who reported seeing single cigarettes sold on the street several times a week were more than two times as likely to be current smokers compared to participants who reported that they never or infrequently saw single cigarettes being sold, after controlling for demographics (OR = 2.16; p = 0.034). Tax increases have led to an overall reduction in cigarette smoking. However, smoking rates in urban, low SES communities and among young adults remain high. Attention and resources are needed to address the environmental, normative, and behavioral conditions influencing tobacco use and the disparities it causes. Addressing these factors would help reduce future health care costs and save lives.

Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore

Objectives: Neighborhood socioeconomic status (SES) can be associated with depression. We aimed to assess prevalence of depression amongst community-dwelling elderly in a multiethnic, urban, low-SES, Asian neighborhood, comparing against a higher SES neighborhood.Method: The study population involved all residents aged ≥60 years in two Singaporean housing estates comprising owner-occupied public housing (higher SES) and public rental housing (low SES) in 2012. Having lifetime prevalence of depression was defined as having a score ≥5 on the Geriatric Depression Scale-15 or a history of depression. Demographic/clinical details were collected via questionnaire. Those with depression were referred to local polyclinics. Multilevel multivariate logistic regression determined predictors of depression and depression screening.Results: Participation was 61.5% (559/909). In the low-SES community, 26.2% (104/397) had depression, compared with 14.8% (24/162) in the higher SES community. After adjusting for other sociodemographic variables, staying in a low-SES community (public rental housing) was independently associated with depression [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) = 1.02–2.84]. Within the low-SES community, not being married (aOR = 2.27, CI = 1.35–3.70), falls (aOR = 2.72, CI = 1.59–4.67), visual impairment (aOR = 2.37, CI = 1.28–4.39), and poorer social network (aOR = 3.70, CI = 1.96–7.14) were associated with depression.Conclusion: Residing in a low-SES community was independently associated with depression after controlling for individual SES.

Using environmental print to foster emergent literacy in children from a low-SES community

Young children are exposed to environmental print within their communities and this print may be a useful resource to foster emergent literacy skills. This pre-post-test randomised controlled study examined the effects of using environmental print to enhance emergent literacy skills in children aged three to four years (N=50) from a low-SES community in south-east Queensland, Australia. The 8-week (30min/week) environmental print programme provided multisensory strategies for children to interact with environmental print by identifying letters and words, tracing letters with fingers, and writing letters. ANCOVAs were conducted with pre-test scores as covariates. Children in the environmental print group significantly out-performed the control group on print knowledge, sound knowledge, and print awareness skills. The programme had moderate to large effects sizes and showed that guiding low-SES preschoolers’ interactions with environmental print using multisensory strategies is an effective way to foster emergent literacy skills.

Abstract TP177: Discharge to Skilled Nursing Facility May Explain the Association Between Neighborhood Disadvantage and Mortality after Stroke: the Cardiovascular Health Study

Background: Older adults who reside in disadvantaged communities have higher mortality after stroke. We examined whether hospital discharge disposition contributed to neighborhood differences in post-stroke mortality. Methods: We used data from the Cardiovascular Health Study, a population-based, longitudinal study of adults ≥65 years. The outcome was death after stroke. Neighborhood socioeconomic status (NSES) was a composite of 6 census variables. Post stroke discharge status, assessed using linked Center for Medicare and Medicaid Services (CMS) data, was classified into no hospitalization, discharge home, or discharge to a skilled nursing facility (SNF)/other subacute care. Multilevel Cox proportional hazard models adjusted for age, sex, race, and stroke type were constructed to examine the association of post-stroke discharge status to mortality at 1 year. Results: Among the 592 participants (93% matched to CMS data) with a stroke during the mean 11.5 year follow up, mortality at 1-year post stroke was higher among those discharged to SNF/other care than those discharged home (HR=3.85, 95% CI 2.49-5.93). Participants with no hospitalization did not differ in mortality from those discharged home (HR = 1.08, 0.59-1.99). There was higher mortality in the most disadvantaged neighborhoods among those discharged to SNF/other care, but no differences for those who were discharged home or never hospitalized (Figure). Conclusions: The association between lower neighborhood socioeconomic disadvantage and higher post-stroke mortality may be due to characteristics of the SNFs/other facilities where residents of lower SES communities receive care after stroke.

Bogart et al. Respond

We appreciate the opportunity to respond to Nathan’s insightful questions and to elucidate several aspects of our research. Nathan asks about the implications of grouping together all discrimination sources. As she notes, Greene et al. suggest that discrimination source plays a role in health outcomes, with peer discrimination more highly related to mental health than adult discrimination.1 However, the Healthy Passages fifth-grade survey did not ask separate questions about discrimination by adults and discrimination by peers. Measuring and analyzing the distinct effects of different discrimination sources on health disparities in this age group would be an important contribution to the field. Nathan also asks the extent to which perceived discrimination results from socioeconomic status (SES) disparities. We controlled for SES and still found robust effects. It may also be useful to jointly examine effects of SES- and race-based discrimination. Some research has done so; one study found that SES-related discrimination had significant effects on mental health whereas racial discrimination did not,2 and two studies found similar effects on physical and mental health for the two discrimination types.3,4 Additional studies are needed among youths to further examine the effects of multiple forms of discrimination. Finally, we would like to clarify our study’s implications for intervention. We believe that there is potential benefit from structural-level interventions (e.g., policies to decrease racial residential segregation and improve resources in lower-SES communities; school programs to encourage reporting of discrimination) and individual-level interventions for all racial/ethnic groups. Therapeutic interventions for Black and Latino youths could help to validate their experiences by acknowledging the extent of societal discrimination in their lives and the toll it takes and could foster adaptive coping responses to the stress of discrimination (such as support-seeking). For Whites, individual-level interventions could focus first on raising awareness about the harmful effects of discrimination and the ways in which stigma unconsciously influences behaviors (even among individuals who do not see themselves as prejudiced)5 and second on employing social-psychological stigma-reduction strategies such as facilitating positive contact among racial/ethnic groups via anti-discrimination school policies.6 A comprehensive strategy of intervening at both the individual and community levels and addressing the experiences and behaviors of both perceivers and targets offers a promising approach for reducing discrimination.

Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore

Background/Aims: Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood. Methods: The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment. Results: Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (β = –1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98–13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected. Conclusion: Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.