low-SES Communities Research Articles

Single or Multiplayer Mode? Examining the Effects of Exergames in Improving Physical Health and Well-Being Among Older Adults.

Objective: This study assesses the impact of single-player and multiplayer exergaming modes on improving exercise intentions, reduction of fear of falling, and emotional well-being among older adults, primarily from low socioeconomic status (SES) backgrounds-a group often underrepresented in exergame research. Method: We engaged 48 participants, primarily from low-SES communities in Singapore for a 4-week community-based exergaming intervention. Participants were divided into four groups as follows: (1) conventional exercise alone, (2) exergames alone, (3) exergames with a health coach, and (4) exergames with a peer. Using two-way repeated-measures ANOVA, we analyzed the effects of these interventions. Results: The findings revealed that all exergaming modes positively influenced exercise intentions, fear of falling, and emotional well-being to varying extents. Notably, exergaming with a health coach significantly improved participants' exercise intentions and emotional well-being, underscoring the value of expert guidance in motivating and supporting older adults in adopting healthier lifestyles. Exergaming with a peer was most effective in reducing fear of falling, highlighting the importance of social support and peer interaction in addressing physical health concerns among this population. Conclusion: This study emphasizes the potential of tailored exergame interventions incorporating various social interactions to improve health outcomes for older adults, contributing to more inclusive health promotion strategies.

IPA Analysis: Exploring the Postsurgical Needs of Guatemalan Children & Their Families From Low-SES Communities Using an OT Lens

Abstract Date Presented 03/22/24 This study explores the experiences of children and families from low-socioeconomic status (SES) communities after short-term surgical mission trips in Guatemala. The findings highlight the occupational injustices that challenge recovery experienced by this population. Primary Author and Speaker: Diana Del Carmen Tojin Additional Authors and Speakers: Karen Aranha Contributing Authors: Karen Aranha, Angela Labrie Blackwell

Scaffolding attention and perseverance skills in a diverse population of preschool children in Sweden

In two interventions, 139 and 52 preschool children, age 4–6, from low-SES communities in Sweden, used a play-&-learn game in early mathematics for 10 weeks, about 20 min at a time. 50 % of the participating children were Swedish second language speakers with low language proficiency and about 20 % had learning vulnerabilities in the form of developmental language disorders and neurocognitive diagnoses. In contrast to teachers' predictions ahead of the interventions, game log data and teacher observations regarding children's sustained attention and perseverance – core elements of ‘learning-related behaviors’ – suggest that a majority of children, including children with reported learning difficulties, did well with respect to sustained attention and perseverance. It is proposed that the interventions allowed children with learning difficulties to demonstrate – and practice – these skills to a larger degree than expected. A relative difference in outcome between the two interventions is interpreted as an effect of differences in structured guidance and scaffolding by teachers and peers. Educational relevance statementThe two intervention studies reported in the paper engaged preschool children, age 4–6, in using a play-&-learn educational game in early mathematics for 10 weeks, about 20 min at a time. The children were from environments with low SES indexes. A substantial part of the participants were Swedish second language speakers with low language proficiency and some children had different neurocognitive diagnoses. Ahead of the intervention studies teachers raised doubts regarding the intervention setup, predicting that many children would not be able to stay sufficiently focused on the learning activities. Teachers also predicted that many children would have difficulties to engage in the learning activities as long as 20 min and to hold out all through the intervention period. In contrast to the predictions the data suggests that a majority of the children – including children with learning difficulties – managed well. Specifically, most of the children who encountered substantial challenges in gameplay, again including children with learning difficulties, showed high degrees of perseverance as well as sustained attention. In practical terms the results, together with similar and related results, suggest that high-quality early math activities can have a dual benefit and promote not only growth of math skills, but also growth of central basic skills such as perseverance and sustained attention. With the pressure many preschool teachers experience regarding pedagogical requirements, it may ease their burden to know that growth of more than one important skill can be targeted by one and the same intervention.

Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study.

Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.

Hidradenitis Suppurativa Disease Severity and Outcomes Among Black Patients from Low-Income Neighborhoods at a Tertiary Care Hospital: A Retrospective Review

Hidradenitis suppurativa (HS) is a debilitating, inflammatory condition of apocrine sweat glands. Black patients are disproportionately affected, a finding largely attributed to lower socioeconomic status (SES) in the literature; yet, most HS studies include majority White cohorts. We present, to our knowledge, the first retrospective review of an entirely Black patient population living in low-income neighborhoods diagnosed with hidradenitis suppurativa (HS) to identify potentially modifiable factors related to disease severity and outcomes. We reviewed charts of Black patients with an encounter for HS from 2010-2020 in the New Orleans University Medical Center database. HSt III disease was associated with early and chronic onset, longer time-to-treatment, higher body mass index, and Medicaid insurance. Flared disease was associated with fewer dermatology visits, more incision and drainage procedures, and higher lost-to-follow-up rates while well-controlled patients had more surgical excisions, biologic use, and lower smoking rates. Patients were nearly evenly split among initial Hurley stages (HSt), and ~50% of the 473 patients were stable or well-controlled at latest disease status, suggesting low SES alone cannot explain HS race-based discrepancies. Our findings highlight potentially modifiable factors for healthcare providers to consider when holistically treating Black patients living in low-SES communities.

Snack consumption frequency of children and adults in the Vaal region of Gauteng, South Africa.

Energy-dense, nutrient-poor snacks are associated with an increased risk of non-communicable diseases (NCDs) and the double burden of malnutrition, especially among poor communities. To determine and compare the snacking preferences and consumption frequency of children and adults from a low SES community in South Africa. A preschool, primary school, and an elderly centre in Gauteng. A cross-sectional study with a convenience sample of 90 children (3-8 years) and 100 adults (≥ 18 years) to assess snack consumption frequency and preferences of children and adults by means of a snack survey. Mann-Whitney U test was used to determine the differences in preferences and snack consumption frequency of children and adults. The most preferred and consumed snacks included fruits, potato chips, corn chips, sweets, and cookies. Children frequently ate more potato chips (p < 0.001), corn chips (p < 0.001), cheese curls (p < 0.001), and muffins (p = 0.024) than adults. In contrast, adults frequently consumed more peanuts or nuts (p = 0.024), savoury biscuits (p = 0.048) and biltong (p < 0.001) than children. Apart from fruits, the most preferred and frequently consumed snacks by the sample were highly processed snacks, which are low in fibre and high in added sugars, saturated fat, and sodium. Findings from this study highlight current snack trends and can guide future nutrition education interventions on healthy snacking and in developing nutritious snacks for the South African community.

FRI060 Real World Experience Of Weight Management In Low Socioeconomic Community Clinic

Abstract Disclosure: B.A. West: None. S. Mon: None. Pilot Study: Real-world experience of weight management in low socioeconomic community clinic Introduction: Management of obesity and unhealthy behaviors is an essential step in patients with Prediabetes and T2DM, particularly those with socioeconomic status (SES) in whom obesity is more prevalent. While several behavior interventions targeting obesity exist, a successful adaptation of interventions in routine care is challenging especially in those with low SES. We examined the real word experience of weight loss management in our community clinic. Method: Retrospective chart review of consecutive patients seen in an endocrinology clinic at a hospital-based community clinic. Result: A total of 23 female patients, average age 48.4 ± 10.8 years, with average BMI 37.4 ± 6.9 kg/m2, were provided comprehensive lifestyle counseling focusing on nutrition, exercise, sleep health at each visits along with semaglutide at the highest tolerable dose of 2.4 mg/dl weekly. Within 6 months from the initiation of semaglutide and the weight loss intervention, 11/23 (48%) patients lost weight by &amp;gt;5% from their baseline visit, and 17/20 (85%) patients at the end of 1 year. 12/20 (60%) and 6/20 (30%) lost weight at least by 10% and 15% respectively at the end of 1 year. Compared to the baseline data, weight ( 101.2±18.4) kg, SBP 127.6 ± 13.4 mmHg, HbA1C 6.0 ± 1.1 mg/dL, Total Cholesterol 182.1 ± 40.4 mg/dL, LDL 102.4 ± 35.8 mg/dL, most parameters were improved at the end of 6 and 12 months respectively: weight 91.0± 18.6 vs 88.4± 16.2 kg, SBP 125.2± 16.8 vs. 126.9± 15.6 mmHg, HbA1C 5.8 ± 1.2 vs 6.3 ± 1.4 mg/dl, Total cholesterol 178.9± 33.1 vs 175.0 ± 50.7mg/dl, LDL 100.4± 27.7 vs 101.8± 47.7 mg/dL. Conclusion: This real-world implementation study reported the benefits of weight loss and other clinical parameters after the intervention consisting of a combined health behavior counseling and use of semaglutide at the low-SES community clinic. Presentation: Friday, June 16, 2023

Maternal postnatal depressive symptoms and children's internalizing problems: The moderating role of mother-infant RSA synchrony.

Maternal depressive symptoms are a crucial risk factor for children's internalizing problems, though positive mother-child relationships may buffer this risk transmission. Mother-child physiological coregulation (e.g., synchrony) has emerged as a potentially important mechanism of developmental psychopathology and may play a role in the transmission of internalizing symptoms. In this two-wave longitudinal study, we examined whether and how mother-infant physiological synchrony (of respiratory sinus arrhythmia; RSA) moderated the association between maternal postnatal depressive symptoms and children's internalizing problems in a rural, low-SES community sample (N = 166 dyads). At 6 months, mother-infant RSA synchrony and infant negative affect were assessed during free play. Mother reported their depressive symptoms at 6 months and children's internalizing problems at 24 months. Multilevel structural equation models indicated that mother-infant dyads demonstrated significant and positive RSA synchrony on average and RSA synchrony significantly moderated the association between maternal depressive symptoms and children's internalizing problems even after controlling for infant negative affect. Greater maternal depressive symptoms were associated with higher child internalizing problems when RSA synchrony was lower but not when it was higher. This finding suggests that mother-infant RSA synchrony may operate as a resilience factor for the intergenerational transmission of internalizing symptoms in community samples.

School principals’ perceptions of autonomy and control in low-SES communities - navigating local school administration on the front line

ABSTRACT In the decentralized Swedish school system, the local education authority (LEA) level has an important position when it comes to school governance. This article takes a micro-level perspective on principals’ perceptions of autonomy and control as they navigate local school administration in their front-line work in low – socio-economic status (SES) communities. The point of departure is taken in a multidimensional understanding of principal autonomy and street level bureaucracy. Empirical data consist of group conversations among principals, all of them working in a highly segregated Swedish city. The analysis shows that the principals perceive local school administration to be dominated by uniformity expressed through digitalization and specialization lacking contextual adaption. This orientation gives the principals a sense of local school administration being controlling and non-supportive. In addition, lack of adaption to the specific conditions of the low-SES community context tend to increase the principals’ workload and further restrict their autonomy. To cope with the situation and still deliver the education the students are entitled to, the principals act pragmatically in an innovative way. Based on contextual awareness they delay demands, deviate from routines and come up with alternative solutions, hence expanding their autonomy and intensifying their professional judgement.

Screening for parent and child ADHD in urban pediatric primary care: pilot implementation and stakeholder perspectives

BackgroundADHD commonly co-occurs in children and parents. When ADHD is untreated in parents, it contributes to negative child developmental and treatment outcomes. Screening for parent and child ADHD co-occurrence in pediatric primary care may be an effective strategy for early identification and treatment. There is no data on whether this screening model can be implemented successfully and there exists limited guidance on how to effectively approach parents about their own ADHD in pediatric settings. Even greater sensitivity may be required when engaging with families living in urban, low SES communities due to systemic inequities, mistrust, and stigma.MethodsThe current pilot study described the first 6 months of implementation of a parent and child ADHD screening protocol in urban pediatric primary care clinics serving a large population of families insured through Medicaid. Parents and children were screened for ADHD symptoms at annual well-child visits in pediatric primary care clinics as part of standard behavioral health screening. Independent stakeholder group meetings were held to gather feedback on factors influencing the implementation of the screening and treatment strategies. Mixed methods were used to examine initial screening completion rates and stakeholder perspectives (i.e., parents, primary care office staff, pediatricians, and behavioral health providers) on challenges of implementing the screening protocol within urban pediatric primary care.ResultsScreening completion rates were low (19.28%) during the initial 6-month implementation period. Thematic analysis of stakeholder meetings provided elaboration on the low screening completion rates. Identified themes included: 1) divergence between provider enthusiasm and parent hesitation; 2) parent preference versus logistic reality of providers; 3) centering the experiences of people with marginalized identities; and 4) sensitivity when discussing parent mental health and medication.ConclusionsFindings highlight the importance of developing flexible approaches to screening parent and child ADHD in urban pediatric health settings and emphasize the importance of cultural sensitivity when working with marginalized and under-resourced families.Trial registrationNCT04240756 (27/01/2020).

Overall and sex‐specific AT(N) biomarker prevalence in a low SES community: A population‐based study

AbstractBackgroundMost previous studies of amyloid[A], tau[T], and/or neurodegeneration[(N)] prevalence have been completed in highly selected samples, leaving low SES older adults from medically underserved areas underrepresented in research. Furthermore, women consistently have greater T and sometimes greater A accumulation than men, but clear characterizations of AT(N) biomarker positivity overall and by sex in different populations are lacking.MethodsNeuroimaging (NI) sub‐study participants in a population‐representative study of older adults from a low SES, medically underserved US Rust Belt area underwent PET and MRI. We calculated overall and sex‐specific AT(N) biomarker positivity within the NI sub‐study (Table 2) and population‐representative prevalence (Table 3) with inverse probability of selection weighting (IPSW). We calculated age and education adjusted odds ratios (ORs) for women vs men.ResultsThe overall sample (N = 1226) was 61% female, 94% white, and 98% dementia‐free. NI study participants (N = 115) were older, likelier to be from the parent study’s original (vs. replenishment) cohort, and less likely to report diabetes than non‐NI participants (N = 1111; Table 1). IPSW based on variables associated with AT(N) biomarkers (age, cohort, sex, race, education, hypertension, diabetes, and number of medications) successfully balanced these characteristics across NI and non‐NI samples. Population‐weighted prevalence of the A‐T‐(N)‐ profile was 18.8%. Based on 2018 NIA‐AA Research Framework terminology, prevalence of AD continuum biomarkers (any A+) was 24.4%; about 2/3 of these cases were specifically due to AD (A+T+ biomarkers). Prevalence of any T+ was 34.7%, and any (N)+ was the most common at 63.0%. Prevalence of A‐ with T+ and/or (N)+ was 56.8%. Any T+ and AD continuum/AD+ biomarkers were non‐significantly more common in women than men (weighted ORs ranging from 1.20 to 1.69, Table 3).ConclusionsCompletely normal AD biomarkers (A‐T‐(N)‐) were comparatively rare in older participants in this community, while any N+ and A‐ with T+ and/or (N)+ were quite common. Women trended toward a greater prevalence of AD+ biomarkers than men. These results are more applicable to other primarily white, low SES, and medically underserved populations than results from highly selected samples. Characterizing brain health across varying cohorts is essential to advance precision medicine and population health.

Generating data to facilitate more equitable distribution of health resources: an illustration of how local health surveys can identify probable need in mixed socio-economic regions

ObjectivesThis study aimed to (1) encourage allocation of governmental and grant funds to the administration of local area health surveys and (2) illustrate the predictive impact of socio-economic resources on adult health status at the local area level to provide an example of how health surveys can identify residents with the greatest health needs. Study designRandomly sampled and weight-adjusted regional household health survey (7501 respondents) analyzed with categorical bivariate and multivariate statistics, combined with Census data. Survey sample consists of the lowest, highest, and near highest ranked counties in the County Health Rankings and Roadmaps for Pennsylvania. MethodsSocio-economic status (SES) is measured regionally with Census data consisting of seven indicators and individually with Health Survey data consisting of five indicators based on poverty level, overall household income, and education. Both of these composite measures are examined jointly for their predictive effects on a validated health status measure using binary logistic regression. ResultsOnce county-level measures of SES and health status are broken down into smaller areas, better identification of pockets of health need is possible. This was most strongly revealed in an urban county, Philadelphia, which is ranked lowest of 67 counties on health measures in the state of Pennsylvania, yet when broken down into ‘neighborhood clusters’ contained both the highest- and lowest-ranked local area in a five-county region. Overall, regardless of the SES level of the County subdivision one lives in, a low-SES adult has close to six times greater odds of reporting ‘fair or poor health status’ than does a high-SES adult. ConclusionLocal health survey analysis can lead to a more precise identification of health needs than surveys attempting to cover broad areas. Low-SES communities within counties, and low-SES individuals, regardless of the community they live in, are substantially more likely to experience fair to poor health. This adds urgency to the need to implement and investigate socio-economic interventions, which can hopefully improve health and save healthcare costs. Novel local area research can identify the impact of intervening variables such as race in addition to SES to add more specificity in identifying populations with the greatest health needs.

Changes over Time in COVID-19 Vaccination Inequalities in Eight Large U.S. Cities.

The authors estimate the associations between community socioeconomic composition and changes in coronavirus disease 2019 (COVID-19) vaccination levels in eight large cities at three time points. In March, communities with high socioeconomic status (SES) had significantly higher vaccination rates than low-SES communities. Between March and April, low-SES communities had significantly lower changes in percentage vaccinated than high-SES communities. Between April and May, this difference was not significant. Thus, the large vaccination gap between communities during restricted vaccine eligibility did not narrow when eligibility opened up. The link between COVID-19 vaccination and community disadvantage may lead to a bifurcated recovery whereby advantaged communities move on from the pandemic more quickly while disadvantaged communities continue to suffer.

PSUN276 GLP1RAs use for treating NALFD in a multidisciplinary clinic in low socioeconomic community

Abstract GLP1RAs have been proven beneficial for weight loss in patients with NAFLD with or without Diabetes. However, such use is limited due to cost and limited insurance coverage in those without diabetes. Method: Retrospective chart review of patients with NAFLD seen at Multidisciplinary NAFLD clinic in Low SES community Result: A total of 11 patients (55% Female, mean age 49.2±13.8 yrs, BMI 39.3±7.8 kg/m2) diagnosed with NAFLD were seen by hepatologist, endocrinologist and dietician and instructed and counseled for lifestyle modification aiming for at least 5% weight loss within 6 months. Five had diabetes with A1C 6.7% to 8.3%, and the remaining had Pre-Diabetes. Semaglutide 1 mg weekly SC was used in 8 patients (72.3%), liraglutide 3 mg qd in 1 patient, metformin in 1 patient, generic phentermine topiramate in 1 patient. Initial data of SBP(mean 129±9.0 mmHg), LDL (mean 97.8±31.6 mmol/L), TAGs (mean 193.6±109.6 mg/dl), AST (mean 43.5±21.8 U/L), and ALT (mean 50.8±25.9 U/L) were collected and followed at 6 and 12 months. Among 8 patients with complete 1 year data, all except one (87.5%) achieved weight loss goal at least 5% at 6 and 12 months. Among Five patients with greatest weight lost 14-20% at 1 year with significant improvement in metabolic panels, 80% of them were on GLP1RA. At 6 months and 12 months mean SBP was 125.3±5.8 and 123.9±10.3 mmHg, mean LDL was 75.5±16.4 and 71.4±21.2 mmol/L, mean TAGs was 161.2±114.5 and 158.7±90.9 mg/dl, mean AST was 19.4±4.0 and 19.4±4.5 U/l, and mean ALT was 26.7±8.3 and 33±16.1 U/L respectively. Conclusion In this case series from our multidisciplinary NAFLD clinic, we observed the achievement of weight loss goal and improved clinical parameters by 12 months. The clinic can be beneficial in low SES community. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

956-P: Integrating an Evidence-Based Diabetes Digital Texting Program (Dulce Digital) via an EMR Patient Portal in a Large Health System

Dulce Digital (DD) , a simple low-cost text message program designed to enhance clinical diabetes care with educational, motivational and glucose reminder messages when delivered 2-3 times/day over 6 months has been shown to be highly acceptable in diverse racial/ethnic minorities and low SES communities and results in a mean 1% reduction in HbA1c compared to usual care. During the COVID pandemic, barriers to in-person care, including quarantines, stay-at-home work schedules, childcare, and transportation, make digital messaging a practical means of improving patient health. To maximize reach in the T2DM population, a large Southern California health care provider integrated DD into their DSME/S offering. This study aims to learn the reach, acceptability, and effectiveness of Dulce Digital in a real-world patient care setting to motivate patients with daily self-care behaviors. An existing diabetes registry identified N=1423 patients with T2DM and HbA1c&amp;gt;7.5% in the last 6 months. There was enthusiastic adoption of the DD texting program byprimary care clinic sites with 78 providers across the County. Patient recruitment was conducted via a patient portal message (EPIC My Chart) sent from healthcare providers encouraging participation in the program. Within one week of portal outreach, 116 patients (8.2%) enrolled (mean age = 57.3 y/o +/- 14.4, range 24-92; 50% female; mean HbA1c= 9.9 % +/- 1.5, range 8.1-16.2) . Program workflows include using support staff to monitor blood glucose responses in the texting platform, assess possible reasons for hyper/hypoglycemia, and encourage follow up with a provider as needed. Adoption by patients and providers to date demonstrate a digital texting program is acceptable and desired equally by men and women across a wide range of ages in patients with T2D and elevated HbA1c. Outreach to enroll patients using a patient EMR portal can be successful and can serve as an enhanced approach to support DSME/S. Disclosure M.Ruiz: n/a. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. H.Sandoval: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. M.A.Stechschulte: None. S.R.Bagsic: None. K.Patel: None. K.Mendez: None.

Effectiveness of a Low-Cost Solution to Increase Utilization of Community Resources in Preventing Food Insecurity

ObjectivesFood insecurity affected roughly 10.5% of U.S. households in 2020, according to the USDA Economic Research Service. There is limited evidence regarding the effectiveness of educational resources provided to low-socioeconomic status (SES) individuals to curb food insecurity. This study aimed to identify the effectiveness of a practical education session regarding how to access affordable, nutrient-dense foods for those affected by food insecurity. MethodsA total of 102 subjects, aged 32–69 years in low-SES communities participated in a 5-minute nutrition and resource education session. The education session focused on nutrition knowledge, self-efficacy in locating purchase sites with nutrient-dense foods, and self-efficacy in identification of resources that can be utilized for acquiring nutrient-dense foods. Each participant completed a demographic and 5-point, 3-question pretest and posttest survey. The survey measured self-reported understanding of a healthy diet, where to purchase nutrient-dense foods locally, and how to utilize local resources to acquire nutrient-dense foods. Pre-survey data collection and the education session was performed in-person; post-survey data was collected by telephone. Analysis was conducted through Stata with significance at p < 0.05. ResultsMean pretest to posttest scores increased significantly for self-reported understanding of a healthy diet (p = 0.000), where to purchase nutrient-dense foods locally (p = 0.000), and how to utilize local resources to acquire nutrient-dense foods (p = 0.000). ConclusionsNutrition and resource education play a valuable role in enabling low-SES individuals to access and consume nutrient-dense food. Funding SourcesNone.

The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China

BackgroundThere was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.MethodsUsing data from the China Health and Retirement Longitudinal 2011–2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.ResultsCommunity SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.ConclusionsThis study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

Interventions on Socioeconomic and Racial Inequities in Respiratory Pandemics: a Rapid Systematic Review.

Purpose of ReviewRacial and socioeconomic inequities in respiratory pandemics have been consistently documented, but little official guidance exists on effective action to prevent these. We systematically reviewed quantitative evaluations of (real or simulated) interventions targeting racial and socioeconomic inequities in respiratory pandemic outcomes.Recent FindingsOur systematic search returned 10,208 records, of which 5 met inclusion criteria, including observational (n = 1), randomized trial (n = 1), and simulation (n = 3) studies. Interventions studied included vaccination parity, antiviral distribution, school closure, disinfection, personal protective equipment, and paid sick leave, with a focus on Black (n = 3) and/or Latinx (n = 4) or low-SES (n = 2) communities. Results are suggestive that these interventions might be effective at reducing racial and/or SES disparities in pandemics.SummaryThere is a dearth of research on strategies to reduce pandemic disparities. We provide theory-driven, concrete suggestions for incorporating equity into intervention research for pandemic preparedness, including a focus on social and economic policies.

Selecting Picture Books for EL beginners in Panama: Tellability

AbstractTeachers spend a lot of time finding ‘just right’ picture books for their students. However, much of what is known about a book's difficulty level was developed with native English speakers. More needs to be developed with the distinctive characteristics of English Learners (ELs). This study reports on the selection of picture books to teach in an intensive week‐long intervention with Spanish‐speaking ELs in a low SES community in Panama. It applies the concept of tellability rather than readability. Tellability considers who is speaking about what to whom and in what circumstances. Novice teachers who were not fluent in Spanish learned to successfully select and instruct using carefully selected books for teaching English in science‐themed lessons. These teachers considered features of books that matched the ELs’ oral and written English abilities as well as matched specific language teaching strategies for EL beginners.

Process evaluation and challenges in collecting data from an after-school sports and literacy program in a diverse, low-income community

BackgroundTo understand how programs succeed we must evaluate them. The purpose of this paper was to examine the intervention and evaluation processes and identify areas of success and challenges in delivering and evaluating the Reflective Educational Approach to Character and Health (REACH) after-school program in a low SES community. MethodsSixty-six fifth and sixth graders from two schools participated. Data were collected at the intervention and control schools at four time points over the year. Data collected at baseline (Aug/Sep 2016), and Time 4 (May, 2017) were used for the analysis. Reach and fidelity to the intervention were assessed along with information on the process of data collection for variables of interest (e.g., accelerometer-measured physical activity level, FITNESSGRAM tests, vertical jump, and literacy). Missing data were imputed and a 2(School) by 2(Time) mixed factorial ANOVA was performed to examine the efficacy of the intervention. ResultsThere were no significant time by school interactions for any of the outcomes assessed. There were several challenges in evaluating the program such as low compliance to wearing the accelerometer, lack of effort during literacy tests, peers affecting effort on physical tests, and missing data. ConclusionsWe posit that research implementation be re-examined in community-based research that is conducted with students at the elementary level in low-income communities. Future research should engage with youth in the data collection process to make it a meaningful experience for them and to possibly reduce attrition from the program.