low-SES Participants Research Articles

Lower Childhood Socioeconomic Status Is Associated with Greater Neural Responses to Ambient Auditory Changes in Adulthood.

Humans' early life experience varies by socioeconomic status (SES), raising the question of how this difference is reflected in the adult brain. An important aspect of brain function is the ability to detect salient ambient changes while focusing on a task. Here, we ask whether subjective social status during childhood is reflected by the way young adults' brain detecting changes in irrelevant information. In two studies (total n = 58), we examine electrical brain responses in the frontocentral region to a series of auditory tones, consisting of standard stimuli (80%) and deviant stimuli (20%) interspersed randomly, while participants were engaged in various visual tasks. Both studies showed stronger automatic change detection indexed by MMN in lower SES individuals, regardless of the unattended sound's feature, attended emotional content, or study type. Moreover, we observed a larger MMN in lower-SES participants, although they did not show differences in brain and behavior responses to the attended task. Lower-SES people also did not involuntarily orient more attention to sound changes (i.e., deviant stimuli), as indexed by the P3a. The study indicates that individuals with lower subjective social status may have an increased ability to automatically detect changes in their environment, which may suggest their adaptation to their childhood environments.

Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data

BackgroundGiven limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations.MethodsRetrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort’s distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial’s intervention was targeted (national).ResultsRecruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001).ConclusionsSignificant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials.Trial registrationNCT01581476. Registered on 20 April 2012.

Race- and Gender-Specific Associations between Neighborhood-Level Socioeconomic Status and Body Mass Index: Evidence from the Southern Community Cohort Study.

Obesity and a low socioeconomic status (SES), measured at the neighborhood level, are more common among Americans of Black race and with a low individual-level SES. We examined the association between the neighborhood SES and body mass index (BMI) using data from 80,970 participants in the Southern Community Cohort Study, a cohort that oversamples Black and low-SES participants. BMI (kg/m2) was examined both continuously and categorically using cut points defined by the CDC. Neighborhood SES was measured using a neighborhood deprivation index composed of census-tract variables in the domains of education, employment, occupation, housing, and poverty. Generally, the participants in lower-SES neighborhoods were more likely to have a higher BMI and to be considered obese. We found effect modification by race and sex, where the neighborhood-BMI association was most apparent in White female participants in all the quintiles of the neighborhood SES (ORQ2 = 1.55, 95%CI = 1.34, 1.78; ORQ3 = 1.71, 95%CI = 1.48, 1.98; ORQ4 = 1.76, 95%CI = 1.52, 2.03; ORQ5 = 1.64, 95%SE = 1.39, 1.93). Conversely, the neighborhood-BMI association was mostly null in Black male participants (ORQ2 = 0.91, 95%CI = 0.72, 1.15; ORQ3 = 1.05, 95%CI = 0.84, 1.31; βQ4 = 1.00, 95%CI = 0.81, 1.23; ORQ5 = 0.76, 95%CI = 0.63, 0.93). Within all the subgroups, the associations were attenuated or null in participants residing in the lowest-SES neighborhoods. These findings suggest that the associations between the neighborhood SES and BMI vary, and that other factors aside from the neighborhood SES may better predict the BMI in Black and low-SES groups.

Disparities in greenspace associated with sleep duration among adolescent children in Southern California.

In 2010, a total of 1476 Southern California Children's Health Study (CHS) participants in grades 9 and 10 (mean age, 13.4 years; SD, 0.6) completed a questionnaire including topics on sleep and psychosocial stress. Exposures to greenspace, artificial light at night (ALAN), nighttime noise, and air pollution were estimated at each child's residential address, and SES was characterized by maternal education. Odds ratios and 95% confidence intervals (95% CIs) for sleep outcomes were estimated by environmental exposure, adjusting for age, sex, race/ethnicity, home secondhand smoke, and SES. An interquartile range (IQR) increase in greenspace decreased the odds of not sleeping at least 8 hours (odds ratio [OR], 0.86 [95% CI, 0.71, 1.05]). This association was significantly protective in low SES participants (OR, 0.77 [95% CI, 0.60, 0.98]) but not for those with high SES (OR, 1.16 [95%CI, 0.80, 1.70]), interaction P = 0.03. Stress mediated 18.4% of the association among low SES participants. Residing in urban neighborhoods of greater greenness was associated with improved sleep duration among children of low SES but not higher SES. These findings support the importance of widely reported disparities in exposure and access to greenspace in socioeconomically disadvantaged populations.

Moving well-being well: Using machine learning to explore the relationship between physical literacy and well-being in children.

Physical literacy provides a foundation for lifelong engagement in physical activity, resulting in positive health outcomes. Direct pathways between physical literacy and health have not yet been investigated thoroughly. Associations between physical literacy and well-being in children (n= 1073, mean age 10.86 ± 1.20 years) were analysed using machine learning. Motor competence (TGMD-3 and BOT-2) and health-related fitness (PACER and plank) were assessed in the physical competence domain. Motivation (adapted-Behavioural Regulation in Exercise Questionnaire) and confidence (modified-Physical Activity Self-Efficacy Scale) were assessed in the affective domain. Well-being was measured using the KIDSCREEN-27. Accuracy of predicting well-being from physical literacy was investigated using five machine learning classifiers (decision tree, random forest, XGBoost, AdaBoost, k-nearest neighbour) in the full sample and across subgroups (sex, socioeconomic status [SES], age). XGBoost predicted well-being from physical literacy with an accuracy of 87% in the full sample. Predictive accuracy was lowest in low SES participants. Contribution of physical literacy features differed substantially across subgroups. Physical literacy predicts well-being in children but the relative contribution of physical literacy features to well-being differs substantially between subgroups.

A South African adaptation of the international affective picture system: The influence of socioeconomic status and education level on picture ratings.

The International Affective Picture System (IAPS) is used globally in emotion research. However, normative studies in diverse contexts do not consider the influence of education and socioeconomic status (SES) on picture ratings. We created the South African Affective Picture System (SA-APS) for use in low- and middle-income countries (LMICs) by replacing some original IAPS images with pictures featuring more diverse groups of people and culturally appropriate stimuli. Healthy South African adults from higher and lower education/SES backgrounds (n = 80; n = 70 respectively) provided valence and arousal ratings for 340 images from the original IAPS and 340 images from the new SA-APS. Overall, their ratings of SA-APS images were better aligned with the US normative standards than their ratings of IAPS images, particularly with regard to valence. Those with higher SES/education rated IAPS images differently from those with lower SES/education (e.g., valence ratings of the latter were similar to US normative standards, whereas those of the former were more negative). Regression modelling indicated that sex and SES significantly predicted the current sample's IAPS and SA-APS ratings (e.g., women and higher-SES participants rated high-arousal images as being significantly more arousing than men and lower-SES participants); hence, we created regression-based norms for both picture sets. These norms are especially useful in emotion research, because few studies emerge from LMICs, and few instruments account for substantial sociodemographic diversity. Extending the reach of tools such as the IAPS to LMICs can help ensure a more globally representative body of research in this field.

Long-COVID and comorbid depression and anxiety two years into the COVID-19 pandemic

Long-COVID, or the persistence of COVID-19 symptoms for months after initial infection, has been shown to impact the lives of those affected. The current study sought to investigate the relationships between long-COVID, COVID-19 related stress, depression, anxiety, and comorbid depression and anxiety outcomes. Data were collected in Winter 2021-2022 from a population of adults enrolled in at least one course across multiple City University of New York (CUNY) campuses. Frequencies and chi-square tests were computed to assess for demographics and relationships to probable diagnoses of depression and anxiety, and binary logistic regressions were computed to assess for the odds of probable comorbid depression and anxiety based on demographics, stressors, and long-COVID. Women participants reported higher odds of probable depression outcomes, and stressor levels were significant correlates of probable anxiety outcomes. Women participants, 3.2 [1.5-6.9], as compared to men, lower-SES participants, 2.16 [1.1-4.2], as compared to higher-SES participants, participants with higher COVID-19 related stress levels, 4.8 [2.0-12.0], as compared to those with low levels, and participants with long-COVID, 3.7 [1.9-7.0], as compared to those without, all had higher odds of probable comorbid depression and anxiety. Findings highlight the importance of social location, stress, and long-COVID, in tandem, as correlates of psychological health during the shifting pandemic.

Cross-dimensional assimilation effect in facial trustworthiness evaluation: The asymmetry of in-group favoritism under the moderation of socioeconomic status

<p indent="0mm">It is common for within-dimensional assimilation effect in the social evaluation of faces under social context. Recent studies have also found a cross-dimensional assimilation effect in the facial trustworthiness evaluation with the socioeconomic status (SES) background information as social context. However, whether the SES of evaluators moderates this cross-dimensional assimilation effect remains unclear, since the relationship between evaluators and evaluatees has largely been ignored in studies of the assimilation effect. Therefore, the present study aimed to investigate whether the SES of evaluators moderates the impact of the SES background information for evaluated faces on facial trustworthiness evaluation, and thereby to explore the broader theoretical issue on the interaction between evaluator and evaluatee on assimilation effect. There were two phases in the experiment. In the first phase, participants completed a status-color association training task, to learn how to associate colored backgrounds (purple/blue) with different levels of SES (high-SES/low-SES). This was to enable the participants to accurately perceive the SES information of the evaluated faces based on the background color in the subsequent evaluative task. In the second phase, they completed a facial trustworthiness rating task that used a 100-point scale to evaluate the trustworthiness of the faces displayed on colored backgrounds indicating high- or low-SES (<italic>T</italic>_high-SES/<italic>T</italic>_low-SES). After that, the facial trustworthiness baseline (<italic>T</italic>₀) was also measured by presenting participants the isolated faces without the colored backgrounds. The cross-dimensional assimilation effect of SES information of evaluated faces on facial trustworthiness (<italic>T</italic>_change) was calculated as follows: <italic>T</italic>_change=<italic>T</italic>_high-SES–<italic>T</italic>₀ or <italic>T</italic>₀–<italic>T</italic>_low-SES. One-sample <italic>t</italic>-test analysis revealed that the presence of high/low SES background information for the evaluated faces led to the evaluators’ trustworthiness evaluation being closer to the faces’ SES background information. That is, both the high and low SES information for the evaluated faces led to a significant assimilation effect on facial trustworthiness evaluation. But the assimilation of low SES information among low-SES participants is non-significant. Furthermore, a 2 (SES background information for evaluated faces: High vs. low) × 2 (SES of evaluators: High vs. low) repeated-measures ANOVA of the <italic>T</italic>_change showed a significant interaction of evaluators and evaluatees’ SES. Simple effect analysis revealed that the assimilation of low-SES information on facial trustworthiness evaluation among low-SES participants is significantly smaller than that among high-SES participants, which was also supported by the item-based ANOVA analysis. In summary, the results of the experiment suggested: (1) Both high-SES and low-SES information for evaluated faces exerted an assimilation effect on facial trustworthiness evaluation; (2) the assimilation effect is moderated by the SES of evaluators with an asymmetry of the in-group favoritism among high-SES evaluators and low-SES evaluators. The present study also contributed to the literature on the assimilation effect, by showing that: (1) Assimilation effect can occur not only between context and evaluative targets in the within dimension but also in cross-dimensions; (2) the social relationship between evaluator and evaluatee should be taken into account when evaluating the assimilation effect of social context.

Population variation in social brain morphology: Links to socioeconomic status and health disparity

ABSTRACT Health disparity across layers of society involves reasons beyond the healthcare system. Socioeconomic status (SES) shapes people’s daily interaction with their social environment and is known to impact various health outcomes. Using generative probabilistic modeling, we investigate health satisfaction and complementary indicators of socioeconomic lifestyle in the human social brain. In a population cohort of ~10,000 UK Biobank participants, our first analysis probed the relationship between health status and subjective social standing (i.e., financial satisfaction). We identified volume effects in participants unhappy with their health in regions of the higher associative cortex, especially the dorsomedial prefrontal cortex (dmPFC) and bilateral temporo-parietal junction (TPJ). Specifically, participants in poor subjective health showed deviations in dmPFC and TPJ volume as a function of financial satisfaction. The second analysis on health status and objective social standing (i.e., household income) revealed volume deviations in regions of the limbic system for individuals feeling unhealthy. In particular, low-SES participants dissatisfied with their health showed deviations in volume distributions in the amygdala and hippocampus bilaterally. Thus, our population-level evidence speaks to the possibility that health status and socioeconomic position have characteristic imprints in social brain differentiation.

Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies.

In recent decades, increased attention has been paid to the impact of socioeconomic status (SES) on cognition function and dementia, however, an ongoing debate continues to exist. The objective of our study was to explore the potential effect of SES on the risks of cognitive dysfunction and dementia. PubMed, Cochrane Library, and EMBASE were searched for prospective studies from inception to 9 January 2022. Meta-analyses using random-effect models were performed, and then subgroup analyses stratified by study characteristics for specific outcomes were conducted. Thirty-nine prospective studies (1,485,702 individuals) were eligible for inclusion, of which 25 reported the incidence of dementia and 14 reported cognitive decline. Primary results of the meta-analyses found an elevated combined risk of cognitive impairment and dementia (relative risk [RR] = 1.31, 95% confidence interval [CI] = 1.16-1.49) in low-SES participants compared with high-SES participants. We also found an elevated risk of all-cause dementia (RR = 1.40, 95% CI = 1.12-1.74) in low-SES participants. Further subgroup analyses stratified by education, occupation, and income showed that low education subgroup (RR = 1.21, 95% CI = 1.04-1.41) and low-income subgroup (RR = 1.22, 95% CI = 1.10-1.35) had an increased combined risks of cognitive impairment and dementia, but only individuals with lower education had a higher risk of dementia (RR = 1.66, 95% CI = 1.20-2.32). Low SES substantially increased the risk of dementia and cognitive dysfunction, suggesting that public health strategies could reduce the dementia burden by reducing social inequalities.

Socioeconomic status as an effect modifier of the association between built environment and mortality in elderly Hong Kong Chinese: A latent profile analysis

BackgroundPrevious studies have focused on associations between individual built environment (BE) characteristics and mortality, and found the BE-mortality associations differed by socioeconomic status (SES). Different individual BE characteristics may have different impacts on health and thus could interact. Combinations of BE characteristics may be a better approach to explore the BE-mortality associations. ObjectivesThis study aimed to investigate the associations of BE pattern with mortality in a prospective cohort of elderly Hong Kong Chinese (Mr. OS and Ms. OS Study), and assess whether the BE-mortality association differed by SES. MethodsBetween 2001 and 2003, 3944 participants aged 65–98 years at baseline were included in the present analysis. BE characteristics were assessed via Geographic Information System. Data on all-cause and cause-specific mortality were obtained from the Hong Kong Government Death Registry. Latent profile analysis was used to derive BE class, and the Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsThree BE classes were identified. During a total of 53276 person-years of follow-up, 1632 deaths were observed. There were no significant associations of BE class with all-cause and cause-specific mortality. However, we found the associations of BE class with all-cause mortality were modified by SES. In comparison with Class 3 (characterized by greater green space), HRs (95%CIs) were 0.72 (0.54, 0.97) for Class 1 (characterized by greater commercial land use) and 0.77 (0.64, 0.94) for Class 2 (characterized by greater residential land use) among low-SES participants. The associations were stronger among high-SES participants, with 0.55 (0.33, 0.89) for Class 1 and 0.68 (0.48, 0.97) for Class 2. In contrast, Class 2 (HR 1.18, 95%CI 1.01–1.39) had a higher mortality risk compared with Class 3 among middle-SES participants. ConclusionsOur findings provide new evidence on the role of SES as an effect modifier of BE pattern and mortality. BE pattern has a varied effect on mortality risk for different SES groups.

Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study.

BackgroundTypically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy).ObjectiveThis study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes.MethodsA participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes.ResultsQUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings.ConclusionsThis is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

Testing sampling bias in estimates of adolescent social competence and behavioral control

In 5 of the 6 large Dutch developmental cohorts investigated here, lower SES adolescents are underrepresented and higher SES adolescents overrepresented. With former studies clearly revealing differences between SES strata in adolescent social competence and behavioral control, this misrepresentation may contribute to an overestimation of normative adolescent competence. Using a raking procedure, we used national census statistics to weigh the cohorts to be more representative of the Dutch population. Contrary to our expectations, in all cohorts, little to no differences between SES strata were found in the two outcomes. Accordingly, no differences between weighted and unweighted mean scores were observed across all cohorts. Furthermore, no clear change in correlations between social competence and behavioral control was found. These findings are most probably explained by the fact that measures of SES in the samples were quite limited, and the low SES participants in the cohorts could not be considered as representative of the low SES groups in the general population. Developmental outcomes associated with SES may be affected by a raking procedure in other cohorts that have a sufficient number and sufficient variation of low SES adolescents.

Social and Demographic Patterns of Health-Related Internet Use Among Adults in the United States: A Secondary Data Analysis of the Health Information National Trends Survey

National surveys of U.S. adults have observed significant increases in health-related internet use (HRIU), but there are documented disparities. The study aims to identify social and demographic patterns of health-related internet use among U.S. adults. Using data from the Health Information National Trends Survey (HINTS) 4 cycle 3 and HINTS 5 cycle 1, we examined HRIU across healthcare, health information seeking, and participation on social media. Primary predictors were gender, race/ethnicity, age, education, income, and nativity with adjustments for smoking and survey year. We used multivariable logistic regression with survey weights to identify independent predictors of HRIU. Of the 4817 respondents, 43% had used the internet to find a doctor; 80% had looked online for health information. Only 20% had used social media for a health issue; 7% participated in an online health support group. In multivariable models, older and low SES participants were significantly less likely to use the internet to look for a provider, use the internet to look for health information for themselves or someone else, and less likely to use social media for health issues. Use of the internet for health-related purposes is vast but varies significantly by demographics and intended use.

Feasibility of a social media-based weight loss intervention designed for low-SES adults.

Low-socioeconomic status (SES) individuals have higher rates of obesity. Social media platforms are used frequently by low-SES individuals and facilitate important weight loss program components including social support. Very few social media-based weight loss interventions, however, have enrolled or been tailored to low-SES participants. The purpose of this article is to examine the feasibility of a social media-based weight loss intervention among low-SES adults. We conducted a one-group pretest post-test pilot intervention study with two groups (group 1, n = 39, group 2, n = 16) of low-SES overweight/obese adults who were enrolled in a 12-week social media-based weight loss intervention including self-monitoring via Fitbits and participation in a private Facebook group. A moderator provided educational content and encouraged social support via Facebook. Descriptive statistics were used to assess intervention acceptability and engagement. Exploratory analyses were conducted to examine changes in study outcomes and engagement patterns. The study had good retention (86%). Among 55 total participants enrolled, there were 9,175 participant interactions within the Facebook group. Among completers (n = 47), 96% indicated they would recommend the intervention to a friend. Mean weight loss was 1.07 kg (SD = 3.96, p = .0498), and participants reported increases in positive dietary social support (mean = 2.47, SD = 5.09, p = .0007). Engagement in this social media-based pilot intervention was high and exceeded results from previous studies using similar formats. Participants evaluated the intervention favorably. Changes in weight loss and several theoretical mediators were in the desired direction. Overall, our results indicate social media groups as a platform for weight loss intervention delivery among low-SES adults are feasible and should be studied in larger randomized trials.

ECONOMIC INEQUALITY AND FUTURE THOUGHT AMONG OLDER ADULTS

Cumulative advantage theory sees inequality extending into later life. Does inequality also extend to the imagination of one’s future and desires for life yet to come? We draw from semi-structured interviews with 55 individuals residing in Midwest cities to explore differences in talk about finances and expectations for longevity, fulfillment, and “active” pursuits. Addressing personal futures, participants’ desires for longevity varied. Lower SES individuals discussed not having expected to live to their current age (or much beyond it) and not wanting to live a long time. Higher SES individuals, by contrast, expressed confidence that they could afford care no matter how long they lived. Higher SES participants often described future leisure goals whereas lower SES participants tended not to name leisure goals, or they named activities they desired but could not afford. For low SES individuals, active pursuits also were limited by diseases disproportionately affecting poor Americans, such as diabetes.

Comparing in person and internet methods to recruit low-SES populations for tobacco control policy research

Tobacco use and the associated consequences are much more prevalent among low-SES populations in the U.S. However, tobacco-based research often does not include these harder-to-reach populations. This paper compares the effectiveness and drawbacks of three methods of recruiting low-SES adult smokers in the Northeast. From a 5-year, [funding blinded] grant about impacts of graphic warning labels on tobacco products, three separate means of recruiting low-SES adult smokers emerged: 1) in person in the field with a mobile lab vehicle, 2) in person in the field with tablet computers, and 3) online via Amazon Mechanical Turk (MTurk). We compared each of these methods in terms of the resulting participant demographics and the “pros” and “cons” of each approach including quality control, logistics, cost, and engagement. Field-based methods (with a mobile lab or in person with a tablet) yielded a greater proportion of disadvantaged participants who could be biochemically verified as current smokers—45% of the field-based sample had an annual income of <$10,000 compared to 16% of the MTurk sample; 40–45% of the field-based sample did not complete high school compared to 2.6% of the MTurk sample. MTurk-based recruitment was substantially less expensive to operate (1/14th the cost of field-based methods) was faster, and involved less logistical coordination, though was unable to provide immediate biochemical verification of current smoking status. Both MTurk and field-based methods provide access to low-SES participants–the difference is the proportion and the degree of disadvantage. For research and interventions where either inclusion considerations or external validity with low-SES populations is critical, especially the most disadvantaged, our research supports the use of field-based methods. It also highlights the importance of adequate funding and time to enable the recruitment and participation of these harder-to-reach populations.

The BeHealthyR Study: a randomized trial of a multicomponent intervention to reduce stress, smoking and improve financial health of low-income residents in Rotterdam

BackgroundCompared to higher socioeconomic status (SES) groups, those in lower SES groups are financially strained, experience higher rates of smoking-related morbidity, are in poorer health and have reduced life expectancy. This is especially true for the city of Rotterdam, where a large inequality in health is observed between low and high SES groups. The BeHealthyR study (Dutch: Grip en Gezondheid) is a randomized controlled trial (RCT) which will evaluate the impact of a theory-based multicomponent behavior intervention aiming to reduce stress, smoking, and improve financial health by means of a group-based stress management program combining cognitive and behavioral techniques, and nudges in low-SES residents living in Rotterdam.MethodsThe BeHealthyR study is a three-arm RCT. Between February 2018 and July 2019, low-SES participants who perceive stress, smoke, are financially strained and reside in Rotterdam (one of the four largest cities in The Netherlands) are recruited. Subsequently, participants are randomly assigned to either a stress management condition (SM), stress management with a buddy condition (SM-B) or a control condition (CC). Participants in the SM and SM-B conditions will attend four weekly group sessions (1.5 h/session) and a follow-up session eight weeks later. The SM condition includes psychoeducation and exercises, and cognitive and behavioral intervention techniques. Demographic data and objective measures will be collected at baseline (T0), four weeks post-baseline (T1), and twelve weeks post-baseline (T2). Primary outcome measures are to reduce stress, smoking and improve financial health. We hypothesize that low-SES participants in the intervention conditions, compared with those in the control condition, will experience less stress, smoke less and have improved financial health.DiscussionThis study is a group-based intervention which aims to investigate the effects of a theory-based behavioral change intervention employing several components on reducing stress, smoking, and improving financial health in low-SES residents living in Rotterdam. If effective, the findings from the present study will serve to inform future directions of research and clinical practice with regard to behavioral change interventions for low-SES groups.Trial registrationClinicalTrials.gov (ID: NCT03553979). Registered on January 1 2018.

Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health.

Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans. We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets. Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument. In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans. Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.

Characterizing internet health information seeking strategies by socioeconomic status: a mixed methods approach

BackgroundThe Internet is valuable for those with limited access to health care services because of its low cost and wealth of information. Our objectives were to investigate how the Internet is used to obtain health-related information and how individuals with differing socioeconomic resources navigate it when presented with a health decision.MethodsStudy participants were recruited from public settings and social service agencies. Participants listened to one of two clinical scenarios – consistent with influenza or bacterial meningitis – and then conducted an Internet search. Screen-capture video software captured the Internet search. Participant Internet search strategies were analyzed and coded for pre- and post-Internet search guess at diagnosis and information seeking patterns. Individuals who did not have a college degree and were recruited from locations offering social services were categorized as “lower socioeconomic status” (SES); the remainder was categorized as “higher SES.” Participants were 78 Internet health information seekers, ranging from 21–35 years of age, who experienced barriers to accessing health care services.ResultsLower-SES individuals were more likely to use an intuitive, rather than deliberative, approach to Internet health information seeking. Lower- and higher-SES participants did not differ in the tendency to make diagnostic guesses based on Internet searches. Lower-SES participants were more likely than their higher-SES counterparts to narrow the scope of their search.ConclusionsOur findings suggest that individuals with different levels of socioeconomic status vary in the heuristics and search patterns they rely upon to direct their searches. The influence and use of credible information in the process of making a decision is associated with education and prior experiences with healthcare services. Those with limited resources may be disadvantaged when turning to the Internet to make a health decision.