Low Socioeconomic Neighborhoods Research Articles

Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study.

BackgroundInnovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods.ObjectiveThe primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation.MethodsThe proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3’s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5’s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers.ResultsThe National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021.ConclusionsFindings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health.International Registered Report Identifier (IRRID)PRR1-10.2196/29191

Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population

BackgroundFew studies assess use of parathyroidectomy among older adults with symptomatic primary hyperparathyroidism. Our objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. MethodsWe identified older adult patients with symptomatic primary hyperparathyroidism using Medicare claims (2006–2017). Primary study variables were race/ethnicity, rurality, and zip-code socioeconomic status. We calculated cumulative incidence of parathyroidectomy and used multivariable Cox proportional hazards regression models to assess the adjusted association of our study variables with parathyroidectomy. ResultsWe included 94,803 patients. The median age at primary hyperparathyroidism diagnosis was 76 years (interquartile range 71–82). The majority of patients were female (72%), non-Hispanic White (82%), from metropolitan areas (82%), and had a Charlson Comorbidity score ≥3 (62%). Nine percent of patients (n = 8,251) underwent parathyroidectomy during follow-up. After adjustment, non-Hispanic Black patients, compared to non-Hispanic White (hazard ratio 0.80; 95% confidence interval 0.74, 0.87), and living in a low socioeconomic status neighborhood (low socioeconomic status vs highest socioeconomic status hazard ratio 0.89; 95% confidence interval 0.83, 0.95) were both associated with lower incidences of parathyroidectomy. Patients from non-metropolitan areas were more likely to undergo parathyroidectomy. ConclusionParathyroidectomy is underused for symptomatic primary hyperparathyroidism in older adults. Quality improvement efforts, rooted in equitable care, should be undertaken to increase access to parathyroidectomy for this disease.

Evaluating Perception of Child Health and Safety Needs in a Community Through the Perspective of Caregivers and Physicians

Objective: To identify and compare child health and safety concerns in the community from the perspective of physicians and caregivers in Louisville. Design: We administered surveys to physicians and caregivers who were asked to list, via open-ended questions, the top three health or safety concerns they had for children in three separate age groups (≤ 3, 4-11, and ≥12 years old). Four reviewers assigned responses to a pre-specified category/subcategory through a schematic designed by the study team and a fifth reviewer addressed any discrepancies and assigned final categories. Agreement in assigning overall categories was measured using Fleiss Kappa and descriptive statistics were used to characterize the responses. Setting: Surveys were administered to caregivers who attended community events in Park Duvalle, a lower socioeconomic neighborhood in Louisville whose residents are predominantly black. Surveys were simultaneously administered to physicians throughout the University of Louisville/Norton Healthcare system. Participants: A total of 41 caregivers with at least one child and 43 physicians were surveyed in this study. Results: Overall categorical agreement between reviewers was k = 0.839, indicating good agreement on assignment. Injury/violence was identified by both caregivers and physicians as the top concern for children across all age groups. Wide variation was found when analyzing specific injury/violence subcategories, with caregivers more worried about household safety (17-40%) and gangs/unsafe neighborhoods (10-50%) while physicians were more concerned about sleep safety (36%), domestic violence (8-27%), and unintentional injury (10-20%). Conclusions: Survey administration was a feasible method of comparing health and safety concerns among caregivers and physicians. We identified injury/violence as the top health and safety concern across all age groups in our community but noted variation on the specific type of injury/violence. Replication of our study methodology in other neighborhoods may allow for improved comparison of caregiver and physician concerns.

Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico

ObjectiveTo assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income...

Musical learning as a contributing factor in the development of socio-emotional competence in children aged 4 and 5: an Exploratory study in a naturalistic context

ABSTRACT Research has shown that young children’s socio-emotional development may benefit from participating in a music programme. In this study, we explored the association between participation in a general music programme and the development of socio-emotional skills in relation to the duration of the programme. Children aged 4 and 5 (N=50), from a low socio-economic neighbourhood, participated in an 8- or 15-week music programme. Children’s social skills development and emotion comprehension were measured. Teachers reported an increase in the social interaction and independence skills scores of the younger children and a decrease in the cooperation skills scores of the older children. Additionally, the older children showed an increase in their comprehension of emotions. The duration of the programme, however, did not yield any significant effect. Results suggest that the association between participation in a music programme and the development of social-emotional skills may be influenced by the age of the children.

Influence of Socioeconomic Status on Incident Medical Conditions in Two-Year Survivors of Adolescent or Young Adult Differentiated Thyroid Cancer.

Purpose: We sought to enumerate secondary medical conditions from hospitalization records in adolescent and young adult (AYA) differentiated thyroid cancer (DTC) survivors and identify characteristics of patients with increased likelihood of subsequent medical diagnoses. Methods: Using data from the California Cancer Registry and statewide hospitalization data, we examined incident oncologic, endocrine, pulmonary, hematologic, and cardiovascular diagnoses in 12,312 AYA (aged 15-39) patients diagnosed with DTC in 1996-2012 and surviving >2 years after diagnosis with follow-up through 2014. We calculated the cumulative incidence of each condition accounting for the competing risk of death and used multivariable Cox proportional hazards regression to evaluate sociodemographic and clinical characteristics associated with each incident condition. Results: The 10-year cumulative incidences of multiple medical conditions were particularly high in blacks and Hispanics. Asian/Pacific Islander survivors were most likely to develop subsequent cancers. Men had higher rates of cardiovascular and diabetes diagnoses than women, but lower rates of asthma and cytopenias. Low socioeconomic status and/or public or no insurance were associated with a higher risk of several diagnoses. More extensive disease stage and thyroid surgery increased the risk of calcium and phosphorus metabolism disorders. Neck reoperation associated with the risk of cytopenias, as well as subsequent endocrine, cardiovascular, and respiratory diagnoses. Conclusion: The incidence of medical conditions after thyroid cancer diagnosis and treatment differ among racial/ethnic groups and sexes. Those residing in lower socioeconomic neighborhoods, those with public or no insurance, and those who require further neck surgery have substantially higher burdens of subsequent medical diagnoses.

Barriers to the Initiation of Home Modifications for Older Adults for Fall Prevention

Introduction:Home modifications are associated with decreased risk for falls and facilitate safe aging in place. The purpose of this study was to identify barriers to procurement of home modifications for older adults.Materials and Methods:Cross-sectional interviews by 2 separate (1 male and 1 female) researchers in a Midwestern city of home repair (“handyman”) and construction businesses within 15 miles of the areas of interest (neighborhood with a high socioeconomic status and neighborhood with low socioeconomic status) with a publicly listed phone number (n = 98). Estimated cost, earliest date of installation, and duration for a home modification project (installation of 3 grab bars) were collected.Results:At least 1 response was attained only 43% of the time (n = 42), and residential grab bar installations were not provided by most businesses (n = 24). The average quote for materials and labor was $394.31 (range $125-$1300). Five of the 7 businesses that responded to both researchers with the same representative differed in cost estimates, generally offering a reduced quote for the low socioeconomic status neighborhood by as much as $300. Quotes provided to the female researcher were also higher than those obtained by the male researcher by about $30 regardless of socioeconomic status. The average wait for home modifications was 23 days and the average anticipated duration of the project was 2.6 hours.Discussion:There are financial and procedural barriers to accessing home modifications for older adults who independently attempt to acquire them. There is a need for pathways in clinical and community settings to reduce barriers to home modifications to reduce the risk of falls.Conclusion:Home modifications are a promising tool to reduce falls and fall-related injuries in older adults. However, further work to identify cost-effective and timely options to reduce acquisition barriers is necessary to leverage the preventive power of home modifications.

Spatiotemporal distribution and socioeconomic disparities of dengue, chikungunya and Zika in two Latin American cities from 2007 to 2017.

To assess the presence, pattern and magnitude of socioeconomic inequalities on dengue, chikungunya and Zika in Latin America, accounting for their spatiotemporal distribution. Using longitudinal surveillance data (reported arboviruses) from Fortaleza, Brazil and Medellin, Colombia (2007-2017), we fit Bayesian hierarchical models with structured random effects to estimate: (i) spatiotemporally adjusted incidence rates; (ii) Relative Concentration Index and Absolute Concentration Index of inequality; (iii) temporal trends in RCIs; and (iv) socioeconomic-specific estimates of disease distribution. The spatial analysis was conducted at the neighbourhood level (urban settings). The socioeconomic measures were the median monthly household income (MMHI) for Brazil and the Socio-Economic Strata index (SES) in Colombia. There were 281426 notified arboviral cases in Fortaleza and 40887 in Medellin. We observed greater concentration of dengue among residents of low socioeconomic neighbourhoods in both cities: Relative Concentration Index=-0.12 (95% CI=-0.13, -0.10) in Fortaleza and Relative Concentration Index=-0.04 (95% CI=-0.05, -0.03) in Medellin. The magnitude of inequalities varied over time across sites and was larger during outbreaks. We identified a non-monotonic association between disease rates and socioeconomic measures, especially for chikungunya, that changed over time. The Relative Concentration Index and Absolute Concentration Index showed few if any inequalities for Zika. The socioeconomic-specific model showed increased disease rates at MMHI below US$400 in Brazil and at SES-index below level four, in Colombia. We provide robust quantitative estimates of socioeconomic inequalities in arboviruses for two Latin American cities. Our findings could inform policymaking by identifying spatial hotspots for arboviruses and targeting strategies to decrease disparities at the local level.

Chronic medical conditions and late effects after acute myeloid leukaemia in adolescents and young adults: a population-based study.

Curative-intent treatment of acute myeloid leukaemia (AML) can lead to multiple chronic medical conditions ('late effects'). Little is known about the burden of late effects in adolescent and young adult (AYA, 15-39 years) survivors of AML. We aimed to estimate the cumulative incidence and investigate the main predictors of late effects among these patients. During 1996-2012, 1168 eligible AYAs with AML who survived ≥2 years after diagnosis were identified in the California Cancer Registry. Late effects were reported from State hospital discharge data, and patients were followed through 2014. Hazard ratios and 95% confidence intervals of late effects occurrence were estimated using Cox proportional hazard models, adjusted for sociodemographic and clinical factors. The most common late effects at 10 years after diagnosis were: endocrine (26.1%), cardiovascular (18.6%) and respiratory (6.6%), followed by neurologic (4.9%), liver/pancreatic (4.3%), renal (3.1%), avascular necrosis (2.7%) and second primary malignancies (2.4%). Of 1168 survivors, 547 (46.8%) received a haematopoietic stem cell transplant (HSCT). After multivariable adjustments, AYAs who underwent HSCT or had a non-favourable risk AML experienced ∼2-fold or higher increased likelihood of all late effects. Additionally, AYAs of Hispanic, Black or Asian/Pacific Islander (vs non-Hispanic White) race/ethnicity and those who resided in lower socio-economic neighbourhoods were at higher risk of numerous late effects. Our findings underscore the need for long-term surveillance for the prevention, early detection and treatment of late effects, and can inform the development of AYA-focused consensus-based guidelines that will ultimately improve the quality of life and survival of these young vulnerable patients.

Perceptions of men aged 24-60 from three different socioeconomic level on child marriage, Ankara

Abstract Background It is estimated that one in every five women has married before 18 year of age in Turkey. In majority of studies on child marriages the data have been collected from women. Number of studies conducted with men are limited and mostly qualitative. This study aims to determine some attitudes and perceptions of 24-60 age group men on child marriages in three neighborhoods with different socioeconomic status in Ankara. Methods A descriptive epidemiological study was conducted in three neighborhoods with low, middle and high socioeconomic status. The data was collected through a self-administrated questionnaire from 500 men aged 24-60 in each neighborhood through household visits. Ethics Commission permission was granted. Results The median age of first marriage increased both among men and their wives as the socioeconomic status improved (p < 0.001 and p < 0.001, respectively). From low socioeconomic status to high (respectively, 3.2%, 1.3%, 0.2%), men agreed women could marry before the age of 18 (p = 0.001). Men with low (69.2%) and medium (74.2%) socioeconomic status believed “marriage” was the most important experience in women's lives. Men with low socioeconomic status found marriage of their daughters and sons under 18 more acceptable compared to the men with high socioeconomic status (p < 0.001, p < 0.001, respectively). 14.0% of men whose wife was below 18 at the time of marrige, agreed women could marry before the age of 18, compared to 0.8% whose wife was 18 year old or older at the time of marriage (p < 0.001). Conclusions This is the first quantitative study in Turkey conducted to understand the perceptions and attitudes of men on child marriages. These findings confirm that socioeconomic status is an important determinant of child marriages, there are disparities in gender perspective among different socioeconomic levels and child marriage is carried over between generations. Key messages Traditional gender roles for women and men in the family have a continuing trend in all socioeconomic levels, but more significant in the low and middle socioeconomic level neighborhoods. Specific male groups including fathers need to be targeted in interventions to prevent child marriages. Specific male groups need to be targeted in interventions to prevent child marriages.

Spatial and seasonal variation of outdoor BC and PM2.5 in densely populated urban slums.

A large proportion of residents in urban centers of low- and middle-income countries live in low-socioeconomic neighborhoods called "slums" characterized by low-cost housings of high population density, poor ventilation, and likely poor air quality. This study provides the first quantitative assessment of spatial and seasonal variation of outdoor BC and PM2.5 concentrations in several densely populated slums of Mumbai, India. Mobile outdoor real-time BC and PM2.5 monitoring was conducted along pre-designed monitoring routes in seven slums in Mumbai during the summer (May-June 2015 and May 2016) and repeated in four of them during the winter (February 2016). The measurements were repeated on the routes during different hours and days to account for the temporal variability of air pollution (nsummer = 80 trips; nwinter = 48 trips). PM2.5 exhibited homogenous distribution inside each slum (coefficient of divergence (COD) = 0.11-0.23), while BC varied significantly showing increasing concentrations with proximity to major roads (COD = 0.26-0.64). BC/PM2.5 ratio, an indicator of impact of traffic emissions, was higher along major roads of all slums (14-43%) and minor roads and alleys of high-traffic slums (10-17%) while lowest along alleys and minor roads of low-traffic slums (7-11%). Comparison of pollutant concentrations among major roads revealed the dominant effect of emissions from heavy-duty vehicles and traffic congestion. Significantly high concentrations were observed during winter season compared with summer for both PM2.5 (125 ± 46 μg m-3 in winter and 41 ± 25 μg m-3 in summer) and BC (12 ± 6 μg m-3 in winter and 7 ± 6 μg m-3 in summer). The results of this study indicate that slum residents in Mumbai and similar slums around the world are at a higher risk of traffic-related air pollution, with risk being more severe in winters due to poorer dispersion conditions. Our findings suggest that targeted mitigation strategies to reduce vehicular emissions, especially in high-traffic slums, would yield required benefits.Graphical abstract.

The contribution of teacher structure, involvement, and autonomy support on student engagement in low-income elementary schools

ABSTRACT Providing high-quality teaching practices is central to promote student engagement in school. High quality teaching is even more important in schools located in low socioeconomic neighborhoods, where a larger proportion of children present more important academic difficulties and lower classroom behavioural, affective, and cognitive engagement. The Self-System Model of Motivational Development posits that learner engagement is favored when teachers structure classroom activity, are involved with students, and support their autonomy. How these dimensions interact to create effective classroom contexts that foster student engagement remains less documented. The goal of the present study was to test additive and combined (interactive) multilevel longitudinal associations between teacher structure, autonomy-support, and involvement on students behavioral, affective, and cognitive engagement across one school year. Based on a sample of 696 low SES elementary school students, results of our path analysis revealed that teacher involvement and autonomy-support contributed to various dimensions of classroom engagement. Besides, structure was not directly to this outcome. Yet, a combined use of autonomy-support and structure or autonomy-support and involvement was associated with higher behavioral engagement among low-SES children. These results suggest that teacher practices cannot be interpreted in isolation as they add up and interact to contribute to elementary school student academic experience.

Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children

The aim of the current study was to evaluate the one- and two-year effectiveness of the KEIGAAF intervention, a school-based mutual adaptation intervention, on the BMI z-score (primary outcome), and energy balance-related behaviors (secondary outcomes) of children aged 7–10 years.A quasi-experimental study was conducted including eight intervention schools and three control schools located in low socioeconomic neighborhoods in the Netherlands. Baseline measurements were conducted in March and April 2017 and repeated after one and 2 years. Data were collected on children’s BMI z-score, sedentary behavior (SB), physical activity (PA) behavior, and nutrition behavior through the use of anthropometric measurements, accelerometers, and questionnaires, respectively. All data were supplemented with demographics, and weather conditions data was added to the PA data. Based on the comprehensiveness of implemented physical activities, intervention schools were divided into schools having a comprehensive PA approach and schools having a less comprehensive approach. Intervention effects on continuous outcomes were analyzed using multiple linear mixed models and on binary outcome measures using generalized estimating equations. Intervention and control schools were compared, as well as comprehensive PA schools, less comprehensive PA schools, and control schools. Effect sizes (Cohen’s d) were calculated.In total, 523 children participated. Children were on average 8.5 years old and 54% were girls. After 2 years, intervention children’s BMI z-score decreased (B = -0.05, 95% CI -0.11;0.01) significantly compared to the control group (B = 0.20, 95% CI 0.09;0.31). Additionally, the intervention prevented an age-related decline in moderate-to-vigorous PA (MVPA) (%MVPA: B = 0.95, 95% CI 0.13;1.76). Negative intervention effects were seen on sugar-sweetened beverages and water consumption at school, due to larger favorable changes in the control group compared to the intervention group. After 2 years, the comprehensive PA schools showed more favorable effects on BMI z-score, SB, and MVPA compared to the other two conditions.This study shows that the KEIGAAF intervention is effective in improving children’s MVPA during school days and BMI z-score, especially in vulnerable children. Additionally, we advocate the implementation of a comprehensive approach to promote a healthy weight status, to stimulate children’s PA levels, and to prevent children from spending excessive time on sedentary behaviors.Trial registrationNetherlands Trial Register, NTR6716 (NL6528), Registered 27 June 2017 – retrospectively registered.

The association between natural outdoor environments and common somatic symptoms.

There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(β) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(β) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(β) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.

Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics.

The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.

ChicagO Multiethnic Prevention and Surveillance Study (COMPASS): Increased Response Rates Among African American Residents in Low Socioeconomic Status Neighborhoods.

African American (AA) populations experience persistent health disparities in the USA. Low representation in bio-specimen research precludes stratified analyses and creates challenges in studying health outcomes among AA populations. Previous studies examining determinants of bio-specimen research participation among minority participants have focused on individual-level barriers and facilitators. Neighborhood-level contextual factors may also inform bio-specimen research participation, possibly through social norms and the influence of social views and behaviors on neighbor's perspectives. We conducted an epidemiological study of residents in 5108 Chicago addresses to examine determinants of bio-specimen research participation among predominantly AA participants solicited for participation in the first 6years of ChicagO Multiethnic Prevention and Surveillance Study (COMPASS). We used a door-to-door recruitment strategy by interviewers of predominantly minority race and ethnicity. Participants were compensated with a $50 gift card. We achieved response rates of 30.4% for non-AA addresses and 58.0% for AA addresses, with as high as 80.3% response among AA addresses in low socioeconomic status (SES) neighborhoods. After multivariable adjustment, we found approximately 3 times the odds of study participation among predominantly AA addresses in low vs. average SES neighborhoods (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 2.20-4.24). Conversely, for non-AA addresses, we observed no difference in the odds of study participation in low vs. average SES neighborhoods (OR = 0.89; 95% CI = 0.69-1.14) after multivariable adjustment. Our findings suggest that AA participants in low SES neighborhoods may be recruited for bio-specimen research through door-to-door approaches with compensation. Future studies may elucidate best practices to improve bio-specimen research participation among minority populations.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives.

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

Examining the impact of a social skills training program on preschoolers\u2019 social behaviors: a cluster-randomized controlled trial in child care centers

BackgroundPreschoolers regularly display disruptive behaviors in child care settings because they have not yet developed the social skills necessary to interact prosocially with others. Disruptive behaviors interfere with daily routines and can lead to conflict with peers and educators. We investigated the impact of a social skills training program led by childcare educators on children’s social behaviors and tested whether the impact varied according to the child’s sex and family socio-economic status.MethodsNineteen public Child Care Centers (CCC, n = 361 children) located in low socio-economic neighborhoods of Montreal, Canada, were randomized into one of two conditions: 1) intervention (n = 10 CCC; 185 children) or 2) wait list control (n = 9 CCC; 176 children). Educators rated children’s behaviors (i.e., disruptive and prosocial behaviors) before and after the intervention. Hierarchical linear mixed models were used to account for the nested structure of the data.ResultsAt pre-intervention, no differences in disruptive and prosocial behaviors were observed between the experimental conditions. At post-intervention, we found a significant sex by intervention interaction (β intervention by sex = − 1.19, p = 0.04) indicating that girls in the intervention condition exhibited lower levels of disruptive behaviors compared to girls in the control condition (f2 effect size = − 0.15). There was no effect of the intervention for boys.ConclusionsGirls may benefit more than boys from social skills training offered in the child care context. Studies with larger sample sizes and greater intervention intensity are needed to confirm the results.Trial registrationCurrent clinical trial number is ISRCTN84339956 (Retrospectively registered in March 2017). No amendment to initial protocol.

Restructuring Democratic Infrastructures: A Policy Approach to the Journalism Crisis

Democracy requires a free press. However, most people rarely reflect on the requisite infrastructures and policies that maintain a healthy press system. Today, as we look to journalism to protect us against misinformation and authoritarianism, the press is in a structural crisis. Journalism’s institutional support is collapsing, leaving entire regions and issues uncovered at a time when we desperately need reliable information and robust reporting. The crisis is disproportionately harming specific groups and regions, especially communities of color, rural areas, and lower socio-economic neighborhoods. This article addresses key policy issues that are central to the future of journalism, including those connected to media ownership, broadband policy, and the rise of new digital monopolies such as Facebook. It concludes with a call for designing a new public media system in the United States.

Child and Parent Perceived Determinants of Children's Inadequate Sleep Health. A Concept Mapping Study.

Many children do not meet the recommendations for healthy sleep, which is concerning given the potential negative effects on children’s health. To promote healthy sleep, it is crucial to understand its determinants. This concept mapping study therefore explores perspectives of children and parents on potential determinants of children’s inadequate sleep. The focus lies on 9–12 year old children (n = 45), and their parents (n = 33), from low socioeconomic neighbourhoods, as these children run a higher risk of living in a sleep-disturbing environment (e.g., worries, noise). All participants generated potential reasons (i.e., ideas) for children’s inadequate sleep. Next, participants sorted all ideas by relatedness and rated their importance. Subsequently, multidimensional scaling and hierarchical cluster analyses were performed to create clusters of ideas for children and parents separately. Children and parents both identified psychological (i.e., fear, affective state, stressful situation), social environmental (i.e., sleep schedule, family sleep habits), behavioural (i.e., screen behaviour, physical activity, diet), physical environmental (i.e., sleep environment such as temperature, noise, light), and physiological (i.e., physical well-being) determinants. These insights may be valuable for the development of future healthy sleep interventions.