Low Socioeconomic Areas Research Articles

Reasons for littering: Social constructions from lower income communities in South Africa

Littering has been defined as the careless and improper disposal of small amounts of waste that results in unwanted and unnatural elements remaining in the environment. People tend to blame external factors for their own littering. A person seldom refers to themselves as being the litterer but will rather place the blame on insufficient infrastructure, such as lack of bins, or on other persons. When referring to other people, they identify problematic behaviour and personal traits such as ignorance, naivety, need for convenience, laziness and inattentiveness as causes of littering. This study addressed the gap in the literature on the socially constructed perceptions people hold about reasons for littering in the South African context, as subjectively perceived reasons for littering may correspond with actual causes and could point towards options for tackling the littering problem. Five lower socio-economic areas in South Africa – particularly those that experience major infrastructural challenges – were included in the study. Qualitative semi-structured interviews were held with 322 residents from the respective areas. The data were thematically analysed and the results from the areas compared with each other. The cross-case analysis confirmed that littering is contingent on contextual effects, and unique reasons for littering in the South African context were mentioned. The research reported on in this study highlights that we have only thematically ‘identified’ or named the socially constructed perceptions about the reasons for littering by the participants. The importance of creating platforms and processes for dialogues to deepen our understanding of people’s socially constructed perceptions and subsequent behaviour, is of critical importance.Significance: This study presents subjective or self-reported perceptions of people living in lower socio-economic areas on the reasons for littering and dumping. These perceptions about reasons for littering then provide directions for possible interventions to manage and curb littering in the South African context.

Self-reported lifestyle behaviours in families with an increased risk for type 2 diabetes across six European countries: a cross-sectional analysis from the Feel4Diabetes-study

BackgroundA healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria).MethodsParents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire (eight items questioning age, Body Mass Index, waist circumference, PA, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families’ lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status.ResultsMost Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries.ConclusionsCountries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.

Youth Justice, Community Safety and Children’s Rights in Australia

Abstract Australian children have few legal rights and in the context of youth justice, community safety tends to be prioritised over the best interests and wellbeing of children. “Tough on crime” approaches to youth justice law and policy have been influenced by penal populism, whilst the voices of practitioners who work with young people who commit offences remain largely ignored. We interviewed 92 practitioners who work in criminal law settings in a low socioeconomic area in Queensland, Australia, to ascertain their views on the effectiveness of criminal law interventions in their community. Practitioners recognised the need to ensure the safety of the community when dealing with the offending behaviour of children, but they felt that current criminal law responses do not achieve this goal. Instead, they were in favour of interventions that prioritised children’s wellbeing so that the causes of their offending behaviour were addressed. Whilst they did not use rights-based language, their suggestions for reform were consistent with the protection of children’s fundamental rights as recognised by international law.

Impact of Family Structure and Parental Involvement in Low Socioeconomic Areas on Reading and Writing Development of Grade 3 Students from San Rafael Elementary School in the Division of Agusan Del Sur, Philippines

Impact of Family Structure and Parental Involvement in Low Socioeconomic Areas on Reading and Writing Development of Grade 3 Students from San Rafael Elementary School in the Division of Agusan Del Sur, Philippines

Motivations to Change Smoking Behaviors Between 2007 and 2019 in Australia: A Repeated Cross-sectional Study.

In 2010, Australian tobacco excise (administered federally) increased by 25%, and by 12.5% annually from 2013 to 2020, with additional increases on roll-your-own (RYO) tobacco between 2017 and 2020. We estimated past year changes in smoking behavior among Australian adults who smoked (daily and non-daily) in the past year, and the association between consumer characteristics and stated motivations to change/attempt to change smoking behavior between 2007 and 2019. Logistic regression analysis of combined data from national representative triennial cross-sectional surveys in Australia (N = 22 977). The main motivation cited for changing smoking behavior switched from health-related from 2007 to 2010 to cost-related from 2013 to 2019. Among those who quit between one and 12 months ago, living in a lower socioeconomic area (odds ratio (OR) = 1.61, 95% CI = 1.18% to -2.18%), was associated with reporting the cost of smoking motivated them to quit. Among those who reduced their smoking, smoking daily and >20 cigarettes/day vs. non-daily smoking (OR = 2.11, 95% CI = 1.60% to 2.78%), having high/very high psychological distress (OR = 1.33, 95% CI = 1.12% to 1.59%), and alcohol consumption (ORdaily drinking = 1.38, 95% CI = 1.05% to 1.81%) was associated with cost as a motivation. Exclusive (OR = 0.65, 95% CI = 0.53% to 0.80%) and non-exclusive (OR = 0.77, 95% CI = 0.65% to 0.91%) RYO use was associated with being less likely to report the cost of tobacco as motivation for cutting down. The cost of smoking became the most cited motivator to change smoking behavior (eg, quitting and cutting down), particularly for those who lived in low socioeconomic areas, smoked more cigarettes per day, drank alcohol, and had high/very high psychological distress. A change in the main federal tobacco control intervention implemented in Australia from mass-media campaigns to tobacco tax increases has likely led to cost, rather than health, being the main motivation cited for changing smoking behavior in Australia since 2013. Further monitoring is needed to ensure the harmonization in tax rates for RYO and factory-made cigarettes has effectively reduced the price difference between these products because the lower cost of RYO may have reduced the effectiveness of tax increases as a motivator to change smoking behavior.

OROPHARYNGEAL SQUAMOUS CELL CARCINOMA: A SERIES OF 152 CASES FROM RIO DE JANEIRO

<h3>Objectives</h3> The aim of the present study was to evaluate the clinicopathologic features of oropharyngeal squamous cell carcinoma (OPSCC) in a population from Rio de Janeiro, Brazil. <h3>Study Design</h3> One hundred fifty-two patients were diagnosed with primary OPSCC in an oral pathology laboratory between 2014 and 2020. Demographic and clinical data were retrospectively collected from the records and all cases were microscopically classified as keratinizing, nonkeratinizing, or nonkeratinizing with maturation. Immunohistochemistry for p16INK4a was performed in 46 cases (30.2%) and the positive ones were submitted to DNA in situ hybridization (ISH) for human papillomavirus (HPV). <h3>Results</h3> There were 29 females and 123 males, with a mean age of 61 years (range, 39-89). Most patients regularly consumed tobacco (69%) and alcohol (50.7%) and lived in low socioeconomic status areas. Most tumors measured more than 2 cm and were located mainly in the soft palate (48%), followed by unspecified oropharynx, tonsil, and base of the tongue. The 3 histologic subtypes were similarly distributed among the cases. Five cases were positive for p16INK4a (10.9%), and of these, 4 were positive for HPV by DNA ISH (8.7%), most of them nonkeratinizing. <h3>Conclusions</h3> HPV prevalence is low in OPSCC cases from this Brazilian population.

Designing a motor skill intervention for preschool children in a low-income rural setting in South Africa: A Delphi study

INTRODUCTION: There is a high prevalence of motor skill impairment among pre-school children in rural low socio-economic areas. While therapy input is paramount, resources are limited. This Delphi study aimed to determine what the components would be of a feasible, cost-effective motor skill intervention for pre-school children in a rural, low socio-economic area of South Africa METHOD: A three-round Delphi study was conducted with experts in the field, including occupational therapists, physiotherapists, kinder kineti-cists and teachers. The first round investigated demographic details of participants and agreement of participants on role players, structure and content of an intervention. Subsequent rounds' questions followed up on participants' comments and areas of dissent. Agreement was calculated at 75% or mean &gt;4 RESULTS: Outcomes suggest that a school-based, small-group programme, facilitated by the teaching team, but with clear guidelines, support and advice from therapists should be feasible in a low-income rural context. Inclusivity of intervention groups and aim-formulation proved to be controversial issues that need further investigation CONCLUSION: The results from this study helped develop a guide for motor skill intervention for pre-school children in low socio-economic and rural areas

Infant-Feeding Patterns and the Effects of Early Introduction to Formula and Solid Foods on Childhood Overweight or Obesity among 10-Years-Olds in a Low Socioeconomic Area of Lebanon: An Exploratory Analysis.

In Lebanon, there has been an alarming increase in childhood overweight and obesity. In addition, most mothers do not meet the WHO recommendation that infants should be introduced to formula or solids only during the second half of their first year. Because the study population, Burj Hammoud, which is a low socioeconomic district, is small, we performed an exploratory analysis of infant feeding patterns and the effects of introducing formula and solids within six months, respectively, on childhood overweight/obesity among 10-year-old children. A total of 101 mothers were recruited from seven intercommunity dispensaries located across the district. Descriptive, univariate and multivariate logistic regression analyses were performed. There were 86.1% infants initiating breastfeeding, 18% exclusively breastfeeding at 6 months of age, 67.1% and 52.6% starting formula and solids by 6 months, respectively, and 53.5% becoming overweight/obese by the age of 10 years. Working mothers were significantly less likely to introduce formula but not solids within the first six months of infancy. Based on two case-control studies, after controlling for maternal employment, there were 2.278- and 1.511-fold significantly higher odds of introducing solids and formula before the age of 6 months compared with after the age of 6 months, respectively, for the overweight/obese individuals among 10-year-olds. Future research should focus on conducting a larger study by incorporating other low socioeconomic regions to confirm these relationships.

Molecular Profiling of Large B-Cell Lymphomas

Background: Large B-cell non-Hodgkin's lymphoma (NHL) comprises of a heterogeneous group of lymphomas with a high-grade morphology and aggressive nature. The diagnosis has gradually evolved from morphological characterization to classification of this group based on ancillary techniques such as immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and molecular studies. Diffuse large B-cell lymphomas (DLBCL), not otherwise specified (NOS) is the most common B-cell NHL reported and a new diagnostic entity termed high-grade B-cell lymphoma harboring an MYC rearrangement with a BCL2 and/or BCL6 have been introduced by the WHO in 2017. MYC and BCL2/BCL6 proteins expression on IHC due to mutations leading to nuclear factor kappa B pathway activation is considered as double-expressor lymphoma (DEL). Materials and Methods: Sixty-two patients diagnosed with DLBCL, NOS on histopathology were subjected to IHC markers such as (CD20, CD79a, PAX5, CD10, Bcl6, Bcl2, MUM1, TDT, and Myc) and classified into activated B-cell and germinal center B-cell based on Hans' Algorithm. The samples were consequently subjected to tissue FISH for the detection of MYC, BCL2, and BCL6 gene translocations and classified as double-hit lymphoma (DHL)/triple-hit lymphoma (THL). The FISH results were subsequently compared for IHC expression of c-myc, Bcl2, and Bcl6. The staging, international prognostic index (IPI) scoring and lactate dehydrogenase levels were compared with progression-free survival (PFS) of 15 months among DHL/THL and DEL/TEL. Results: The median age of presentation among DLBCL-NOS patients is 58 years, while males (66.7%) were affected more commonly than females (33.3%). The majority of the patients presented with nodal involvement (71%) while extranodal involvement was seen in 29% cases. Hans' algorithm showed a significant P value with the IHC expression of BCL2, BCL6 and C-MYC. IHC and FISH correlation for BCL2 and BCL6 showed 100% sensitivity and 100% negative predictive value. IHC and FISH for c-MYC showed concordant results with a significant P &lt; 0.03. The clinicopathological results of S/D/THL showed association with higher stage disease, higher IPI scoring, and high Ki-67 index with inferior PFS. Conclusions: IHC MYC is a sensitive screening modality for MYC translocation and can be used for the identification of rearrangement in lower socioeconomic areas. Based on clinicopathological studies, all patients with DLBCL must undergo MYC FISH testing as these patients behave as high-grade lymphomas. Hence, a new entity DLBCL with MYC rearrangement without BCL-2/6 rearrangements maybe considered as a novel entity and to be studied in future cohorts.

Changes in perceived parental self-efficacy after a Child-Centred Health Dialogue about preventing obesity.

AimThis randomised controlled trial evaluated changes in parental self‐efficacy and children's weight, after a Child‐Centred Health Dialogue about preventing obesity.MethodsWe randomly assigned 37 Child Health Centres in Skåne county Sweden to provide usual care or the dialogue intervention. They included centres from high and low socioeconomic areas. The outcomes were changes in parental self‐efficacy and any moderating effect on their children's body mass index 1 year later.ResultsThe baseline data were based on 1115 mothers and 869 fathers representing 1197 children (52% females) aged 4 years (3.9–4.2) with a standardised body mass index (zBMI) of 0.1 ± 0.9. The participation rates at follow‐up, 1.1 ± 0.2 years after the intervention were 817 mothers and 508 fathers. Overall, parental self‐efficacy had decreased by the 1‐year follow‐up. There was a significant intervention effect on maternal self‐efficacy in promoting physical activity, however with unclear clinical relevance. Mothers' change in perceived self‐efficacy in promoting a healthy diet seemed to moderate the intervention effect on zBMI change in children with zBMI > 0 with −0.01 (95% CI: −0.025 to −0.001; p = 0.03).ConclusionOur study suggested a possible link between increased maternal self‐efficacy in promoting a healthy diet and a favourable development of zBMI.

A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth

Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically diverse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital divide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital divide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families: the Strong Families Trial

BackgroundObesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years.MethodsEight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention.DiscussionThis study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status.Trial RegistrationThis study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019.

Association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID-19 pandemic.

ObjectiveThe aim of this study is to explore the association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID‐19 pandemic.DesignA cross‐sectional study via SurveyMonkey was conducted in Australia between August 2020 and October 2020. Descriptive and inferential statistics were used to analyze the data.ResultsA total of 1211 individuals responded to the survey. Income loss was significantly associated with those from low socioeconomic status (OR = 1.65; 95% CI 1.01–2.68). Access of superannuation was significantly associated with those in outer regional (OR = 3.61; 95% CI 0.81–16.03) and low socioeconomic status (OR = 2.72; 95% CI 1.34–5.53). Financial inability to pay for services was significantly associated with living in remote areas (OR = 2.26; 95% CI 0.88–5.80).ConclusionsThe economic wellbeing of people who identify as Aboriginal and Torres Strait Islander, live in regional or remote areas, and reside in low socioeconomic areas have been substantially impacted during the pandemic. Findings call for policies to address the underlying social determinants of health.

Adolescents’ School Travel and Unhealthy Snacking: Associations with School Transport Modes, Neighbourhood Deprivation, and Body Weight

Active transport to and/or from school (ATS), alone or combined with motorised transport, provides an opportunity to increase adolescents’ physical activity levels to prevent obesity. However, travel through and exposure to an unhealthy food environment en route to school may have unintended consequences, specifically unhealthy snacking. This study examined the association between adolescents’ unhealthy snack food/soft drink purchases/consumption during the journey to and from school and their school transport modes, neighbourhood deprivation, and body weight. Adolescents (n = 660, age: 15.3 ± 1.3 years, 51.7% female) from 11 schools in the Otago region, New Zealand, completed an online survey and anthropometry. Data were analysed using χ2 test and logistic regression. Overall, 36.7% of adolescents purchased/consumed unhealthy snack foods and 25.9% purchased/consumed soft drinks at least once during their weekly school trips. ATS and mixed transport users reported more frequent unhealthy snack food/soft drinks purchases/consumption on the way to school than motorised transport users. Neighbourhood deprivation, but not body weight, was positively associated with unhealthy snack food/soft drink purchases/consumption during the school journey. Our findings highlight the importance of considering not only travel mode shift but also the obesogenic environment and unhealthy food/drinks purchases/consumption during adolescents’ school journeys, particularly in lower socio-economic areas, to prevent obesity.

Snapshot of a Child and Adolescent Psychiatric ER during Pandemic

IntroductionThe COVID-19 pandemic has disrupted numerous fundamental systems ranging from businesses to education system. The long-term consequences of the Pandemic, namely virtual learning and prolonged social isolation are coming to fruition in Child/Adolescent-Psychiatric Emergency-Rooms (CAP-ER). Discontinuity of in-person attendance of schools has poorly impacted the mental health of children and adolescents (C&amp;A) of low-socioeconomic areas, who often rely on schools for meals, physical activity, and mental-health support. An increase in agitation, suicidal ideation, and a declining school performance has been observed in such situations.ObjectivesThe primary objective of this study is to explore the increase in these symptoms as the presenting complaint in the psychiatric ER.MethodsBetween April to June 2021 a cross-sectional quality improvement (QI) study was done on children presenting to CAP-ER BronxCare-Hospital NY with psychiatric complaints. Concomitant substance use disorder was determined using CRAFT questionnaire.ResultsOur data comprised 209 patients (84 M/125 F) with 79 children and 130 adolescents. Ethnicity: 116 Hispanics (56%), 84 African Americans (40%), and 9 others. The most common presenting complaints were aggression (111, 53%), suicidal ideation/suicide attempt (50, 24%), acute exacerbation of chronic illness (7, 3.3%), accidental overdosage (5, 2.3%) and others (36, 17.4). Marijuana was the most used substance (34 patients).ConclusionsThere has been a surge in severity of presentation of psychiatric disorders among children and adolescents, aggression so far, the most prevalent. Further studies are needed to delineate the social links with this high emergent load and pandemic.DisclosureNo significant relationships.

Early childhood caries sequelae and relapse rates in an Australian public dental hospital.

Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n= 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan-Meier curves and parametric exponential survival models for time-to-event series. The study population demonstrated higher-than-national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio-economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors.

Knowledge, Attitude and Practice of Osteoporosis among Adult Patients in Bashair Hospital, Sudan, 2021

Osteoporosis is a skeletal disorder distinguished by micro architectural deterioration and rapid bone loss at the osseous tissue, increasing the risk for bone fracture especially at the hip, wrist, and spine. Knowledge, Attitude and Practices (KAP) is a quantitative method that provides access to quantitative and qualitative information. The study aimed to assess the level of Knowledge, Attitude and Practice regarding Osteoporosis among adult patients in Bashair University Hospital 202l. Methodology: This was descriptive cross-sectional hospital-based study conducted in Bashair Hospital 2021. 200 participants were chosen. Data were collected using designed interview questionnaire. Statistical package for social sciences version 26 used for analysis. Results: (53.5%) of participants were females. (33.0%) of participants their level of educational is basic school. (45.2%) of the participants had poor knowledge, (40%) of the participants had poor attitude, and (54%) of the participants had moderate practice about Osteoporosis among adult patients. There was a significant relation between age groups and level of educational regarding Knowledge, Attitude and Practice (p≤ .001). There was a significant relation between Knowledge and Attitude (P&lt;.001) and Knowledge and Practice (P&lt;.001). Conclusion: The study concluded that adult patients had poor knowledge, attitude and moderate practice regarding Osteoporosis. Factors such as age, level of educational and gender were significantly influence the level of knowledge, attitude and practice. Recommendation: Upraise the level of awareness; establish screening programs for community population especially in low socioeconomic areas, regular investigations and at least once for bone scanning regarding Osteoporosis.

EHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review.

BackgroundChronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas.ObjectiveThis is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping.MethodsA systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool.ResultsAs of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022.ConclusionsThis systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations.Trial RegistrationPROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119International Registered Report Identifier (IRRID)PRR1-10.2196/35408

Nutritional status and associated factors of older persons in sub-Saharan Africa: a scoping review

BackgroundThe older person population is rapidly increasing globally, including sub-Saharan Africa (SSA). Concurrently, malnutrition is also increasing among older persons in SSA, with a dearth of empirical evidence on nutritional status and associated factors among the older persons in the region to inform effective interventions to promote healthy ageing.Aim/ObjectiveThis review assessed the nutritional status and associated factors among older persons in SSA.MethodPubMed, Google Scholar, and Cochrane Library electronic databases were searched for published articles from 2010 to 2021 using keywords and Boolean logic. Also, we carried out a free web-based search to retrieve other relevant evidence that assesses the older persons’ nutritional status. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart was used to appraise the research articles that responded to the study’s research questions.FindingsTwenty studies met the inclusion criteria, from which data were extracted as findings. The malnutrition prevalence was between 6 to 54% among older persons in SSA. We found that the prevalence of malnutrition vary and could be as high as 28.4% in a low socio-economic status area. Of these studies, twelve (12) provided data on undernutrition with prevalence ranging from 2.9 to 41%;10 provided data on overweight (8.1–54.1%) and 5 on obesity (2.7–44.7%). Seventeen of the studies evaluated factors associated with malnutrition; 4 studies revealed the association between socioeconomic status and malnutrition, 7 studies reported a significant association between dietary habits and malnutrition. Four studies showed an association between educational status and malnutrition. Disease conditions associated with malnutrition were reported in four of the studies.ConclusionThis review shows that malnutrition is a problem among older persons in SSA coupled with many risk factors which should be given critical attention. We recommend nutrition education for older persons as well as the development of nutrition interventions for this vulnerable group.

Integrated Child and Family Hub models for detecting and responding to family adversity: protocol for a mixed-methods evaluation in two sites

IntroductionIntegrated community healthcare Hubs may offer a ‘one stop shop’ for service users with complex health and social needs, and more efficiently use service resources. Various policy imperatives exist to...