Adults Of Low Socioeconomic Status Research Articles

The burden of premature coronary heart disease among adults with low socioeconomic status in Argentina: A modeling study.

The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors. To model the role SES plays in the burden of premature CHD in Argentina. We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk. 56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6-84.9] vs 42.9 [95%CI 37.4-48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3-20.9]; CHD deaths: men 10.0 [95%CI 9.5-10.5] vs 6.0 [95%CI 5.6-6.4], women 3.2 [95%CI 3.0-3.4] vs 1.8 [95%CI 1.7-1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively. CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.

Some young adults can maintain good oral health despite socioeconomic challenges.

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19-23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was 'Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health', comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Effects of socioeconomic status on physical activity and cardiovascular diseases prior to and during the COVID-19 pandemic in the older adults.

This research seeks to evaluate the repercussions of socioeconomic status (SES) on physical activity (PA) among the older population, both pre and intra-COVID-19 pandemic. The study aims to scrutinize whether alteration in PA behaviors based on SES impacts cardiovascular diseases (CVDs). It is well established that PA has a significant association with CVDs and the pandemic has restricted PA in the older population. We endeavor to discern whether SES modulates PA levels and whether these levels of PA behavior subsequently influence the incidence of CVDs among older adults. The analytical framework of this study relies on the data procured from the Fact-Finding on the Status of Senior Citizens (FSSSC) survey conducted in 2017 and 2020, involving 10,299 (75 ± 6 years) and 10,097 (74 ± 6 years) participants, respectively. We employ Structural Equation Modeling (SEM) to elucidate the ramification of the COVID-19 pandemic on CVDs while accommodating potential mediating and confounding variables, including socioeconomic status, PA levels, body mass index (BMI), and gender, in the context of the pandemic and CVDs. Our empirical models indicated a tendency for older adults of lower socioeconomic status (SES) to exhibit diminished levels of physical activity (PA) compared to their counterparts of higher SES, particularly considering the influence of the COVID-19 pandemic. Furthermore, prolonged engagement in PA is associated with a reduced risk of hypertension (p = 0.010), and congestive heart failure & arrhythmia (p < 0.001), when accounting for confounding factors. The COVID-19 pandemic has generated an SES-based disparity in PA among older adults, despite PA time being greater in older individuals with higher SES. Interestingly, this did not result in a reduction in CVDs. Therefore, the study emphasizes the need for targeted exercise programs may be necessary to mitigate health inequality among the older population.

Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore.

During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES. A questionnaire assessing digital literacy, social connectedness, wellbeing and quality of life was administered. Socio-demographic variables, pre-existing internet-enabled, and willingness to participate in a home-based DLP was also collected. Logistic regression was used to identify demographic factors associated with digital literacy, smartphone ownership, and willingness to enroll in a DLP. Serial mediation analysis was also performed using a structural equation model framework. A total of 302 participants were recruited. Female gender, older age, lower education levels were associated with lower digital literacy. Those who owned a smartphone tended to be younger and better educated. Older adults who were better educated, of Chinese descent (the ethnic majority in Singapore), and who had lower digital literacy, were most willing to enroll in the digital literacy education program. Social-use digital literacy had a positive indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness. In contrast, instrumental-use digital literacy had a negative indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness. The results suggest there are demographic barriers to participation in DLPs and highlight the benefit of focusing on enhancing social-use digital literacy. Further study is needed to evaluate how well specific interventions to improve social-use digital literacy help to reduce social isolation and loneliness, and ultimately improve wellbeing and quality of life.

Unpacking Psychological Vulnerabilities in Deaths of Despair.

Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.

The impact of socioeconomic status on changes in cancer prevention behavior during the COVID-19 pandemic.

The impacts of socioeconomic status (SES) on COVID-19-related changes in cancer prevention behavior have not been thoroughly investigated. We conducted a cohort study to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. We invited adult participants from previous studies conducted at Ohio State University to participate in a study assessing the impact of COVID-19 on various behaviors. Post-COVID-19 cancer prevention behaviors, including physical activity, daily intake of fruits and vegetables, alcohol and tobacco consumption, and qualitative changes in post-COVID-19 behaviors relative to pre-COVID levels, were used to construct a prevention behavior change index that captures the adherence status and COVID-related changes in each behavior, with higher index scores indicating desirable changes in prevention behaviors. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted regression models were used to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. The study included 6,136 eligible participants. The average age was 57 years, 67% were women, 89% were non-Hispanic Whites, and 33% lived in non-metro counties. Relative to participants with high SES, those with low SES had a 24% [adjusted relative ratio, aRR = 0.76 (95%CI 0.72-0.80)], 11% [aRR = 0.89 (95%CI 0.86-0.92)], and 5% [aRR = 0.95 (95%CI 0.93-0.96)], lower desirable changes in prevention behaviors for physical activity, fruit and vegetable intake, and tobacco use, respectively. Low SES had a higher desirable change in alcohol consumption prevention behaviors, 16% [aRR = 1.16 (95%CI 1.13-1.19)] relative to high SES. The adjusted odds of an overall poor change in prevention behavior were adjusted odds ratio (aOR) 1.55 (95%CI 1.27 to 1.89) and aOR 1.40 (95%CI 1.19 to 1.66), respectively, higher for those with low and middle SES relative to those with high SES. The adverse impacts of COVID-19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

Predictors of Mental Health Literacy among Parents, Guardians, and Teachers of Adolescents in West Malaysia.

Parents, guardians, and teachers are the informal sources of mental health support that adolescents rely on. Nevertheless, limited mental health knowledge limits their ability and confidence in providing appropriate assistance. This study aims to (1) evaluate the relationship between the roles of parents/guardians and teachers and their responses to discover the common misconceptions on mental health among those providing informal support to adolescents and (2) determine which demographic factors would act as the strongest predictor influencing their mental health literacy (MHL) status. The cross-sectional study recruited 867 parents, guardians, and teachers of adolescents from 24 government secondary schools' parent-teacher associations via multistage stratified random sampling. Parents, guardians, and teachers' MHL were evaluated using the Mental Health Knowledge Schedule-Malay Version (MAKS-M). The collected data were analyzed using Pearson's Chi-squared test to investigate the association between the respondents' roles and responses. Multiple Regression analysis was used to determine the predictors of MHL. The score of MAKS-M for the current study sample is 73.03% (M = 43.82, SD = 4.07). Most respondents responded incorrectly on Items 1 (employment), 6 (help-seeking), 8 (stress), and 12 (grief). Teachers provided more favorable responses on several items than parents and guardians. Finally, younger age, higher income, knowing someone with mental disorders, and having experience of attending formal training on mental health first aid were the significant predictors of MHL. MHL interventions in Malaysia should cater to older adults of lower socioeconomic status and lesser experience in mental health, specifically highlighting the stigmas on mental health help-seeking behaviors, treatment, and employment concerns, plus the recognition of various mental health diagnoses.

Acceptance Rates of COVID-19 Vaccine Highlight the Need for Targeted Public Health Interventions.

We aimed to examine rates of COVID-19 vaccination to elucidate the need for targeted public health interventions. We retrospectively reviewed the electronic medical files of all adults registered in a central district in Israel from 1 January 2021 to 31 March 2022. The population was characterized by vaccination status against COVID-19 and the number of doses received. Univariate and multivariable analyses were used to identify predictors of low vaccination rates that required targeted interventions. Of the 246,543 subjects included in the study, 207,911 (84.3%) were vaccinated. The minority groups of ultra-Orthodox Jews and Arabs had lower vaccination rates than the non-ultra-Orthodox Jews (68.7%, 80.5% and 87.7%, respectively, p < 0.001). Adults of low socioeconomic status (SES) had lower vaccination rates compared to those of high SES (74.4% vs. 90.8%, p < 0.001). Adults aged 20–59 years had a lower vaccination rate than those ≥60 years (80.0% vs. 92.1%, p < 0.0001). Multivariate analysis identified five independent variables that were significantly (p < 0.001) associated with low vaccination rates: minority groups of the ultra-Orthodox sector and Arab population, and underlying conditions of asthma, smoking and diabetes mellitus (odds ratios: 0.484, 0.453, 0.843, 0.901 and 0.929, respectively). Specific targeted public health interventions towards these subpopulations with significantly lower rates of vaccination are suggested.

Youth invisible work: the sociocultural and collaborative processes of online search and brokering between adolescents and English-language learning families

PurposeThis study aims to investigate the collaboration processes of immigrant families as they search for online information together. Immigrant English-language learning adults of lower socioeconomic status often work collaboratively with their children to search the internet. Family members rely on each other’s language and digital literacy skills in this collaborative process known as online search and brokering (OSB). While previous work has identified ecological factors that impact OSB, research has not yet distilled the specific learning processes behind such collaborations.Design/methodology/approachFor this study, the authors adhere to practices of a case study examination. This study’s participants included parents, grandparents and children aged 10–17 years. Most adults were born in Mexico, did not have a college-degree, worked in service industries and represented a lower-SES population. This study conducted two to three separate in-home family visits per family with interviews and online search tasks.FindingsFrom a case study analysis of three families, this paper explores the funds of knowledge, resilience, ecological support and challenges that children and parents face, as they engage in collaborative OSB experiences. This study demonstrates how in-home computer-supported collaborative processes are often informal, social, emotional and highly relevant to solving information challenges.Research limitations/implicationsAn intergenerational OSB process is different from collaborative online information problem-solving that happens between classroom peers or coworkers. This study’s research shows how both parents and children draw on their funds of knowledge, resilience and ecological support systems when they search collaboratively, with and for their family members, to problem solve. This is a case study of three families working in collaboration with each other. This case study informs analytical generalizations and theory-building rather than statistical generalizations about families.Practical implicationsDesigners need to recognize that children and youth are using the same tools as adults to seek high-level critical information. This study’s model suggests that if parents and children are negotiating information seeking with the same technology tools but different funds of knowledge, experience levels and skills, the presentation of information (e.g. online search results, information visualizations) needs to accommodate different levels of understanding. This study recommends designers work closely with marginalized communities through participatory design methods to better understand how interfaces and visuals can help accommodate youth invisible work.Social implicationsThe authors have demonstrated in this study that learning and engaging in family online searching is not only vital to the development of individual and digital literacy skills, it is a part of family learning. While community services, libraries and schools have a responsibility to support individual digital and information literacy development, this study’s model highlights the need to recognize funds of knowledge, family resiliency and asset-based learning. Schools and teachers should identify and harness youth invisible work as a form of learning at home. The authors believe educators can do this by highlighting the importance of information problem solving in homes and youth in their families. Libraries and community centers also play a critical role in supporting parents and adults for technical assistance (e.g. WiFi access) and information resources.Originality/valueThis study’s work indicates new conditions fostering productive joint media engagement (JME) around OSB. This study contributes a generative understanding that promotes studying and designing for JME, where family responsibility is the focus.

Cross-sectional and longitudinal associations between the built environment and walking: effect modification by socioeconomic status

BackgroundAlthough socioeconomic status (SES) has been shown to modify associations between the neighborhood built environment and physical activity, contradictory results exist. Objectives of this cross-sectional and longitudinal analysis were to: 1) examine whether overall neighborhood walkability and specific built characteristics were associated with walking among adults at a single point in time and after they relocate neighborhoods, and 2) test for effect modification of these associations by SES.MethodsWe linked longitudinal data from 703 adults who relocated urban neighborhoods between two waves of Alberta’s Tomorrow Project (2008–2015) to neighborhood built environment data. We created a walkability index from measures of population counts, street connectivity, and destination diversity within 400 m of participants’ homes. In cross-sectional analyses, we used generalized linear models to estimate associations between built characteristics and minutes walked per week at baseline. For the longitudinal analyses, we used fixed-effects linear regression models to estimate associations between changes in built characteristics and minutes walked per week. We also assessed if indicators of SES (individual education or household income) modified both sets of associations.ResultsMost cross-sectional and longitudinal associations were small and statistically non-significant. Neighborhood population count (b = 0.03, 95% CI: 0.01, 0.07) and street connectivity (b = − 1.75, 95% CI: − 3.26, − 0.24) were cross-sectionally associated with walking duration among the overall sample. None of the longitudinal associations were statistically significant among the overall sample. There was limited evidence of effect modification by SES, however, we found negative cross-sectional associations between street connectivity and walking among adults with lower education and income, and a positive association between percent change in walkability and change in walking among lower educated adults.ConclusionsDespite population count and street connectivity being associated with walking at baseline, changes in these built environment variables were not associated with changes in walking following residential relocation. Our findings also provide evidence, albeit weak, that changes in neighborhood walkability, resulting from residential relocation, might more strongly affect walking among low SES adults. Further longitudinal research is needed to examine built environment characteristics with walking for different purposes and to test for inequitable socioeconomic impacts.

Socioeconomic status for predicting COVID-19-related changes in cancer prevention behaviors.

10547 Background: Disruptions of daily life activities during the CVOID-19 pandemic have adversely affected cancer-prevention behaviors. Socioeconomic status (SES) impacts on changes in cancer prevention behaviors have not been fully investigated. To tackle this gap, we examined the effects of SES on COVID-19 related changes in cancer prevention behaviors. Methods: We invited participants from previous studies conducted at the Ohio State University Comprehensive Cancer Center who agreed to be re-contacted to participate in a survey assessing the impact of COVID-19 on various behaviors between June and November 2020. Participants reported current cancer prevention behaviors, including physical activity, daily fruit and vegetable intake, alcohol consumption, and tobacco use. In addition, participants reported qualitative changes in current behaviors relative to pre-COVID levels. We combined current behaviors with COVID-related changes to construct a 24-point cancer prevention score. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted multinomial logistic regression was used to examine the association between SES and COVID-19 related changes in cancer prevention behaviors. Results: The study sample included 6136 eligible participants. The average age was 57 years, 67% were female, 89% were non-Hispanic White, and 33% lived in non-metro counties. The proportion of participants in the lowest cancer prevention behavior quartile decreased significantly with higher SES [low SES vs. high SES; 32% vs. 28%; P-value &lt;.001]. Relative to pre-COVID-19 levels, higher SES was significantly associated with increases in post-COVID-19 prevalence of more physical activity [low SES vs. high SES; 12% vs. 28%; P-value &lt;.001], higher fruit and vegetable intake [low SES vs. high SES; 12% vs. 14%; P-value &lt;.001], and more alcohol consumption [low SES vs. high SES; 15% vs. 22%; P-value &lt;.001]. Higher SES was associated with lower tobacco use prevalence [low SES vs. high SES; 5% vs. 2%; P-value &lt;.001]. Relative to the highest prevention score quartile, the adjusted odds of scoring in the lowest prevention score quartile were: adjusted odds ratio (aOR) 1.55 (95% CI: 1.27 - 1.89) and aOR 1.40 (95% CI: 1.19 - 1.66), respectively higher for low and middle SES. Low SES was significantly associated with higher odds of less frequent physical activity (aOR = 1.87; 95% CI: 1.49 - 2.35) and less fruit and vegetable consumption (aOR = 1.56; 95% CI: 1.15 - 2.12). Middle SES relative to high SES was associated with lower odds of more alcohol consumption (aOR = 0.64; 95% CI: 0.49 - 0.85) and higher odds of binge drinking (aOR = 1.32; 95% CI: 1.09 - 1.59). Conclusions: The adverse impacts of COVID-19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

Child socioeconomic status, childhood adversity and adult socioeconomic status in a nationally representative sample of young adults

IntroductionNumerous studies have examined the consequences of childhood adversity (CA) and socioeconomic status (SES) for health over the life course. However, few studies have examined the relation between childhood SES and CA as well as the influence of CA on adult SES. The objective of this study was to examine direct and indirect associations between childhood SES, CA and adult SES. MethodsParticipants in the National Longitudinal Study of Adolescent to Adult Health, (N = 6844) reported on nine CA experiences. Childhood SES was characterized as a composite measure of parental highest education level, median household income, and parental occupational status. Adult SES was characterized as composite measure of highest education level attained at age 37, median household income and occupation. ResultsIn mediation analyses, adjusted for age, race and sex pathways were noted in that lower child SES was associated with CAs and CAs were associated with lower adult SES. Furthermore, CAs partially mediated the relation between childhood SES and adult SES. The proportion mediated by CA was small and only noted among African-American (4%) and White participants (5%). ConclusionsChildhood SES is associated with CAs. In turn, CAs are associated with lower adult SES, independent of childhood SES supporting the notion that intervening on CAs early on in the lifecourse could influence health and wellbeing throughout the life course.

Perceptions of and hesitancy toward COVID-19 vaccination in older Chinese adults in Hong Kong: a qualitative study

BackgroundCOVID-19 vaccination is recommended for older adults by the World Health Organization. However, by July 15, 2021, only 26% of individuals over 60 years old in Hong Kong had received a first dose of the vaccine. The health belief model and the theory of planned behavior have been used to understand the determinants for COVID-19 vaccination in past literature. However, vaccination determinants can be complex and involve social and cultural factors that cannot be explained by micro-individual factors alone; hence, the health belief model and the theory of planned behavior cannot provide a complete understanding of vaccine hesitancy. Few studies on the barriers to, hesitancy toward, and motivations for COVID-19 vaccination among older Chinese adults have been performed. The aim of this study is to fill this gap by conducting a comprehensive analysis of this subject using the critical medical anthropology framework, extending the health belief model and the theory of planned behavior in understanding vaccination determinants among the older adult population.MethodsBetween November 2020 and February 2021, 31 adults (24 women and 7 men) over the age of 65 took part in semi-structured, one-on-one interviews. The data we gathered were then analyzed through a phenomenological approach.ResultsTwo major themes in the data were examined: barriers to vaccination and motivations for vaccination. The participants’ perceptions of and hesitancy toward vaccination demonstrated a confluence of factors at the individual (trust, confidence, and social support networks), microsocial (stigma toward health care workers), intermediate-social (government), and macrosocial (cultural stereotypes, civic and collective responsibility, and economic considerations) levels according to the critical medical anthropology framework.ConclusionsThe decision to receive a COVID-19 vaccination is a complex consideration for older adults of low socioeconomic status in Hong Kong. Using the critical medical anthropology framework, the decision-making experience is a reflection of the interaction of factors at different layers of social levels. The findings of this study extend the health belief model and the theory of planned behavior regarding the understanding of vaccination perceptions and relevant behaviors in an older adult population.

Early childhood adversity and late-life depressive symptoms: unpacking mediation and interaction by adult socioeconomic status.

Adverse childhood experiences (ACEs) have been linked to diminished health achievement across the life course. However, few studies have rigorously investigated the role of adult socioeconomic status (SES) as a mediator and an effect modifier of the association between ACEs and late-life depression. We used a four-way decomposition analysis to examine the relative contributions of mediation and interaction by low adult SES to the association between ACEs and late-life depression. Data came from two waves (2013 and 2016) of the Japan Gerontological Evaluation Study, a nationwide cohort of older people (n = 7271). ACEs were determined as ≥ 2 experiences of the following: parental loss, parental divorce, parental mental illness, domestic violence, physical abuse, psychological neglect, psychological abuse, and economic disadvantage. Low adult SES was defined as earning < 2 million yen of income and < 10years of schooling. Depressive symptoms were assessed using the Geriatric Depression Scale. Controlled direct effect (coefficient 0.28; 95% CI 0.08-0.46) accounted for 69.1% of the total effect, which was greater than the other three estimates for the decomposed effects (reference interaction 20.8%, mediated interaction 5.7%, and pure indirect effect 4.4%). Adult SES accounted for 10.1% (via mediation) and 26.5% (via exposure-mediator interaction) of the total association between ACEs and depressive symptoms, respectively. ACEs appeared to be a strong and independent determinant of depressive symptoms in later life. Nonetheless, the interaction between ACEs and adult SES indicates that achieving high adult SES could mitigate the adverse effect of ACEs on late-life depression.

How young adults cope with loneliness: a study of London’s most deprived boroughs

ABSTRACT There is growing recognition that young adults of low socioeconomic status are among the loneliest in the United Kingdom. However, there has been a dearth of qualitative research exploring how they cope with their loneliness. Using a novel free association technique, this study sought to explore how young adults (n = 48) in London’s most deprived areas cope with feeling lonely. A thematic analysis, informed by an inductive approach, identified six key themes. Seeking connection, avoidance, seeking support and cognitive strategies were most prevalent. Meaning-focused coping and distraction were also identified, albeit less often. Overall, there were diverse ways of coping within and across respondents and important differences were found between the genders. The findings call for the early identification of those at risk of persistent avoidance behaviours and for interventions that provide meaningful leisure activities, with mutual goals in communities, alongside the strengthening of support and authenticity in relationships.

Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis.

To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Day-to-day pattern of work and leisure time physical behaviours: are low socioeconomic status adults couch potatoes or work warriors?

BackgroundMost studies on day-to-day patterns of physical behaviours (i.e. physical activities and sedentary behaviour) are based on adults with high socioeconomic status (SES) and without differentiating between work and leisure time. Thus, we aimed to characterise the day-to-day leisure time physical behaviours patterns among low SES adults and investigate the influence of work physical behaviours.MethodsThis cross-sectional study included 963 adults from low SES occupations (e.g. manufacturing, cleaning and transportation). The participants wore accelerometers for 1–7 days to measure physical behaviours during work and leisure time, expressed as time-use compositions consisting of time spent sedentary, standing or being active (walking, running, stair climbing, or cycling). Compositional multivariate multilevel models were used to regress daily leisure time-use composition against work time-use compositions. Interaction between weekday and (1) type of day, (i.e., work/non-work) and (2) the work time-use composition were tested. Compositional isotemporal substitution was used to interpret the estimates from the models.ResultsEach weekday, workers consistently spent most leisure time being sedentary and most work time standing. Leisure time physical behaviours were associated with type of day (p < 0.005, more sedentary on workdays vs. non-workdays), weekday (p < 0.005, more sedentary on Friday, Saturday and Sunday), standing work (p < 0.005, more sedentary and less standing and active leisure time on Sunday), and active work (p < 0.005, less sedentary and more standing and active leisure time on Sunday). Sedentary leisure time increased by 18 min, while standing and active leisure time decreased by 11 and 7 min, respectively, when 30 min were reallocated to standing at work on Sunday. Conversely, sedentary leisure time decreased by 25 min, and standing and active leisure time increased by 15 and 10 min, respectively, when 30 min were reallocated to active time at work on Sunday.ConclusionsWhile low SES adults’ leisure time was mostly sedentary, their work time was predominantly standing. Work physical behaviours differently influenced day-to-day leisure time behaviours. Thus, public health initiatives aiming to change leisure time behaviours among low SES adults should consider the influence of work physical behaviours.

Young Adults' Experience of Loneliness in London's Most Deprived Areas.

Young adults (16–24 years old) are currently the loneliest group in Western countries. In particular, young adults of lower socio-economic status (SES) living in the most deprived areas are loneliest in the United Kingdom. This mixed-methods study explored the experience of loneliness among this under-explored demographic in London. Using a novel free association technique, the experience of loneliness was found to be characterized by: a sense of isolation, negative emotions and thoughts, coping and a positive orientation to aloneness. An exploration of these themes revealed that: one can feel isolated or excluded even when surrounded by people; the experience of loneliness is accompanied by a set of interrelated feelings and thoughts like rumination; and technological and/or non-technological outlets can be used to cope. Social media play both a positive and negative role in loneliness, and loneliness is not always experienced negatively. The quantitative data indicated that this sample was lonely. By providing insight into young adults’ loneliness, the findings indicate what types of interventions are likely to diminish it.

Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial.

BackgroundA decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown.ObjectiveThe objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications.MethodsWe will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients’ medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control.ResultsOur study was funded in July 2020. As of May 2021, we have enrolled 6 participants.ConclusionsOur findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials.Trial RegistrationClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242International Registered Report Identifier (IRRID)PRR1-10.2196/18984

Pathways connecting family socioeconomic status in adolescence and sleep continuity in adult Black and White men

ObjectiveTo evaluate the roles of parenting and adolescent characteristics during ages 13 to 16 in connecting family socioeconomic status (SES) during adolescence with adult sleep in Black and White men. DesignLongitudinal school-based community study beginning in 1987-1988 when participants were enrolled in the first or seventh grade. SettingPittsburgh, PA. Participants291 men (54.4% Black, mean age = 33, SD = 2.5) participated in 2012-2014 in a week-long study of sleep measured by actigraphy and diary. MeasuresIn adolescence (ages 13-16), measures of family SES based on occupation, education, income and public assistance; parenting based on monitoring, positive expectations for future, warm parent-child relationship, and communication; and adolescent characteristics based on anxiety, hyperactivity/impulsivity, and peer rejection. In adulthood, participant SES, minutes awake after sleep onset (WASO), duration, and diary-assessed sleep quality. ResultsStructural equation modeling confirmed significant indirect pathways: (1) low family SES in adolescence to negative parenting to low adult SES to greater WASO; (2) low family SES in adolescence to adolescent characteristics to low adult SES to greater WASO; (3) Black race to low family SES in adolescence to negative parenting to low adult SES to greater WASO; and (4) Black race to low family SES in adolescence to adolescent characteristics to adult SES to greater WASO. Similar models for duration and quality were not confirmed. ConclusionsParenting and adolescent characteristics may have an indirect association with adult sleep continuity. Parenting and mental health interventions in adolescence may improve adult sleep.