Low Socioeconomic Status Areas Research Articles

The association of short-term increases in ambient PM2.5 and temperature exposures with stillbirth: racial/ethnic disparities among Medicaid recipients.

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code-level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10μg m-3 increase in PM2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, -0.04% to 1.40%) and lag 2 (0.52%; 95% CI, -0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, -0.81 to 6.45). An association between daily PM2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM2.5 exposure. This article is part of a Special Collection on Environmental Epidemiology.

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Economically disadvantaged areas in rural Australia. Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Ambient air pollution and mortality: The role of socioeconomic conditions.

There is a vast body of literature covering the association between air pollution exposure and nonaccidental mortality. However, the role of socioeconomic status (SES) in this relationship is still not fully understood. We investigated if individual and contextual SES modified the relationship between short-term exposure to ozone (O3), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter <10 µm (PM10) on cardiovascular, respiratory, and all nonaccidental mortality. We conducted a time-stratified case-crossover study. Analyses were based on information on 280,685 deaths from 2011 to 2015 in the city of São Paulo. Education was used as an individual SES, and information on the district of residence was used to build a contextual SES. Exposure to PM10, NO2, and O3 was accessed from monitoring stations and linked to each case based on the date of death. Conditional logistic regression models were used to estimate the effects of air pollutants, and interaction terms were added to access the effect modification of SES. Individuals with lower education had an increased chance of dying for all nonaccidental outcomes (1.54% [0.91%, 2.14%]) associated with exposure to PM10. Individuals living in lower SES areas had an increased chance of dying for nonaccidental (0.52% [0.16%, 0.88%]), cardiovascular (1.17% [0.88%, 1.46%]), and respiratory (1.70% [0.47%, 2.93%]) causes owing to NO2 exposure. Exposure to air pollutants increases the chance of dying by nonaccidental, cardiovascular, and respiratory causes. Lower educational levels and living on lower contextual SES increased the risk of mortality associated with air pollution exposure.

Evaluation of an early childhood caries preventive programme starting during pregnancy-Results after 3 and 6 years.

Early childhood caries (ECC) has been found to be up to five times more common among children living in areas of low socio-economic status (SES) than among children in areas of higher SES. To evaluate an ECC prevention programme from pregnancy to 3 and 6 years of age. A prospective, controlled, intervention cohort study was initiated in 2013 in a low-SES area in Sweden. The intervention group received an individual interdisciplinary ECC prevention programme starting pre-birth, consisting of supportive oral health-promoting talks using motivational interviewing techniques and individual ECC preventive actions. A control group, consisting of pregnant women living in a comparable area, received ordinary routines. Of the 336 pregnant women, 64 mothers (with 64 children) completed the programme, and 394 children were born in the control group. At the sixth year examination, the proportion of children with no caries was similar between the groups (53% resp. 52%, p = .976), whereas the proportion with decayed, missed, filled primary teeth (dmft = 1-5) was slightly lower (23% resp. 36%, p = .063), and the proportion with severe caries disease (dmft > 5) was higher (p = .013) in the intervention group (25%) than in the control group (12%). No preventive effect regarding caries can be demonstrated at sixth year of age. Maternal behavioural change in dental care was not sufficient to even out inequalities in oral health in children, eventually due to difficulties in reaching the target group and the lack of effects among the families reached.

Construction of residential histories to estimate long-term environmental exposures in the California Teachers Study cohort.

Environmental epidemiologic studies using geospatial data often estimate exposure at a participant's residence upon enrollment, but mobility during the exposure period can lead to misclassification. We aimed to mitigate this issue by constructing residential histories for participants in the California Teachers Study through follow-up (1995-2018). Address records have been collected from the US Postal Service, LexisNexis, Experian, and California Cancer Registry. We identified records of the same address based on geo-coordinate distance (≤250 m) and street name similarity. We consolidated addresses, prioritizing those confirmed by participants during follow-up questionnaires, and estimating the duration lived at each address using dates associated with records (e.g., date-first-seen). During 23 years of follow-up, about half of participants moved (48%, including 14% out-of-state). We observed greater mobility among younger women, Hispanic/Latino women, and those in metropolitan and lower socioeconomic status areas. The cumulative proportion of in-state movers remaining eligible for analysis was 21%, 32%, and 41% at 5, 10, and 20 years post enrollment, respectively. Using self-reported information collected 10 years after enrollment, we correctly identified 94% of movers and 95% of non-movers as having moved or not moved from their enrollment address. This dataset provides a foundation for estimating long-term environmental exposures in diverse epidemiologic studies in this cohort. IMPACT: Our efforts in constructing residential histories for California Teachers Study participants through follow-up (1995-2018) benefit future environmental epidemiologic studies. Address availability during the exposure period can mitigate misclassification due to residential changes, especially when evaluating long-term exposures and chronic health outcomes. This can reduce differential misclassification among more mobile subgroups, including younger women and those from lower socioeconomic and urban areas. Our approach to consolidating addresses from multiple sources showed high accuracy in comparison to self-reported residential information. The residential dataset produced from this analysis provides a valuable tool for future studies, ultimately enhancing our understanding of environmental health impacts.

Universal healthy school start intervention reduced the body mass index of young children with obesity.

To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials. The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data. In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant. The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.

The Effect of Background Noise, Bilingualism, Socioeconomic Status, and Cognitive Functioning on Primary School Children's Narrative Listening Comprehension.

This study focuses on 7- to 9-year-old children attending primary school in Swedish areas of low socioeconomic status, where most children's school language is their second language. The aim was to better understand what factors influence these children's narrative listening comprehension both in an ideal listening condition (in quiet) and for the primary school classroom, a typical listening condition (with multitalker babble noise). A total of 86 typically developing 7- to 9-year-olds performed a narrative listening comprehension test (Lyssna, Förstå och Minnas [LFM]; English translation: Listen, Comprehend, and Remember) in two listening conditions: quiet and multitalker babble noise. They also performed the crosslinguistic nonword repetition test and a digit span backwards (DSB) test. A predictive statistical model including these factors, the children's degree of school language exposure, parental education level, and age was derived. Listening condition had the strongest predictive value for LFM performance, followed by school language exposure and nonword repetition accuracy. Parental education level was also a significant predictor. There was a significant three-way interaction effect between listening condition, age, and DSB performance. Multitalker babble noise has a negative effect on children's narrative listening comprehension. The effect of multitalker babble noise could be explained by age differences in the ability to allocate working memory capacity during the narrative listening comprehension task, suggesting that younger children may be more vulnerable for missing information when listening in background noise than their older peers. https://doi.org/10.23641/asha.25209248.

The Burden of Human Metapneumovirus- and Influenza-Associated Hospitalizations in Adults in New Zealand, 2012-2015.

Unlike influenza, information on the burden of human metapneumovirus (HMPV) as a cause of hospitalizations in adults with acute respiratory illness (ARI) is limited. We compared the population-based incidence, seasonality, and clinical characteristics of these 2 viral infections among adults aged ≥20 years with ARI hospitalizations in Auckland, New Zealand, during 2012-2015 through the Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (SHIVERS) project. Of the 14 139 ARI hospitalizations, 276 of 6484 (4.3%) tested positive for HMPV and 1342 of 7027 (19.1%) tested positive for influenza. Crude rates of 9.8 (95% confidence interval [CI], 8.7-11.0) HMPV-associated and 47.6 (95% CI, 45.1-50.1) influenza-associated ARI hospitalizations were estimated for every 100 000 adult residents annually. The highest rates for both viruses were in those aged ≥80 years, of Māori or Pacific ethnicity, or living in low socioeconomic status (SES) areas. HMPV infections were more common than influenza in those with chronic medical conditions. Although HMPV infections accounted for fewer hospitalizations than influenza in adults aged ≥20 years, HMPV-associated ARI hospitalization rates were higher than influenza in older adults, Māori and Pacific people, and those of low SES. This highlights a need for vaccine/antiviral development.

Occurrence of hepatitis B and C virus infection in socioeconomic population strata from Recife, Pernambuco, Northeast Brazil.

To estimate the probability of infection with hepatitis B (HBV) and C (HCV) viruses in different socioeconomic strata of the population of Recife, Northeast Brazil. Study carried out from samples obtained in a survey of residents of a large urban center that had a population base and stratified sampling with random selection of households using the "Brazil Sample" package in the R software. HBV (HBsAg) and anti-HCV was performed using immunochromatographic tests. In cases positive for HBsAg, anti-HBc and HBeAg were tested using chemiluminescence, as well as HBV-DNA using real-time PCR. For cases positive for anti-HCV, the search for this antibody was repeated by chemiluminescence and for HCV-RNA by real-time PCR. The occurrence of HBsAg and anti-HCV cases in the general population was estimated based on a theoretical negative binomial distribution. Among 2,070 samples examined, 5 (0.24%) were HBsAg and 2 (0.1%) anti-HCV positive. The majority of cases had self-reported skin color as black/brown (6/7), education level up to high school (6/7), a steady partner (5/7) and lived in an area of low socioeconomic status (5/7). The occurrence of HBsAg and anti-HCV was lower than those previously found in population-based studies and slightly lower than the most recent estimates. Individuals with lower socioeconomic status should be a priority target of public health policies.

Mapping the prevalence of cancer risk factors at the small area level in Australia

BackgroundCancer is a significant health issue globally and it is well known that cancer risk varies geographically. However in many countries there are no small area-level data on cancer risk factors with high resolution and complete reach, which hinders the development of targeted prevention strategies.MethodsUsing Australia as a case study, the 2017–2018 National Health Survey was used to generate prevalence estimates for 2221 small areas across Australia for eight cancer risk factor measures covering smoking, alcohol, physical activity, diet and weight. Utilising a recently developed Bayesian two-stage small area estimation methodology, the model incorporated survey-only covariates, spatial smoothing and hierarchical modelling techniques, along with a vast array of small area-level auxiliary data, including census, remoteness, and socioeconomic data. The models borrowed strength from previously published cancer risk estimates provided by the Social Health Atlases of Australia. Estimates were internally and externally validated.ResultsWe illustrated that in 2017–2018 health behaviours across Australia exhibited more spatial disparities than previously realised by improving the reach and resolution of formerly published cancer risk factors. The derived estimates revealed higher prevalence of unhealthy behaviours in more remote areas, and areas of lower socioeconomic status; a trend that aligned well with previous work.ConclusionsOur study addresses the gaps in small area level cancer risk factor estimates in Australia. The new estimates provide improved spatial resolution and reach and will enable more targeted cancer prevention strategies at the small area level. Furthermore, by including the results in the next release of the Australian Cancer Atlas, which currently provides small area level estimates of cancer incidence and relative survival, this work will help to provide a more comprehensive picture of cancer in Australia by supporting policy makers, researchers, and the general public in understanding the spatial distribution of cancer risk factors. The methodology applied in this work is generalisable to other small area estimation applications and has been shown to perform well when the survey data are sparse.

Inequities in Autologous Stem Cell Transplantation, Chimeric Antigen Receptor T-Cell Therapy and Clinical Trial Participation in Patients Receiving Second-Line and Later Multiple Myeloma Treatment

Introduction: Despite improvements in care and novel therapies for the treatment of multiple myeloma (MM), nearly all patients experience relapse. However, few real-world studies have focused on treatment inequities that occur later in the MM patient journey with subsequent lines of therapy - the setting of particular interest for salvage treatment and novel drug development. The objectives of this study were to measure receipt of autologous stem cell transplantation (ASCT), chimeric antigen receptor T-cell therapy (CAR-T) and participation in clinical trials following initiation of second-line (2L) MM treatment and to describe inequities by race/ethnicity and area-level sociodemographic factors. Methods: This was a retrospective cohort study using the nationwide, electronic health record-derived Flatiron Health de-identified database. We included patients that previously received therapy for newly diagnosed MM and were initiating 2L between 2011 and 2023. The exposures of interest were race/ethnicity and area-level (census block group) socioeconomic status (SES) measured by the Yost index. Outcomes of interest were receipt of ASCT, CAR-T and clinical trial participation. Patients were followed from the date of 2L initiation until the first of the outcome of interest, death or end of the study period. Multivariable cause-specific hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations with receipt of ASCT, CAR-T and clinical trial participation separately and as a single outcome. Informed by the Institute of Medicine's framework for healthcare disparities, models were adjusted for clinical factors, specifically, age, sex, and Eastern Cooperative Oncology Group (ECOG) performance status. Results: In a cohort of 2,017 patients with MM that were ASCT and CAR-T naïve with a median age of 72 years (interquartile range [IQR] 63-79), 52% were male, 52% had ECOG scores of 0 or 1, and 59% were treated in community oncology practices. Prior to 2L, 73% received fluorescence in situ hybridization testing for cytogenetic abnormalities and most patients received either doublet (34%) or triplet (51%) therapy. The majority of patients included were non-Latinx (NL)-White (61%), 21% were NL-Black and 4% were Latinx. Compared to NL-White patients, fewer NL-Black patients received FISH testing (70% versus 73%) and either doublet or triplet therapy (81% versus 86%) for newly diagnosed MM. A higher proportion of Black and Latinx patients resided in areas in the lowest quintile of SES (42% and 40% respectively) compared to NL-White patients (8%). Overall, 12.7% received ASCT, 0.8% received CAR-T and 1.3% participated in a clinical trial following the start of 2L. Compared with NL-White patients, Black and Latinx patients had lower rates of treatment with ASCT and CAR-T; and clinical trial participation was also lower among Latinx patients relative to NL-White patients (see Figure). Patients living in the highest quintile of SES had higher rates of ASCT (19.2%), CAR-T (0.8%) and clinical trial participation (2.3%) compared to those living in the lowest quintile of SES (10.1%, 0.3% and 1.5% respectively). In multivariable models, NL-Black (HR 0.57, 95% CI 0.42-0.76) and Latinx (HR 0.41, 95% CI 0.25-0.76) patients had a lower likelihood of receiving these treatments or participating in a clinical trial compared to NL-White patients; similarly, living in the lowest SES quintile (HR 0.38, 95% CI 0.26-0.56) was also associated with lower likelihood of these outcomes. Other area-level factors associated with inequities in ASCT, CAR-T and trial participation included living in segregated Black neighborhoods and areas with greater concentration of non-citizen residence and no vehicle ownership. Conclusion: We observed lower receipt of ASCT, CAR-T, and participation in clinical trials among Black and Latinx patients initiating 2L or later MM therapy, as well as patients living in areas of low SES. Persistent inequities in MM span the entirety of the patient journey, including the limited uptake and availability of novel therapies at later stages of the disease and a lack of representation in trials investigating new MM therapies.

Small-group vocabulary intervention combining elements from shared book Reading and the Lexicon pirate method – A pilot study of multilingual children with speech, language and communication needs

Multilingual children living in areas with low socioeconomic status (SES) are at an increased risk of having speech, language and communication needs (SLCN). Many multilingual children with SLCN in Sweden have insufficient basic vocabulary knowledge in the majority language, preventing them from achieving the school's learning goals. However, there is a lack of studies of interventions that could improve vocabulary development in this group, and that can be delivered in an everyday educational setting. This pilot study evaluates the effect of a school-based vocabulary group intervention, which combines elements from shared book reading and the Lexicon Pirate method, on vocabulary skills. A non-randomised pretest–posttest control group design was used. Eighteen six- to seven-year-old multilingual children attending preschool class in low SES areas either received intervention (n = 9) or were included in a control group (n = 9). The intervention group participated in 12 intervention sessions over six weeks. Word knowledge, semantic fluency, and comprehension of semantic relations were assessed pre- and post-intervention. Results revealed that children in the intervention group demonstrated significant gains in knowledge of both trained and untrained words, compared to the control group. No effects were found on semantic fluency or comprehension of semantic relations.

Capturing youth voices to improve food policy: applying CO-CREATE’s Dialogue Forum Tool in Ireland

Abstract Background The percentage of children eating fruit and vegetables and consuming milk in Europe is low The EU School Fruit, Vegetable, and Milk Scheme (SFVMS) is funded by the European Commission to promote the daily consumption of fruit, vegetables and milk. In 2023, the Commission plan to revise the scheme and are interested in hearing the views of young people. The aim of this research is to capture the voices of European Youth on the SFVMS from a collaboration of 4 countries. The present study provides initial findings from 11 and 12 year olds living in Ireland using the novel CO-CREATE Dialogue Forum Tool (DFT). Methods Two primary schools were recruited from a list of schools participating in the EU school, fruit, vegetables and milk scheme. The schools were from a high and a low socioeconomic status area. In each school, 6 pupils were invited to participate in the forum with consent from their parents. The DFT was applied to capture youth voices. The tool involved a moderated structured discussion about a prewritten SFVMS policy idea. The moderator guided the participants through the discussion with a series of activities on a physical canvas. Results The participants felt the policy idea was important to improve health. They discussed the obstacles and opportunities to the policy idea, including the quality of the school food products and their preferences. They proposed actions for improvement, including raising awareness of the quality and creating an advertising campaign. The participants enjoyed taking part in the dialogue forum and felt it was important to have their voices heard. Conclusions The CO-CREATE DFT was useful to discuss a policy idea for the EU SFVMS. The implementation of the tool by other countries will provide a wider European perspective of the policy idea. Key messages • Participants engaged well with The CO-CREATE dialogue forum tool. • Youth voices can be readily captured to co-create food related policies.

The Suitability of Stool Antigen Testing in the Detection of Helicobacter pylori in a Regional and Rural Area of Australia

Background. Helicobacter pylori is considered the most widespread bacterial pathogen worldwide. Successful eradication protocols are well established, highlighting the importance of appropriate infection detection. Noninvasive testing (NIT) methods are commonly used to detect infection, with test selection dependent on access and previous infection. This study examined trends in NIT by age group and test selection for eradication screening as well as examining H. pylori area prevalence by socioeconomic status (SES) in the Illawarra Shoalhaven and surrounding region. Materials and Methods. This retrospective cohort quantitative study is based on 20,998 NIT including stool antigen test (SAT), urea breath test (UBT), or H. pylori serology via Southern.IML Pathology between 2018 and 2020. Test percentage positives per and total test percentages within age groups were calculated for each NIT. Positive sample postcode data was assigned to socioeconomic percentiles. Total test utilisation and prevalence were calculated and depicted as geospatial representations. Results. Overall: 58.5% UBT, 31% serology, and 10.5% SAT were performed, with 14.7% positive for any NIT. Highest percent positive age group: SAT 80-89yo (18.6%), UBT 0-9yo (20.8%), and serology 90–99yo (32.6%). Test majority per age group: SAT 0-9yo (67.4%), UBT 10-89yo (59.4%), and serology 90-99yo (48.3%). A trend was seen between increasing infection prevalence and increasing socioeconomic disadvantage ( p = 0.161 , R 2 = 0.0361 ). Prevalence rates visually correlated with total test utilisation. Conclusions. SAT was underutilised compared to UBT or serology. Serology was inappropriately used in older age groups, and the result validity was questioned following confirmed infection. SAT is a viable alternative for use in these settings. No significant correlation was seen between lower SES areas and higher H. pylori infection prevalence, but low-test utilisation suggests likely prevalence underestimation within the studied area and may indicate reduced accessibility to healthcare.

Enabling mothers of young children in a low SES area to co-design the support they are seeking for the adoption of healthy behaviours.

There is a need for interventions that meet the needs of low socioeconomic status (SES) groups, to encourage the adoption of healthy diets and physical activity, in line with current public health guidance. This qualitative research used co-production, a method which actively involves the relevant community, to identify and describe public health interventions to support a group of mothers of young children living in a low SES area. A group of 20 mothers took part in three in-depth qualitative interviews to discuss in detail the type of support that would be of value to them for the adoption and maintenance of healthy behaviours. The mothers were subsequently invited to take part in a public engagement project, a community-based self-help group. Four themes explained the principles of interventions that would be of value in supporting the mothers with the adoption of healthy behaviours, namely, a community-based self-help group, support for the whole family and support in the home and influencing the environment. These were then further developed into two types of intervention (1) learning for self-help and family care, which encompassed the first three learning-based themes and (2) community of support, which covered influencing the environment and the experience of the community-based self-help group. Co-production enabled a group of mothers of young children, from a low SES area, to describe the type of support that would help them with the establishment and maintenance of healthy lifestyle behaviours. A community-based self-help group warrants further research.

School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements.

We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.

Development, acceptability and feasibility of a community-based intervention to increase timely initiation of antenatal care in an area of high ethnic diversity and low socio-economic status in the UK

BackgroundAntenatal care plays an important role in preventing adverse maternal and new-born outcomes. Women from ethnic minority backgrounds and of low socio-economic status are at greater risk of initiating antenatal care later than the recommended 10 weeks. There is a paucity of research exploring the development and evaluation of community-based interventions to increase the timely initiation of antenatal care. ObjectiveTo develop and evaluate the acceptability and feasibility of a co-produced community-based intervention to increase uptake of antenatal care in an area with high ethnic diversity and low socio-economic status. DesignThe intervention was developed using co-production workshops and conversations with 20 local service users and 14 stakeholders, underpinned by the theory of Diffusion of Innovation. The intervention was evaluated, on the domains of acceptability, adoption, appropriateness, and feasibility. Questionnaires (n=36), interviews (n=10), and focus groups (n=13) were conducted among those who received the intervention. Observations (n=13) of intervention sessions were conducted to assess intervention fidelity. Quantitative and qualitative data were analysed using SPSS and NVivo software respectively. ResultsOver 91% of respondents positively ranked the intervention. Qualitative findings with respect to ‘acceptability’ included four subthemes: how the intervention was communicated, the characteristics of the person delivering the intervention and their knowledge, and the reassurance offered by the intervention. The ‘adoption’ theme included three sub-themes: being informed helps women to engage with antenatal care, the intervention provides information for future use, and onwards conveyance of the intervention information. The ‘appropriateness’ theme included three sub-themes: existing gap in information, nature of information given as part of the intervention, and talking about pregnancy in public. The ‘feasibility’ theme included two sub-themes: value of delivering the intervention in areas of high footfall and relational aspect of receiving the intervention. Observations showed intervention fidelity of 100%. ConclusionThe community-based intervention, coproduced with women and maternity care stakeholders, was positively evaluated, and offered an innovative and promising approach to engage and educate women about the timely initiation of antenatal care in an ethnically diverse and socio-economically deprived community.

A Socio-Spatial Approach to Define Priority Areas for Bicycle Infrastructure Using Covid-19 Data

The existing distribution of bicycle infrastructure is often quite unequal and concentrated in socially advantaged areas. One key issue is there remain less explored variables and models that could greatly assist in the equitable planning of new or improved bicycle infrastructure. To improve the allocation of cyclist-serving infrastructure, analysis should be: a) attuned to the needs of diverse users, b) temporally robust, and c) able to capture changes in use. I put forward an approach for siting bicycle infrastructure that utilizes administrative data, the inferential opportunity afforded by the interruption of the Covid-19 pandemic, and raster-based methods to describe a) where cycling behavior changed most during the pandemic compared to pre-pandemic conditions, b) where positive changes in cycling behavior during the pandemic concentrate across space and key population groups, and c) where such concentrations, in tandem with social and infrastructure variables, suggest areas for cyclist-serving infrastructure expansion under an equity-oriented paradigm. I find that positive changes in bikeshare trip durations during the pandemic can associate with low socioeconomic status (SES) areas of Philadelphia, and that many streets in these underserved areas may benefit from new or improved bicycle infrastructure.

South Australia's tobacco retail landscape and its intersection with socioeconomic factors and smoking prevalence.

Tobacco product availability is higher in socioeconomically disadvantaged areas, which can further widen tobacco-related health and disease burden inequities. This study aimed to describe retail availability of tobacco products in South Australia and examine the association between tobacco vendor location, population's socioeconomic status (SES) and tobacco smoking prevalence. Cross-sectional 2022 tobacco vendor licence data and 2021-2022 state-wide population health survey data from the South Australian Department of Health were used. Tobacco vendors were enumerated by Statistical Area 2 (SA2) using geocoding software, with SA2s assigned health survey derived smoking prevalence, SES, remoteness category, area size, and population size. As of 2022, there were 1723 tobacco vendors in South Australia and the overall tobacco smoking prevalence across the state was 11.8%. Regression analyses indicated that tobacco vendor density increased with socioeconomic disadvantage and geographic remoteness, and that smoking prevalence was higher in low SES areas. Vendor density was not related to smoking prevalence. Findings are consistent with existing research indicating greater tobacco availability in socially disadvantaged areas. This supports that tobacco vendor saturation may be directed to areas in a way that promotes tobacco availability for vulnerable populations. Our finding that smoking prevalence was unrelated to tobacco availability contrasts existing literature and should be carefully interpreted. SO WHAT?: This is the first study to map tobacco retailers across South Australia, contributing needed evidence on the intersection of tobacco vendor density, social disadvantage, and smoking prevalence.

Socioeconomic disparities in the management and outcomes of acute myocardial infarction

BackgroundPatients from lower socioeconomic status areas have poorer outcomes following acute myocardial infarction (AMI); however, how ethnicity modifies such socioeconomic disparities is unclear.MethodsUsing the UK Myocardial Ischaemia National Audit Project...