Low Socioeconomic Status Communities Research Articles

Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study.

Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

The development and validation of the One Health Community Assessment

Interdisciplinary collaborations to address human, animal, and environmental health have been emphasized since the inception of the One Health framework. A quantitative survey instrument was developed to measure perceptions of the impacts of pets on One Health. Using the exploratory sequential mixed methods approach, 20 interviews were conducted with individuals from a racially diverse and low-socioeconomic status community in the U.S. to understand their perceptions of One Health. Data from those interviews informed the development of a Likert scale survey measuring individual perceptions of community, human, pet, and environmental health and welfare, as well as the connections between the domains of the One Health triad (human, animal, and environment). The resulting One Health Community Assessment (OHCA) was administered in two urban and two rural underserved U.S. communities longitudinally (2018–2021) through door-to-door data collection as well as phone, email, and text surveys. Validation of the instrument was completed using data collected in the third and fourth years of the study (n = 654). Factor analysis with orthogonal varimax rotation was used to assess the structure and internal consistency of the OHCA. Five subscales explained 42.4% of the variance in our 92-item instrument: community health (Cronbach's α = 0.897), human health (α = 0.842), pet health (α = 0.899), environmental health (α = 0.789), and connections between domains of One Health (α = 0.762). The OHCA represents the first reliable and validated instrument to measure the impacts of pets on One Health.

Achievement of Goal Orientation and Academic Engagement among Adolescents in Southwestern Uganda

Enhancing academic engagement is essential for improving the educational experiences of adolescents. Guided by Social Cognitive Theory, this study explored the relationship between achievement goal orientation and academic engagement among 510 secondary school students in Southwestern Uganda. The study focused on two forms of goal orientation—mastery-approach and performance-approach goals—and examined the mediating and moderating role of academic self-efficacy. The results, derived from self-reported data, indicate that approach achievement goals (mastery and performance) positively predict academic engagement, independently. Moreover, academic self-efficacy plays a dual role: while it mediates the relationship between approach achievement goals (mastery and performance) and academic engagement, self-efficacy also moderates the relationship between performance-approach achievement goals and academic engagement. These findings underscore the importance of academic self-efficacy and achievement goal orientation in enhancing academic engagement among adolescent students, especially in low socioeconomic status communities. This research contributes to the understanding of factors like teacher-student relationship, external support offered by Compassion International program, goal setting skills training and predetermined external rewards can enrich the educational experiences of students in low resource education contexts

Comparing population-level humoral and cellular immunity to SARS-Cov-2 in Bangalore, India

Two types of immunity, humoral and cellular, offer protection against COVID. Humoral protection, contributed by circulating neutralizing antibodies, can provide immediate protection but decays more quickly than cellular immunity and can lose effectiveness in the face of mutation and drift in the SARS-CoV-2 spike protein. Therefore, population-level seroprevalence surveys used to estimate population-level immunity may underestimate the degree to which a population is protected against COVID. In early 2021, before India began its vaccination campaign, we tested for humoral and cellular immunity to SARS-Cov-2 in representative samples of slum and non-slum populations in Bangalore, India. We found that 29.7% of samples (unweighted) had IgG antibodies to the spike protein and 15.5% had neutralizing antibodies, but at up to 46% showed evidence of cellular immunity. We also find that prevalence of cellular immunity is significantly higher in slums than in non-slums. These findings suggest (1) that a significantly larger proportion of the population in Bangalore, India, had cellular immunity to SARS-CoV-2 than had humoral immunity, as measured by serological surveys, and (2) that low socio-economic status communities display higher frequency of cellular immunity, likely because of greater exposure to infection due to population density.

Piloting a T-Shaped Approach to Develop Primary Students’ Close Reading and Writing of Literary Texts

AbstractThe study was a pilot intervention to develop Year 5–8 students’ close reading and writing of literary texts using the T-Shape Literacy Model (Wilson and Jesson in Set Res Inf Teach 1:15–22, 2019). Students analysed text sets to explore how different authors use language to engender mood and atmosphere. The study used a single-subject design logic for repeated researcher-designed and a quasi-experimental, matched control group design for repeated standardised measures of reading and writing. Nine teachers and their classes participated. The schools were part of a large school improvement programme using digital tools and pedagogy to accelerate students’ learning participated that the authors were research-practice partners in. The schools all served low socio-economic status communities and the majority of students were Māori (51%) and Pacific (28%). There was a large effect size on the overall score for the researcher-designed measure (effect size = 1.00) and for the close reading of single texts sub-score (effect size = 0.90). There was a moderate-to-high effect for students’ identification of language features (effect size = 0.75) but no significant effect on their synthesis scores. Students in the intervention significantly outperformed matched control group students in the standardised writing post-test (effect size = 0.65) but differences for the standardized reading comprehension test were not significant (effect size = 0.15). Results overall suggest the approach has promise for improving the metalinguistic knowledge, literary analysis and creative writing of younger and historically underserved groups of students.

Teletherapy Used to Breakdown Access Barriers.

The studies presented in this literature review reveal the numerous ways that teletherapy can be used to treat patients with mental health issues. The literature includes six research articles from published scientific journals that span from 2005 to 2020. The three types of telehealth therapy reviewed include mobile telehealth, telephone, and video technology. The six research articles focus on the ways that telehealth can reach communities of lower socioeconomic status (SES) and those suffering from access barriers. The benefits of teletherapy include cost savings, time efficiency, easier access, and a reduction in recidivism. Challenges include access barriers, financial difficulties, anxiety, and fear of stigmatization. Limitations of the studies presented include a lack of accessibility to internet and technology, privacy issues, and insurance coverage. Overall, results show that teletherapy provides an affordable, accessible alternative to traditional in-person mental health therapy, especially in reaching lower SES groups, Veterans, and patients with access restrictions.

Association of neighborhood-level socioeconomic status and urban heat in China: Evidence from Hangzhou

The escalating contradiction between global urban development and thermal environments has become increasingly apparent, underscoring the imperative to address social inequality in heat exposure and advocate for environmental justice (EJ) in the pursuit of sustainable urban development. To bridge the research gap in this domain, a comprehensive study was conducted to examine the correlation mechanism linking the thermal environment with the socioeconomic status (SES) of Chinese cities, employing Hangzhou as a representative case—a pivotal city among China's "four fire stoves". The investigation involved analyzing the spatial distribution pattern of diurnal Land Surface Temperature (LST) during the summer months spanning 2016 to 2018 (July to September). For SES characterization, a holistic indicator was established. Community-level LST variables were derived from LST surfaces obtained through the Terra and Aqua satellite MODIS sensors, with the community serving as the fundamental unit of analysis. The relationship between SES and LST was explored using random forest regression (RF), eXtreme Gradient Boosting (XGBoost), and support vector regression (SVR) to assess socioeconomic inequality in urban heat. The findings reveal that (1) RF exhibits the highest fitting accuracy and adeptly elucidates the nonlinear relationship and marginal effects between LST variables and SES. (2) Community SES in the Hangzhou metropolitan area exhibits spatial clustering. (3) Residents of low and middle SES communities experience heightened heat inequality. (4) A complex nonlinear relationship exists between daytime and nighttime LST and SES, with significant social disparities in urban heat within specific temperature thresholds. When deciding on measures to advance thermal environmental justice, it is crucial to prioritize both relatively disadvantaged groups and specific temperature intervals. This study departs from conventional approaches, exploring the nonlinear relationship between SES and urban heat at a fine scale, thereby assisting urban planners in developing effective strategies.

Teachers’ perceptions and lived experiences of challenges in culturally diverse classrooms: establishing an equitable school environment

Abstract The increasing population of students of color in public school settings in the United States is a persistent challenge for White teachers teaching diverse student populations with students from racially, ethnically, culturally, and linguistically diverse families and communities of lower socioeconomic status to make learning more effective in their classrooms. This qualitative study aimed to identify the challenges in teaching students of diverse backgrounds in public school settings in a school district in Houston, the most ethnically diverse large metropolitan area in the United States. The study focused on the lived experiences with in-depth and semi-structured interviews conducted with 7 participants (6 females; 1 male) to gain insights into their perspectives and understand the essence of their experiences. The findings showed that the lack of language proficiency and trained teachers in culturally responsive teaching often create barriers to effective schooling. The findings emphasize the importance of culturally responsive teaching to prepare highly effective teachers to address the needs of an increasingly diverse student population in the United States.

Abstract 18709: Disparities in Socioeconomic Metrics Associated With Adverse Outcomes Among Medicare Beneficiaries Undergoing Peripheral Endovascular Intervention

Background Low socioeconomic status (SES) is associated with an increased incidence of peripheral artery disease, however there is a lack of granularity in the specific metrics that contribute to this discrepancy. We examine the association of community-level economic distress with adverse outcomes in patients undergoing peripheral endovascular intervention (PVI). Hypothesis: Socioeconomically distressed communities have non-healthcare-related, structural disparities that contribute to incident PVI and adverse outcomes. Methods: Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine the incidence of femoropopliteal PVI. The Distressed Community Index (DCI) was used to categorize adults as distressed (DCI ≥80) or not distressed (DCI <80). Composite outcome of death and major amputation within 1 year of PVI were examined by level of distress using individual community-level metrics. Results: Socioeconomically distressed adults underwent 158 PVIs per 100000 distressed beneficiaries compared with 109 PVIs per 100000 non-distressed beneficiaries (risk ratio, 1.45 [95% CI, 1.42-1.48]; P<0.001). Distressed adults who underwent PVI were more likely to be female (45.5% versus 43.1%; P<0.001) and Black race (21.9% versus 10.1%; P<0.001) (Table I). There was a strong association between distress and the composite outcome at 1 year (incidence rate ratio, 1.11 [95% CI 1.07-1.16; P=0.0001]). Distressed adults lacked high school diplomas (11.88% versus 11.15%; P<0.001), had higher rates of unemployment (24.11% versus 22.76%; P<0.001), and greater housing vacancy rates (9.74% versus 9.31%; P<0.001). Conclusion: Socioeconomic distress is associated with higher rates of PVI-incidence and post-PVI adverse outcomes. This may be driven by structural inadequacies inherent to low SES communities that need to be addressed in order to narrow the gap in care among distressed adults undergoing PVI.

Progress in melanoma treatment: Patient's perspectives.

Upon the 20th Anniversary of the Society for Melanoma Research, we highlight the perspectives of patients aiming to help improve future experiences, outcomes, and their quality of life over the next 20 years. Five melanoma patients generously shared their inspiring and enlightening stories of diagnosis, treatment, and outcomes. Many patients had excellent medical teams that synergistically worked together to provide an accurate diagnosis, effective treatment options, and supportive care. However, it is clear that health inequities persist in communities where people of color are predominant, affecting early detection, patient experience, and outcomes. These stories shed light on the unique challenges faced by patients and how the lack of melanoma awareness and adequate resources, especially in communities of color or low socioeconomic status, can contribute to disparate outcomes in melanoma care. We expect that these stories will raise awareness about the progress in melanoma treatment but also the existent disparities in melanoma diagnosis and treatment and the importance of early detection and prevention.

Extracurricular activity participation, school belonging, and depressed mood: a test of the compensation hypothesis during adolescence

Feelings of acceptance within school communities can promote positive psychological outcomes. Despite occurring outside of the classroom, youth who engage in extracurricular activities typically report greater school belonging. Accordingly, we examined the longitudinal effect of extracurricular activities on school belonging and depressed mood in a nationally representative, Australian sample of adolescents (N = 3,850, Mage = 12.41) followed for four years. A random-intercept cross-lagged panel model revealed extracurricular activity participation at Time 1 predicted higher school belonging two years later. In turn, higher school belonging reinforced positive mental health outcomes, by predicting within-person decreases in depressed mood. Further, the direct and indirect effect of extracurricular activities were moderated by community-level socioeconomic status. Participants residing in low socioeconomic status communities garnered the greatest benefit from participating in activities, despite having the lowest levels of participation. Our data highlight how structured leisure time pursuits can promote wellbeing, especially within more disadvantaged communities.

S12-4 Feasibility evaluation of the Move Well, Feel Good movement behaviours intervention

Abstract Purpose Improving children’s motor competence through school-based physical activity interventions may be a mechanism for promoting positive mental health through psychosocial factors. Move Well, Feel Good (MWFG) is a such an intervention that was co-designed with children, class teachers, physical education (PE) teachers, and school leaders. This presentation describes the feasibility evaluation of MWFG. Methods Five primary schools were recruited from a low socioeconomic status community in northwest England. A 10-week intervention was co-designed which aimed to enhance children’s mental health through motor competence and psychosocial development. The core delivery of the programme involved one PE lesson per week devoted to development of locomotor, object control, and stability skills. This was supplemented by optional recess and home activities, and by non-PE curricular activities. Teachers were asked to record details of each MWFG session taught, and feasibility was evaluated against pre-defined criteria using surveys, interviews (teachers), and participatory focus groups (children). Pre- and post-intervention assessments of motor competence, mental health, wellbeing, psychosocial factors, and 24-hour movement behaviours were also completed. Results The 5 schools represented 83% of the target number of schools and 108 children consented (43% of target). PE and class teachers were recruited in all schools (100% of target). Intervention dose was reflected by 76% of scheduled PE lessons being delivered. Adherence was strong with >85% of children attending ≥75% of lessons. Positive indicators of acceptability were provided by 86% of children, 83% of PE teachers, and 90% of class teachers. Teachers commented on the children’s positive engagement irrespective of ability, the quality of resources provided, and the challenges of competing demands for curriculum time and spaces to deliver MWFG. The data collection methods were deemed acceptable by 91% of children and 80% of class teachers, and children spoke positively about participating in the data collection. Secondary outcome data collection was completed by 87%-100% of children, with a 0%-6% attrition rate at post-intervention. Descriptive analysis revealed favourable changes in motor competence and mental health. Conclusions MWFG was deemed to be feasible to develop further into a pilot trial, with improved school and child recruitment strategies warranted.

An exploration of risk factors in a community sample of low socioeconomic status youth in South Africa

Youth in low socioeconomic status communities experience multiple risks which disrupts their emotional, cognitive, and psychological development. In South Africa, there is a tacit acceptance of risk constructs as researched globally. This study examines risk occurrence with the aim of identifying and examining the uniqueness of risks in a community sample of youth. Data were collected from youth and their maternal caregivers through interviews and standardized instruments. Youth from grade 7 and grade 10, 9 to 18 years ( M = 13.11; SD = 1.54) were recruited. Sixty-five percent were female. Thirty-five frequent risk factors were identified using a z-test for proportion of means. Five risk factors, namely, low household income, race, English not being the primary home language of the parent, low maternal self-esteem, and low dyadic satisfaction, emerged as significant risks. Other risk factors (e.g., single-parent household), which feature prominently in international studies, did not emerge as significantly present. While risk occurrence in our sample shares commonalities with international trends, our study further highlights how risk is underscored and shaped by South Africa’s socioeconomic and political history. We argue that traditional concepts, like family, race, and language require conceptual review when undertaking research and developing policies and interventions that are relevant to South African communities.

Utilization of traditional healers and health-seeking behavior on low socio-economic status community in Gunungkidul, Indonesia

Utilization of traditional healers and health-seeking behavior on low socio-economic status community in Gunungkidul, Indonesia

Benzodiazepine use and risk of incident MCI and dementia in a community sample.

Older adults commonly take benzodiazepines (BZDs) that may have long-term adverse cognitive effects. We investigated whether BZD use was related to developing mild cognitive impairment (MCI) or dementia in cognitively normal older adults in the community. A population-based cohort (n = 1959) of adults aged 65 and over, recruited from communities of low socioeconomic status. BZD use, Clinical Dementia Rating (CDR), anxiety symptoms, depression symptoms, sleep difficulties, and APOE genotype. We examined time from study entry to MCI (CDR = 0.5) and time from study entry to dementia (CDR ≥ 1) in participants who were cognitively normal at baseline (CDR = 0). We used survival analysis (Cox model), adjusted for age, sex, education, sleep, anxiety, and depression. For all the models, we included an interaction term between BZD use and APOE*4. Taking BZDs was significantly associated with higher risk of developing MCI, but not of developing dementia. The effect was not affected by APOE genotype. In a population-based sample of cognitively normal older adults, BZD use is associated with developing MCI, but not dementia. BZD use may be a potentially modifiable risk factor for MCI.

Factors Related to Drug Overdose Deaths in Ohio

Background: Drug overdoses have had a devastating impact on public health in Ohio. Improving our understand-ing of the relationships between factors that are associated with drug overdose deaths can enhance the quality of public policy and health care reach in Ohio. Methods: Utilizing data from the Centers for Disease Control and Prevention (CDC) and University of Wisconsin Population Health Institute, this research seeks to quantify the associations between the drug overdose rate for counties in Ohio with various factors via statistical regressions. Results: The overwhelming majority of drug/alcohol overdose deaths during the years 2017-2019 were uninten-tional. Drug overdose deaths and life expectancy are strongly associated. Communities with higher overdose rates have lower life expectancies. Socioeconomic status and health care factors, such as mental distress and physical inactivity, are significantly correlated with increased drug overdose deaths. Household income is significantly correlated with increased access to health care, implying that communities of lower socioeconomic status may lack adequate access to quality care and suffer from increased overdose deaths. Conclusion: The data indicate the importance of access to health care and health care providers in response to drug overdoses in Ohio. Health care access is currently proportional to income; higher income households have a greater proportion of insured, as well as a greater number of primary care physicians. Thus, implementing policies that support health care infrastructure should be prioritized to increase the capacity of treatment in under-resourced (low-income and low socioeconomic status) communities.

Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence

Fine particulate air pollution (PM2.5) is decreasing in most areas of the United States, except for areas most affected by wildfires, where increasing trends in PM2.5 can be attributed to wildfire smoke. The frequency and duration of large wildfires and the length of the wildfire season have all increased in recent decades, partially due to climate change, and wildfire risk is projected to increase further in many regions including the western United States. Increasingly, empirical evidence suggests differential health effects from air pollution by class and race; however, few studies have investigated such differential health impacts from air pollution during a wildfire event. We investigated differential risk of respiratory health impacts during the 2008 northern California wildfires by a comprehensive list of socio-economic status (SES), race/ethnicity, and smoking prevalence variables. Regardless of SES level across nine measures of SES, we found significant associations between PM2.5 and asthma hospitalizations and emergency department (ED) visits during these wildfires. Differential respiratory health risk was found by SES for ED visits for chronic obstructive pulmonary disease where the highest risks were in ZIP codes with the lowest SES levels. Findings for differential effects by race/ethnicity were less consistent across health outcomes. We found that ZIP codes with higher prevalence of smokers had greater risk of ED visits for asthma and pneumonia. Our study suggests that public health efforts to decrease exposures to high levels of air pollution during wildfires should focus on lower SES communities.

Abstract NG06: Investigating biological mediators of social and environmental risk factors on cancer health disparities

Abstract NG06: Investigating biological mediators of social and environmental risk factors on cancer health disparities

Associations of early-life exposures and socioeconomic status with cognitive development at preadolescence.

The long-term relations of socioeconomic status (SES) and early-life exposures with cognitive development at preadolescence are not fully understood, especially in low SES populations. We examined associations of SES and early-life exposures including feeding practices, physical growth and infections with cognitive development among preadolescents from underprivileged communities. A prospective study was conducted among 146 healthy children from two relatively low SES Arab villages in Israel, who were recruited at age 1-9 weeks and followed until age 18 months. Information was obtained on their feeding practices, health status and growth indicators. Cognitive development at age 10-12 years was assessed using the Wechsler Intelligence Scale, including the full-scale intelligence quotient (FSIQ) and scores of four cognitive domains. Multiple linear regression models were performed. Nearly all the children (98%) were breastfed in infancy. Bivariate correlations were found of SES, growth indices and rates of diarrheal and respiratory illnesses in infancy, but not of feeding practices, with cognitive scores. In multivariable models, SES was positively (p<0.001) associated with all the cognitive domains (beta coefficient ranges 4.3 to 8.2). Birthweight was positively associated with FSIQ (p=0.039) and the perceptual reasoning index (p=0.002). Weight for age Z score at age 10-14 months was positively associated with the verbal comprehension index (p=0.003). The rate of respiratory illnesses was negatively associated with the perceptual reasoning index (p=0.05). SES is strongly associated with cognitive development even in relatively low SES communities. Birthweight, weight indicators and respiratory illness in infancy might affect cognitive development through preadolescence.