Individuals Of Lower Socioeconomic Status Research Articles

Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic.

Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.

Catheter ablation of symptomatic atrial fibrillation: Sex, ethnicity, and socioeconomic disparities.

Catheter ablation for treatment of atrial fibrillation (AF), AF ablation, is more effective than antiarrhythmic drugs in reducing AF burden, reducing symptoms and increasing health-related quality of life. Although females more often experience AF-related symptoms, and have more severe symptoms, have lower quality of life, and experience more serious adverse effects of antiarrhythmic drugs than males, they are less likely to undergo AF ablation. Potential explanations for the disparity include older age at diagnosis, longer AF duration, a greater number of comorbidities, more extensive atrial fibrosis, and presumed lower success rate and more complications after AF ablation in women. Studies have failed to show sex-related differences in AF recurrence or serious complications following AF ablation but show more nuisance bleeds in women. Ethnic minorities, such as African Americans and Latin Americans, and individuals of low socioeconomic status are also less likely to undergo AF ablation, possibly associated with greater numbers of comorbidities, lack of patient advocacy, healthcare costs, and inadequate insurance coverage. Inclusion of marginalized patient groups in clinical trials of AF treatment and a personalized, patient-centered approach may expand equality in utilization of AF ablation.

Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration.

Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. Nineteen focus groups were conducted (N=176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

Dental Anxiety and Influencing Factors in Adults.

Dental anxiety is one of the most common conditions present amongst the masses globally. It is this fear that makes individuals avoid seeking dental treatment which results in a deteriorated oral health-related quality of life (OHRQoL). Discrepancies exist in the prevalence of dental anxiety based on gender, education levels, level of deprivation of a society and its socioeconomic status. In this study, a sample size of 522 respondents was collected. Kuppuswamy's socioeconomic status scale and modified dental anxiety scales were used to collect the necessary data. These data were analyzed by cross tabbing and chi-square test of significance was applied to assess the association between dental anxiety and other factors. Female gender was significantly associated with dental anxiety with p-value = 0.03. Higher education levels and dental anxiety also displayed significant associations with each other, with a p-value of 0.048. Seventy-six percent of the individuals of lower socioeconomic status were prone to be more dentally anxious. Dental anxiety was more significant in individuals with higher levels of education in our study. Respondents who were part of a lower socioeconomic class were also more prone to being anxious while receiving dental treatment. Knowing the factors that cause dental anxiety can help dentists effectively manage and treat their patients.

The Origin of Ferritin Reference Intervals: A Systematic Review

Background: Iron-deficiency is one of the most prevalent conditions worldwide and causes significant morbidity and mortality. Iron-deficiency most commonly affects individuals of lower socio-economic status (SES). Previous research has shown that those of lower SES are both less likely to be diagnosed and treated for iron deficiency. Ferritin is an iron-storage protein that is a sensitive diagnostic marker of iron-deficiency. However, the utility of ferritin is limited due to discrepancies in the thresholds used in clinical guidelines and clinical laboratories. There is growing concern that the lower limit of "normal" ferritin is inappropriately low, particularly for females, and is underestimating and promulgating the prevalence of iron-deficiency. As such, we conducted a systematic review to evaluate the data informing ferritin reference intervals (RIs) in adults. Methods: A systematic review was conducted as per PRISMA guidelines using MEDLINE, EMBASE and CENTRAL databases from inception to November, 2021 to identify studies that reported ferritin RIs in the adult population. Additional articles were hand-selected from screening the reference lists of included studies and the first ten pages of Google Scholar in July, 2022. A search of the grey literature was also conducted using Health Canada, European Medicines Agency, and the U.S. Food and Drug Administration databases to review the manufacturer product inserts for the five most commonly used assays globally. Two reviewers screened and performed data abstraction based on the protocol submitted to PROSPERO. The objectives were to summarize the research studies on the derivation of ferritin RIs and to conduct a quality assessment based on a modified version of the Clinical and Laboratory Standards (CLSI) guidelines for establishing RIs as well as quality indicators specific to iron-deficiency. We also aimed to describe reported ferritin lower limit of normal (LLN) in general and in relevant subgroups of patients using descriptive statistics (i.e., median, range). Results: 2307 studies were screened, and 62 full texts were included. The included studies consisted of "apparently healthy individuals", but only 5 (8%) studies assessed for bleeding history/conditions, 5 (8%) for menstrual history, 7 (11%) for menopause status, 22 (35%) for pregnancy status, 9 (14%) for diet history, and 16 (25%) for iron supplementation. 36 (58%) studies measured the hemoglobin, 19 (31%) measured the mean corpuscular volume, and 22 (35%) measured inflammatory markers. For the quality of the studies, only 28 (45%) referenced a RI guideline, 21 (34%) performed outlier detection, 46 (74%) described RI calculation method, and 18 (29%) reported confidence intervals. The top 5 commercial ferritin lab assays report ferritin RIs with a median LLN of 10.5 μg/L (range: 5-13) for females and 22 μg/L (18-30) for males. One lab assay provided a ferritin RI for pre-menopausal versus post-menopausal women. The studies informing the ferritin lab assays did not explicitly exclude patients at risk of iron-deficiency and none adhered to CLSI RI establishment guidelines. 40 studies were included in the analysis of ferritin LLN in a general population which were comprised of a total of 30,474 females (20-8678 females per study) and 29,615 males (20-8913 males per study). The median ferritin LLN was 8 μg/L (0-40) in females and 27 μg/L (6-133) in males. 11 studies analyzed ferritin RIs in presumed pre- and post-menopausal females with an age threshold of 45-50 years. A median ferritin LLN of 6 μg/L (2-31) was found in pre-menopausal versus 11 μg/L (0-70) in post-menopausal females. There were 4 studies of pregnant individuals (n=1599), and we found a median ferritin LLN of 5.6 μg/L (0-9.3) among them. Conclusions: This systematic review showed that the published literature on numerous ferritin assays have a LLN well below 30 μg/L, despite robust evidence suggesting a ferritin below 30 μg/L is in keeping with clinical iron-deficiency. Data driving existing ferritin RIs appear at high risk of bias given the lack of exclusion of individuals at risk for iron-deficiency and lack of adherence to CLSI standards in the presumed "normal" sample. Therefore, we suggest adoption of evidence-based laboratory clinical decision limits to help clinicians detect and treat iron-deficiency to minimize propagation of related health inequity and medico-social injustice.

Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study

Introduction: Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension. Methods: We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274). Results: Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (> 30 minutes), low SE (<85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation. Conclusions: Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.

Abstract 10779: Lower Socioeconomic Status, Psychological Distress, and Hypertension: A Longitudinal Moderated Mediation Analysis

Introduction: Lower socioeconomic status (SES) has been associated with hypertension (HTN); however, the mediators and moderators of this association remain understudied. We used longitudinal data to examine the mediating effect of psychological distress on the link between lower SES and HTN, as well as the racial and sex moderation effects. Methods: This study was a secondary analysis of data collected from 2009 to 2019 among adults with six-wave biennial surveys from the Panel Study of Income Dynamics (PSID). SES was assessed with individuals’ education, employment status, and income. The Kessler K6 scale was used to assess psychological distress. HTN was a self-reported physician-diagnose. Data of families’ head who did not have HTN in 2009 were analyzed. Sequential mediation and moderated mediation models were performed using the PROCESS macro in SPSS. Results: The mean age of the sample in 2009 was 45 years (33% female). The prevalence of HTN increased significantly from 31% in 2009 to 41% in 2019. Participants who had no HTN with lower SES in 2009 were more likely to develop HTN in 2019 (OR=1.11, 95% CI: 1.03-1.20, p <0.01). Sequential mediation analysis showed that psychological distress was a significant mediator of the association between lower SES and HTN (indirect effect=0.02, p <0.05) and the mediation effect was moderated by sex but not by race. Females with lower SES were at a higher risk (index of moderated mediation=0.01, p <0.05). Conclusions: Lower SES was longitudinally associated with increased risk of HTN 10 years later. The link of lower SES and HTN was mediated by psychological distress and sex moderated the mediation effect. Sex-tailored interventions of psychological distress should be considered to reduce risk of HTN in lower SES individuals.

Socioeconomic status and survival in medieval Canterbury

The adverse urban environment of medieval Canterbury possibly influenced poor health conditions and diseases which ultimately led to death. Individuals of low socioeconomic status may have been more at risk of death than those of higher socioeconomic status due to dense living conditions, consistently encountering unhygienic waste management, and less access to resources during famines and disease outbreaks. This study evaluates survivorship and mortality risk patterns of high- and low-status groups to determine the effect of socioeconomic status on survival and mortality in medieval Canterbury. A sample of 796 low- and 74 high-status individuals were examined from St. Gregory’s Priory. Kaplan-Meier analysis and Cox Regression were used to assess mortality and survival between the socioeconomic status groups. The results reveal lower survivorship for high-status than low-status non-adults, and lower survivorship and high mortality risk for high-status adult females compared to low-status adult males. Meanwhile there were no significant differences found in mortality risks and survivorship between low- and high-status adult males, low- and high-status adult females, and low-status adult females and high-status adult males. High risk of mortality and decreased survivorship of high-status adult females may reflect decreased survivorship of high-status non-adults due to poor nutritional intake during and after pregnancy as well as rationing food. In comparison, low-status adult males would have benefited from the pilgrimage culture that allowed them abundant access to nutritious foods.

In a double-bind: Time-space distanciation, socioeconomic status, and coping with financial stress in the United States.

Psychological research has shown that lower socioeconomic status (SES) individuals experience higher levels of stress and tend to cope in more present-oriented ways. While some research in the field has sought to, for instance, increase future-oriented ways of being among lower SES individuals, we argue that such approaches may come at significant cost. We consider the construct of time-space distanciation (TSD) - the normative way in which time and space are abstracted from one another at cultural and individual levels - as a way to complicate psychological research on social class, stress, and coping. Across four studies, we present research on US geographical regions (Studies 1-2) and US participants (Studies 3-4) suggesting that adopting normative high-TSD orientations represents a double-bind for lower SES individuals: it allows one to enact more proactive coping strategies in the face of financial stressors such as debt (Studies 1-3), but it is also a source of disproportionate stress itself (Study 4), given the burdens faced by lower SES individuals trying to navigate time and space in culturally hegemonic ways in spite of precarity and material insecurity. We discuss how TSD offers a means of situating psychological research into precarity within the broader structural context of flexible capitalism.

Extreme Temperature and Mortality by Educational Attainment in Spain, 2012–2018

Extreme temperatures are a threat to public health, increasing mortality in the affected population. Moreover, there is substantial research showing how age and gender shape vulnerabilities to this environmental risk. However, there is only limited knowledge on how socioeconomic status (SES), operationalized using educational attainment, stratifies the effect of extreme temperatures on mortality. Here, we address this link using Poisson regression and administrative data from 2012 to 2018 for 50 Spanish Provinces on individuals aged above 65 matched with meteorological data provided by the E-OBS dataset. In line with previous studies, results show that hot and cold days increase mortality. Results on the interaction between SES and extreme temperatures show a positive and significant effect of exposure to heat and cold for individuals with medium and low SES level. Conversely, for high SES individuals we do not find evidence of a robust association with heat or cold. We further investigate how the local climate moderates these associations. A warmer climate increases risks with exposures to low temperatures and vice versa for hot temperatures in the pooled sample. Moreover, we observe that results are mostly driven by low SES individuals being particularly vulnerable to heat in colder climates and cold in warmer climates. In conclusion, results highlight how educational attainment stratifies the effect of extreme temperatures and the relevance of the local climate in shaping risks of low SES individuals aged above 65.

Socioeconomic status and social anxiety: attentional control as a key missing variable?

ABSTRACT Background and Objectives The aim was to examine the role of attentional control as a psychological factor involved in socioeconomic status-related mental health differences, and specifically in social anxiety. Based on the literature on socioeconomic status differences in cognitive abilities and attentional control theory, we hypothesized that attentional control would account for the relation between socioeconomic status and social anxiety. We tested this hypothesis in an integrative model also including trait anxiety and subjective socioeconomic status. Design Cross-sectional. Method Online, 439 French adults were recruited via social media. They completed self-reported measures of attentional control, objective socioeconomic status, subjective socioeconomic status, social anxiety, and trait anxiety. Results Using Structural Equation Modelling, findings showed a positive association between objective (but not subjective) socioeconomic status and attentional control, which in turn was related to social anxiety. Exploratory analyses showed that only income, as objective socioeconomic status indicator, was associated with attentional control. Conclusions The current study is the first to support that low socioeconomic status individuals report less attentional control and more social anxiety symptoms. This suggests that attentional control is a psychological factor involved in social anxiety inequalities.

33446 Demographics of melanoma knowledge among middle and high schoolers in Texas

Adolescents, an age group that can reduce sun exposure early, may benefit from school-based skin cancer education programs. Moreover, literature regarding demographics of melanoma knowledge is sparse. This study sought to evaluate melanoma knowledge among students in Texas viewing John Wayne Cancer Foundation Block the Blaze (JWCFBTB) presentations and identify group differences with regards to sociodemographic factors. Prior to JWCFBTB presentations delivered in Houston and Dallas by health professions students, a prepresentation melanoma knowledge quiz was distributed. This survey was adapted from a 2000 study evaluating melanoma knowledge in middle and high schoolers in Houston and Dallas. Respondents were also asked to provide their gender, age, grade, race, parent education level, and whether they are a first-generation American. ANOVA and Tukey tests were used to evaluate demographic group differences in scores. Logistic regression models determined predictors of answering selected true/false questions correctly. One-way ANOVA tests showed statistically significant group differences in pre-test scores for all demographic factors evaluated. Females, Whites/Caucasians, students whose parents hold graduate degrees, and older students had higher scores. Black students and non–first-generation Americans were more likely to answer selected commonly missed questions correctly. Results from both 2000 and 2020-2021 indicate older students from higher grade levels know more about melanoma, suggesting adolescents may benefit from earlier skin cancer education. Racial minorities and individuals of low socioeconomic status, who suffer from disparities in melanoma treatment and mortality, also showed poorer melanoma knowledge. Targeting future skin cancer education to disadvantaged schools may help remedy such gaps.

The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review.

BackgroundPromoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with a low socioeconomic status (SES) remain major challenges. eHealth interventions are a promising approach to change unhealthy behaviors in this target group.ObjectiveThis review aims to identify key components, barriers, and facilitators in the development, reach, use, evaluation, and implementation of eHealth lifestyle interventions for people with a low SES. This review provides an overview for researchers and eHealth developers, and can assist in the development of eHealth interventions for people with a low SES.MethodsWe performed a scoping review based on Arksey and O’Malley’s framework. A systematic search was conducted on PubMed, MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Library, using terms related to a combination of the following key constructs: eHealth, lifestyle, low SES, development, reach, use, evaluation, and implementation. There were no restrictions on the date of publication for articles retrieved upon searching the databases.ResultsThe search identified 1323 studies, of which 42 met our inclusion criteria. An update of the search led to the inclusion of 17 additional studies. eHealth lifestyle interventions for people with a low SES were often delivered via internet-based methods (eg, websites, email, Facebook, and smartphone apps) and offline methods, such as texting. A minority of the interventions combined eHealth lifestyle interventions with face-to-face or telephone coaching, or wearables (blended care). We identified the use of different behavioral components (eg, social support) and technological components (eg, multimedia) in eHealth lifestyle interventions. Facilitators in the development included iterative design, working with different disciplines, and resonating intervention content with users. Facilitators for intervention reach were use of a personal approach and social network, reminders, and self-monitoring. Nevertheless, barriers, such as technological challenges for developers and limited financial resources, may hinder intervention development. Furthermore, passive recruitment was a barrier to intervention reach. Technical difficulties and the use of self-monitoring devices were common barriers for users of eHealth interventions. Only limited data on barriers and facilitators for intervention implementation and evaluation were available.ConclusionsWhile we found large variations among studies regarding key intervention components, and barriers and facilitators, certain factors may be beneficial in building and using eHealth interventions and reaching people with a low SES. Barriers and facilitators offer promising elements that eHealth developers can use as a toolbox to connect eHealth with low SES individuals. Our findings suggest that one-size-fits-all eHealth interventions may be less suitable for people with a low SES. Future research should investigate how to customize eHealth lifestyle interventions to meet the needs of different low SES groups, and should identify the components that enhance their reach, use, and effectiveness.

Anger, Fear, and Sadness: Relations to Socioeconomic Status and the Amygdala.

Here, we test three often proposed hypotheses about socioeconomic status (SES), affect, and the brain, for which evidence is mixed or lacking. The first hypothesis, that negative affect is more common at lower levels of SES, has ample evidence from studies of psychiatric symptoms but is tested for the first time here across multiple measures of negative emotions in healthy young adults. The second hypothesis is actually a set of hypotheses, that SES is associated with three structural and functional properties of the amygdala. Third, and most important for the affective neuroscience of SES, is the hypothesis that SES differences in the amygdala are responsible for the affective differences. Despite the intuitive appeal of this hypothesis, it has rarely been tested and has never been confirmed. Here, we review the literature for evidence on each of these hypotheses and find in a number of cases that the evidence is weak or nonexistant. We then subject each hypothesis to a new empirical test with a large sample of healthy young adults. We confirm that negative affect is more common at lower levels of SES and we find a positive relation between SES and amygdala volume. However, evidence is weak on the relation of SES to functional properties of amygdala. Finally, the tendency toward negative affect in lower SES individuals cannot be accounted for by the structural or functional characteristics of the amygdala measured here.

Emergency Department Presentations of Acute Primary Angle Closure in the United States from 2008 to 2017.

PurposeAcute primary angle closure (APAC) is an ophthalmologic emergency. Nationwide data on the epidemiology and clinical characteristics of APAC are lacking despite the associated visual morbidity.Patients and MethodsA retrospective cross-sectional study using the Nationwide Emergency Department Sample (NEDS). The NEDS was queried by ICD-9/10 code for cases of APAC presenting to the United States emergency departments over a ten-year period from 2008 to 2017. All identified cases were included to produce nationally representative estimates. Linear regression and seasonality tests were used to identify trends. Reported outcomes include the incidence, demographics, seasonality, and economic impact of APAC regionally and nationwide.ResultsA total of 23,203 APAC-related ED visits were identified. The mean (SD) and median ages were 58.8 (16.2) and 60 years, respectively. Females (59.4%, p < 0.01), those in the lowest income quartile (6983, 30.1%, p < 0.01), and those in the seventh decade of life (5599, 24.1%) presented more frequently with APAC. The incidence of ED presentations within each age group rose with age and increased significantly over the study period (p < 0.01). The Northeast region had the highest average incidence (0.93 per 100,000 population). Significant seasonal variation was seen regionally and nationally (p < 0.01), with the highest average incidence in December and lowest in April. Median inflation adjusted charge per ED visit was $2496.10, and the total inflation adjusted charges equaled $101.5 million.ConclusionThe incidence of APAC-related ED visits continues to rise in the United States. High-risk groups include women, individuals of low socioeconomic status, and those between ages 50 and 70. Significant seasonal and regional trends were observed in ED presentations of APAC.

Knowledge of psychology in Cambodia: Exploring the relationships to demographics, psychopathology, and idioms of distress.

Rates of mental health disorders in Cambodia are markedly higher than in other low- or middle-income countries. Despite these high rates, mental healthcare resources remain scarce and mental health stigma is pervasive, particularly for vulnerable populations of young women and individuals of low socioeconomic status. To address this gap, teaching Western mental health treatments and using a mental healthcare framework are recommended within the Cambodian context. However, Western frameworks do not address cultural syndromes or idioms of distress and operate from an individualistic perspective that does not address cultural values and beliefs. The present study employs a mental health literacy framework in an exploratory analysis of rates of psychological knowledge in a nationally representative sample of Cambodian adults (N = 2,690). To address recommendations for increasing mental healthcare, we designed a survey to investigate Cambodians' knowledge about mental health constructs. Results indicated that only 18.9% of Cambodians knew about psychology, and chi-square analyses revealed that women, individuals in rural areas, and individuals with significant distress due to cultural symptoms and syndromes reported knowing about psychology significantly less than their male and non-distressed counterparts. Additionally, those who reported higher income and higher levels of education indicated significantly higher rates of psychological knowledge, as did those with clinically significant rates of PTSD, at a rate of knowledge approaching significance. Implications for this study include the need to tailor interventions and resources to vulnerable populations, to assess the fit of current recommendations for the Cambodian context, and to further emphasize the need for culturally responsive interventions that address all presentations of Cambodian distress and align with understandings of mental health within the nation.

Influential factors on oral health status of the elderly Iranians: A Path analysis

Objectives: This study aimed at assessing the influential factors on oral health status of the elderly Iranian population (65 to 74 years of age) by using Path analysis. Methods: This study was conducted on 7,521 elderly individuals participating in the Iranian National Oral Health Survey in 2012. After data collection process, initially decayed, missing, and filled teeth (DMFT) index as well as functional health (FH) index were evaluated in this study by using clinical data. The socio-economic status (SES), insurance type (IT), dental attendance pattern (DAP), reason of attendance (R of A), tooth cleaning (TC), and nutritional pattern (NP) were evaluated according to responses provided to the questions in the questionnaire by participant. Path analysis was applied to analyze the patterns between these variables and DMFT and FH index. Results: The participants’ mean DMFT was 26.6±8.03, and the median FH was 0 (0.10). Path analysis revealed that seniors with higher SES, and having a dental insurance with greater coverage had a direct effect on more regular DAP, and indirect effect on improvement of FH and reduction in DMFT index. More regular DAP had a direct effect on improvement of FH, and reduction of DMFT index. Also, NP with lower risk of caries had a direct effect on improvement of FH and reduction of DMFT index. Conclusion: Out of all the evaluated factors, IT, SES, DAP, and NP demonstrated to be particularly important and significantly affecting DMFT and FH indices in the elderly population. Out of all aforementioned factors, IT in low SES individuals was more important for obtaining required oral healthcare services. Apparently, seniors’ oral health is absolutely in need of special attention with particular focus on providing access to early prevention and care.

Air pollution exposure disparities in US public housing developments

Fine particulate matter 2.5 microns or less in diameter (PM2.5) is widely recognized to be a major public health concern. While ethnic/racial minority and lower socioeconomic status individuals in the US experience higher PM2.5 exposure, previous research on social disparities in PM2.5 exposure has not examined residents of federally-assisted public housing developments (PHDs). Here we present the first national-scale analysis of the relationship between outdoor PM2.5 exposure and PHD residency in the US, as well as exposure disparities within the population of households residing in PHDs. We integrated data on average annual PM2.5 concentrations (2011–2015) with US Department of Housing and Urban Development data on PHDs (2015), and socio-demographic information from the 2011–2015 American Community Survey. Results from multivariable generalized estimating equations indicated that PHD locations, units, and residents are significantly overrepresented in neighborhoods with greater PM2.5 exposure, after accounting for clustering, urbanization, and other socio-demographic factors. Additionally, significantly higher percentages of Black, Hispanic, disabled, and extremely low-income households reside in PHDs with greater PM2.5 exposure. Findings represent an important starting point for future research and emphasize the urgent need to identify gaps in environmental, public health, and housing policies that contribute to disproportionate air pollution exposures among PHD residents.

A qualitative exploration of melanoma awareness and prevention among Latinx and non-Latinx White populations in urban and rural California.

9588 Background: Melanoma mortality rates remain high among individuals of lower socioeconomic (SES) status, and racial/ethnic minorities, despite rates declining in non-Latinx whites (NLW). To improve understanding about the factors contributing to inequities in melanoma prevention and care, a qualitative exploratory study was conducted in Northern and Southern California regarding awareness, prevention, and early detection of melanoma in lower SES NLW and Latinx populations living in urban and semi-rural areas. Methods: Nineteen focus group (n = 176 individuals: 77% female, 59% self-identified Latinx/Hispanic, and 40% Medi-Cal/state insurance recipients) were conducted with adult participants, stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). The interview topics included: 1) awareness and views of melanoma risk, prevention, and early detection screening practices; 2) acceptability of primary and secondary prevention strategies in their respective community; and 3) barriers and facilitators of engagement in melanoma prevention and care. Using a hybrid inductive and deductive approach, thematic analysis was used for data analysis. Findings were organized within a socioecological model (individual, interpersonal, community and health system/policy level). Results: Individual level findings revealed that many participants were not familiar about melanoma yet were willing to learn through trusted sources. Brown or darker skin tones were perceived as having less risk for skin cancer. Interpersonally, social relationships were important influences for individuals practicing skin cancer prevention. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for dermatology care access. Healthcare systems barriers included burdens of additional medical care costs and obtaining dermatology referral. Many participants were in support of health regulations and education that reduce skin cancer risks for outdoor workers and children. Conclusions: Varying and intersecting factors influence melanoma awareness, and behaviors associated with knowledge, prevention, and early detection of melanoma in low-income NLW and Latinx individuals and in those living in semi-rural areas. Our findings promote understanding of how barriers across the socioecological spectrum may affect melanoma prevention and early detection particularly among men, individuals of lower socioeconomic status, and Latinx individuals. The study results have implications for health education interventions, which can involve health navigation strategies for individuals and families.

582-P: Process Evaluation of Dulce Digital–Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes

Diabetes self-management education and support improves clinical outcomes in populations disproportionately impacted by type 2 diabetes, including ethnic/racial minorities and individuals of low socioeconomic status. Mobile health (mHealth) interventions have been shown to reduce barriers to accessing these services. The Dulce Digital-Me study sought to integrate adaptive mHealth technologies into diabetes management to enhance self-management support and reduce inequities. This process evaluation uses the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population, with no differences in baseline clinical characteristics (HbA1c, systolic blood pressure, or LDL cholesterol) between eligible participants who did not (N=261) versus did (N=310) enroll in the study (ps&amp;gt;0.15) . A key informant interview revealed that the medical assistant health coach (MA) found the adoption of the study to be successful in positively impacting patients’ diabetes self-management. Participants across study arms had no significant differences in delivery of mHealth content (ps&amp;gt;0.07) , demonstrating that the intervention was implemented with fidelity. Participants who received Dulce Digital-Me with additional support from an MA were most engaged in responses to ecological momentary assessment prompts (p&amp;lt;0.02) , suggesting utility and acceptability of integrating medical assistants with mHealth interventions. Perceptions of implementation among study participants were positive—with 93% of all participants reporting that the intervention was helpful in managing their diabetes—and were consistent across study arms (p=0.7) . Further studies are warranted to evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and patient populations. Disclosure S.R.Spierling bagsic: None. E.Farcas: None. J.G.Godino: None. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. L.Gallo: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. K.L.Savin: None. E.Soriano: None. E.N.San diego: None. N.Orendain: None. T.Clark: None. H.Sandoval: None. M.Chichmarenko: None. P.Perez-ramirez: None. Funding National Institutes of Health, NIDDK: (R01DK112322) National Institutes of Health, NCATS: (UL1TR002550 &amp; KL2TR002552)