Low Socioeconomic Status Research Articles

Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project

Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality. In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators. Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07-1·16), cardiovascular disease (1·38, 1·29-1·48), and respiratory disease (1·44, 1·22-1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution. There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity. The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China. For the Chinese translation of the abstract see Supplementary Materials section.

Development of prediction models of COVID-19 vaccine uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study

IntroductionVaccines are essential to prevent infection and reduce the morbidity of infectious diseases. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion and discrimination, and low...

Neighborhood Socioeconomic Disadvantage May Influence 1-Year Patient-Reported Outcome Measures After Total Hip Arthroplasty

The impact of socioeconomic status on achievement of clinically relevant patient-reported outcome measure (PROM) improvements and satisfaction after total hip arthroplasty (THA) is unknown. Area Deprivation Index (ADI) is a metric that can be used as a proxy for a patient's neighborhood socioeconomic status. This study aimed to assess the association between ADI and failure to achieve (1) clinically relevant improvements in PROMs and (2) self-reported satisfaction at 1-year following THA. A prospective cohort of 7,506 patients who underwent primary unilateral THA from January 2016 to July 2021 was included. The ADI was stratified into quintiles based on their distribution in our sample. Multivariable logistic regression models were created to investigate the effect of ADI on 1-year PROMs. The included PROMs were the Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical Function Shortform (PS), and Joint Replacement (JR). Clinically relevant improvements were assessed through minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) threshold achievement. There was no significant association between ADI and failure to achieve MCID for HOOS pain (P = 0.42), PS (P = 0.91), or JR (P = 0.20). However, higher ADI scores were independently associated with increased odds of failing to achieve PASS for HOOS Pain (P = 0.002), PS (P = 0.003), and JR (P = 0.017). The ADI was not associated with failure to achieve patient satisfaction at 1 year (P = 0.93). Greater neighborhood socioeconomic disadvantage was associated with decreased odds of achieving clinically relevant improvement in patient-perceived symptomatic state, but not associated with patients' perception of their overall pain and function 1 year after THA. Targeted interventions to address access and care pathways for low socioeconomic status patients may present an opportunity to improve patient-perceived outcomes following THA.

Low Socioeconomic Status Negatively Impacts Field-test Battery In College-aged Women

Low Socioeconomic Status Negatively Impacts Field-test Battery In College-aged Women

Low Socioeconomic Indicators Correlate with Critical Pre-Operative Glenoid Bone Loss and Care Delays

BackgroundChronic and recurrent shoulder dislocations prior to stabilization can increase the risk of glenoid bone loss. Glenoid bone loss exceeding critical levels can lead to further instability and decreased outcomes following arthroscopic labral repair. Indicators of low socioeconomic status (SES), such as high Area Deprivation Index (ADI) and non-commercial insurance, are related to generalized delays to orthopedic care, which can cause recurrent instability and increase glenoid bone loss. Hypothesis/PurposeHigher national ADI and non-commercial insurance would be associated with greater levels of radiographic glenoid bone loss after glenoid instability. MethodsA retrospective study was performed with patients who underwent anterior labral repair. Chart review included demographics, course of care data, preoperative instability data, national ADI, and insurance status. The Neighborhood Atlas Website and patients’ home addresses were used to obtain national ADI. Glenoid bone loss was measured using the Best-fit circle Pico method on three-dimensionally aligned magnetic resonance images (MRIs). Researchers were blinded to SES indicators during radiographic analysis. Glenoid bone loss was compared between SES indicators using one-way ANOVAs. Results146 patients met inclusion criteria and had complete datasets (23.3% female; 22.4±7.0-years-old; national ADI=16.1±15.3). Patients experienced on average 9.12±6.63% glenoid bone loss. A curve fitting tool determined a quadratic non-linear regression best characterized the association of glenoid bone loss and ADI (R2 = 0.392, p < 0.001). Individuals with commercial insurance experienced 8.58%±6.69% glenoid bone loss as compared to 11.78%±6.30% in individuals with Medicaid insurance (p=0.03). Critical bone loss at a threshold of 13.5% was more likely with higher national ADI (p<0.001) and Medicaid insurance (OR=2.49, CI=1.02-6.09). However, only national ADI was predictive of subcritical bone loss at a threshold of 10% (p<0.001). ConclusionPatients with greater national ADI and Medicaid insurance status had greater rates of critical preoperative glenoid bone loss at a threshold of 13.5%. Greater national ADI is also predictive of subcritical glenoid bone loss at a threshold of 10% and overall glenoid bone loss. Further study is needed to assess the postoperative implications of these findings in this population.

Solid waste characterization in the slum areas of Bagmati River—A case of Kathmandu, Nepal

Solid waste management (SWM) is a challenging environmental issue globally, with developing nations experiencing considerable difficulties in its efficient and effective implementation. Urban slum areas within these regions, particularly, have been reported to face unique challenges in SWM due to a combination of factors, including the low socio-economic status of residents, high population density, inadequate infrastructure, and a thriving informal economy. Despite these critical concerns, most SWM research in Nepal has concentrated on major cities and tourist hotspots. As a result, the condition of SWM in urban slum areas, typically found along the banks of major rivers in Nepal, remains a critical yet neglected aspect in research and policy discussions. This study, therefore, aims to evaluate SWM in the densely populated urban slum areas situated along the Bagmati River, a key river system in Kathmandu, the capital of Nepal. Four major slum locations within the central metropolitan area of Kathmandu—Sinamangal, Thapathali, Teku, and Balkhu—were selected for the study, and systematic random sampling and characterization of household solid waste was conducted. The results reveal that the average household solid waste generation rates in the four study sites were 155.32 g capita−1 d−1, 124.69 g capita−1 d−1, 149.9 g capita−1 d−1, and 218.44 g capita−1 d−1, respectively. Organic wastes was the most prevalent type, comprising 63.34% of the total waste, followed by paper and paper products (13.72%), plastics (12.15%), dirt and construction debris (5.57%), glass (4.31%), and other wastes (0.91%). Qualitative data from the survey revealed that although municipal waste management programs exist, awareness and participation among residents were limited. As a result, many households ended up managing their waste on their own, often in an unscientific manner polluting the river water in the vicinity. The study offers critical insights for policymakers, operators, and regulators in addressing the growing challenges of SWM. Findings are expected to aid in the sustainable management of solid waste along the river basin in central urban regions of the capital city. Under Nepal's new federal governance system, provincial and local governments are recommended to collaborate with all stakeholders, including households, to develop comprehensive, multimodal SWM strategies that also address the needs of slum areas.

Trends and inequalities in thinness and obesity among Chinese children and adolescents: evidence from seven national school surveys between 1985 and 2019.

There are little recent data in China regarding contemporary nutritional inequities among children and adolescents, particularly in relation to urban-rural residence and regional socioeconomic status (SES). We aim to assess inequalities in thinness and obesity in Chinese children and adolescents. Weight and height measurements for 1 677 261 children and adolescents aged 7-18 years were obtained from seven cycles of the Chinese National Surveys on Students Constitution and Health (1985, 1995, 2000, 2005, 2010, 2014, and 2019). Sex-specific BMI-for-age Z scores were applied to define thinness (Z scores <-2SD) and obesity (Z scores >+2SD). Urban-rural classification came from the Statistical Urban and Rural Division Code, and gross domestic product (GDP) per capita in the province in which the school was situated was used as a proxy for SES. T1 represented the provinces with the most disadvantaged SES and T3 represented the provinces with the most advantaged SES. General linear regression models assessed correlations between prevalence and GDP per capita, with projections to 2030 derived from best-fitting models. The mean prevalence of obesity rose from 0·10% (95% CI 0·09 to 0·11) in 1985 to 8·25% (8·13 to 8·37) in 2019, whereas thinness prevalence decreased from 8·49% (8·41 to 8·58) to 3·37% (3·29 to 3·45). High SES provinces exhibited a significant drop in obesity prevalence from 2014 (8·42% [8·19 to 8·65]) to 2019 (7·73% [7·52 to 7·95]). Nationally, the prevalence of obesity was consistently higher in urban areas than in rural areas for both sexes from 1985 to 2019; however, a greater prevalence of obesity was observed in rural than urban girls residing in T3 regions in 2019 (urban-rural gap: -0·37% [-0·07 to -0·80]). Rural boys had a higher prevalence of thinness than their urban counterparts across all survey waves, with the exceptions of 1985 and 1995. For girls, no significant urban-rural gap in thinness was observed in the most recent survey in 2019 (-0·10% [-0·24 to 0·04]). From 1985 to 2014, boys and girls from high SES regions had a higher risk of obesity and a lower risk of thinness than those from low SES regions. However, in 2019, a nationwide shift occurred, and the T3-T1 difference in obesity approached or went below zero for boys (-0·49% [-1·02 to 0·04]) and girls (-0·68% [-1·00 to -0·35]). T3-T1 differences in thinness also approached zero for boys (-0·46% [-0·77 to -0·14]) and girls (-0·14% [-0·43 to 0·15]). The projected estimates to 2030 for urban-rural obesity gaps (boys: -1·00% [-2·65 to 0·65]; girls: -2·88% [-6·91 to 1·15]) and T3-T1 obesity differences (boys: -8·88% [-13·76 to -4·01]; girls: -8·82% [-12·78 to -4·85]) were both negative, with forecasted estimates for urban-rural gaps and T3-T1 differences in thinness prevalence in 2030 close to zero for both boys and girls. China's socioeconomic development continues to influence within-country inequities regarding the regional distribution of child and adolescent weight according to urban-rural location and regional SES. Contemporary Chinese children and adolescents in socioeconomically disadvantaged regions and rural areas constitute a vulnerable population facing nutritional risk, but from obesity rather than thinness. Disrupting projected inequities in obesity will require extensive preventive investments. National Natural Science Foundation of China, Beijing Natural Science Foundation, Peking University Talent Introduction Program Project, and Clinical Medicine Plus X-Young Scholars Project of Peking University. For the Chinese translation of the abstract see Supplementary Materials section.

Impact of screening on mortality for patients diagnosed with hepatocellular carcinoma at a safety-net hospital: An opportunity for addressing disparities.

140 Background: Hepatocellular carcinoma (HCC) is a common and deadly cancer with a rising incidence in the US. HCC almost always develops on a background of chronic liver disease, which disproportionately affects individuals of lower socioeconomic status (SES), perpetuating existing disparities. Compounding these disparities, individuals of lower SES are less likely to participate in recommended cancer screening exams. Here, we describe the outcomes of patients diagnosed with HCC at a large urban safety-net hospital primarily serving the underserved. Methods: We identified patients diagnosed with HCC at John Peter Smith Hospital in Fort Worth, Texas from January 1, 2018, to March 31, 2021 to determine the impact of screening on survival. Patients were allocated to the screened cohort if they had undergone liver imaging within one year prior to HCC diagnosis. Kaplan-Meier methods and log-rank test were used to illustrate and compare 3-year survival curves from an index date of diagnosis until death. Cox proportional hazards model were used to calculate unadjusted and adjusted hazards ratios (HR) and 95% confidence intervals (CI). Lead time bias was adjusted in a sensitivity analysis using the Duffy adjustment and a sojourn time of 70 days and 140 days. Results: A total of 158 patients were included (n=53 screened, n=105 unscreened). The mean age was 62 years; 144 (91%) had cirrhosis, 78% were male, 34% were non-Hispanic white, and 8.2% had private insurance. Those in the unscreened cohort had more severe liver dysfunction (as measured by the ALBI grade) and produced higher levels of AFP, but were less likely to have cirrhosis than the screened cohort. The median overall survival (OS) for the screened cohort was 19.0 months (95% CI: 9.9-NA) and 5.4 months (95% CI: 3.7-8.5) in the unscreened cohort (HR death (unscreened v screened) = 2.4, 95% CI: 1.6-3.6; log rank P &lt;0.0001). After adjusting for ALBI grade, AFP, hepatitis C, insurance status and initial treatment, there was a statistical difference in hazard of death in the three years (HR: 2.3; 95% CI: 1.5-3.6), favoring the screened cohort. The benefit for screening remained after adjusting for lead-time bias. With a mean sojourn time of 70 days, the HR death was 2.19 (95% CI 1.4-3.3, P =0.0002) and was 2.09 (1.4-3.2, P =0.0005) with a 140-day sojourn time. Conclusions: In an urban safety-net population, screening for HCC was associated with improved outcomes compared to patients with incidentally-diagnosed HCC. Altogether, this implies that earlier diagnosis and institution of treatment can positively improve survival for patients with newly diagnosed HCC in a population of patients evaluated at a safety-net hospital. Development of screening programs in accordance with accepted guidelines with outreach to high-risk individuals represents an area of high value care for safety-net hospitals.

Residential food environment and dietary antioxidant consumption among pregnant women: Modifying effects of socioeconomic factors and ethnic identity

BackgroundResidential food environment influences dietary patterns, however the impact of individuals' perceived social identity on the antioxidant intake, an indicator of healthy dietary patterns, remains underexplored. ObjectiveWe conducted a cross-sectional analysis using data collected in a longitudinal cohort. In the study, we aim to investigate the interactions between the food environment and two indicators of social identity, specifically a subjective ladder measure of socioeconomic status (SES) and the Multigroup Ethnic Identity Measure (MEIM) score, in relation to dietary antioxidant intake (DAI) among n = 512 Boston and NYC-resident pregnant women. MethodsThe modified Retail Food Environment Index (mRFEI) was calculated using the Centers for Disease Control and Prevention's equation, with higher scores indicating a healthier food environment. DAI was estimated by summing standardized data from six micronutrients (magnesium, selenium, zinc, and vitamins A, C, and E) obtained through the Block98 Food Frequency Questionnaires administered during pregnancy, with higher scores indicating increased intake. The mRFEI and DAI were dichotomized based on a median split. Multivariable-adjusted logistic regressions were used to analyze associations, both with and without considering women's subjective SES or MEIM levels as effect modifiers. ResultsWomen were racially/ethnically mixed (19.2 % White, 42.7 % Black, and 33.1 % Hispanic) with 32.2 % reporting more than high school education. In the main effect models, no significant association was observed between mRFEI and DAI. Women with higher MEIM scores exhibited higher DAI [Odds ratio (OR) =1.85, 95 % Confidence interval (CI) = 1.26–2.73]. Exploratory interaction models showed that subjective SES significantly modified the association (p-value for interaction = 0.03), women perceiving themselves to have a lower SES compared to their community (n = 45) exhibited a significantly positive association between mRFEI and DAI. ConclusionThese findings suggest that women perceiving their SES to be lower than their neighborhoods may benefit from better access to healthy food.

Use of tobacco price-minimization strategies among public housing residents compared to U.S. low-income adults

BackgroundPrice minimization strategies (PMS) are ways for people to save money on tobacco purchases especially among those of lower socioeconomic status. This study assesses PMS and coupon receipt among public housing residents compared to U.S. low-income adults. MethodsData were from adults who currently use tobacco and live in District of Columbia Housing Authority (DCHA) public housing (n=270) and a US nationally representative sample of low-income adults who currently use tobacco (n=820). We examined the prevalence of PMS use across demographic characteristics and smoking behaviors, and qualitatively compared them across the two datasets. ResultsMost DCHA resident participants (84.2 %) and US low-income adults who currently use tobacco (91.5 %) recently used at least one PMS to save money on tobacco. The top-three most common strategies among DCHA residents were saving cigarettes to finish later (35.6 %), smoking fewer cigarettes (32.2 %), and finding cheaper places to buy cigarettes (30.4 %), while among U.S. low-income adults these strategies were using coupons or promotions (62.7 %), purchasing by bulk (55.5 %), and finding cheaper places to buy tobacco products (53.6 %). People who lightly smoke in DCHA were more likely than people who heavily smoke to use PMS in general (25.0 % vs. 13.7 %) and smoke fewer cigarettes to save money (35.8 % vs. 19.2 %). US low-income people who lightly smoke were more likely than people who heavily smoke to cut back on tobacco use (61.9 % vs. 39.8 %). ConclusionMost U.S. low-income individuals and DCHA residents who smoke engaged in PMS. Regulating these strategies while supporting tobacco use cessation may reduce the impact of tobacco in these populations.

Findings from public engagement programme for school children aged 14-16 years about endocrinology.

To investigate the utility and effectiveness of a school outreach programme in areas of lower socioeconomic status to improve understanding of common endocrine topics and the medical profession. Two secondary school outreach sessions were conducted in July 2022. Students were invited to attend lectures delivered by medical professionals and engage in poster-making sessions using the knowledge they had gained throughout the day. Participants completed anonymised pre- and post-session surveys. Outcomes were identified using Kirkpatrick's training evaluation model. Self-reported perceptions and beliefs (Kirkpatrick's Level 2a) were compared using chi-square tests. Thematic analysis of team-led poster presentations was performed. Of the 254 participants included, the response rates of pre- and post-session questionnaires were 75.6% and 56.2%, respectively. The outreach day increased students' understanding of Obesity and Diabetes, PCOS, and Health Technology. The most well-received activities from the outreach day were voted to be the poster challenge (43.4%) and poster presentation (14.7%). Following the session, there was a trend towards an increased understanding of medical careers and interest in pursuing a medical career, although these did not reach statistical significance. Outreach programmes could be a practical and effective approach to engaging prospective medical applicants from areas of lower socioeconomic status. Further studies are required to expand outreach programmes to investigate the efficacy of school engagement programmes.

Increasing HIV prevalence rate among men who have sex with men: results of a comparison of two national surveys.

Our objective was to compare HIV prevalence between two national surveys among men who have sex with men in Brazil in 2009 and 2016. HIV prevalence was estimated stratifying by age and socioeconomic status. HIV prevalence increased from 11.9% [95% confidence interval (CI): 9.9-14.3], in 2009, to 19.1% (95% CI: 16.5 - 22.0), in 2016 [odds ratio (OR) = 1.8; 95% CI: 1.3-2.3] increasing 320% among Young MSM of low SES. Political leadership is needed to develop a scientifically sound and inclusive solution.

Social order in Sweden's politicized and vulnerable neighborhoods – The perspective of residents

AbstractThis paper draws attention to a group of neighborhoods that are the object of heated elite discussions in many European countries. Using Sweden as our case, we demonstrate the feasibility of conducting high‐quality surveys with residents in neighborhoods where large shares have an immigrant background and low socioeconomic status. Moreover, we develop a measurement that allows us to assess what residents in two of Sweden's politicized and vulnerable neighborhoods think is needed to improve the social order of their local areas. We find that residents believe that neighborhood problems are generally about a lack of social control between people and that residents are not preoccupied with culture clash issues. Overall, beliefs about what contributes to social order are structured, largely homogenous and independent of elite discourse. Based on a comparison with a nationally representative sample, we conclude that residents in vulnerable neighborhoods and residents in other neighborhoods share a similar worldview and approach to daily life, but that the need for local social order is more keenly felt in the vulnerable neighborhoods.

The intersection between transgender identity and migrant background: experienced barriers and facilitators to healthcare in The Netherlands

Background Transgender and gender-diverse (TGD) people, particularly those with migrant backgrounds (mTGD), face health inequalities and barriers to care globally. Aim Examine barriers and facilitators to accessing and continuing healthcare within and beyond gender-specialist centers among mTGD people in the Netherlands. Methods TGD community researchers conducted in-depth interviews with 32 mTGD individuals from twenty-seven countries. Interviews were inductively thematically analyzed. Results Healthcare barriers relating to being TGD and being migrant compounded and interacted. Unmet transition needs, low socioeconomic status, and mental health issues were prevalent, and affected whether healthcare was a priority and access to healthcare. Having a supportive social network facilitated healthcare access. Beyond life circumstances, participants reported that providers outside gender-specialist settings had insufficient knowledge about TGD-related healthcare, and newcomers had difficulty bridging these gaps. The anticipation and experience of discrimination based on any facet of a participant’s identity formed a healthcare barrier, while identity validation was highly meaningful for participants and facilitated trust in providers. Continuity of caregivers was important to avoid having to re-explain one’s identity and needs, but alternating providers was often the reality - especially in refugee settings. Care models with TGD staff facilitated trust, and the integrated health and social care helped participants access healthcare whilst navigating complex life circumstances. Discussion mTGD individuals face unique barriers to accessing healthcare owing to their intersecting migrant and gender identities. Key improvements are enhancing cultural competency and knowledge on TGD healthcare among providers, ensuring equitable access to GAMC for migrants, and integrating gender-affirming care with other healthcare and social support.

The mediating role of subjective social status in the association between objective socioeconomic status and mental health status: evidence from Iranian national data.

Low socioeconomic status (SES) is identified as a pivotal risk factor for mental health. Objective socioeconomic status (OSS) is measured by tangible resources, whereas subjective social status (SSS) reflects an individual's perception of their OSS. A paucity of literature exists that elucidates the specific psychosocial mechanisms or pathways linking OSS with mental illness via SSS. This research aimed to explore the mediating role of SSS in the OSS-mental health association, utilizing data from the Iranian Mental Health Survey (IranMHS). This study is a secondary analysis of data from IranMHS, a national survey conducted in 2011 through face-to-face interviews with 7,886 Iranian adults aged 15-64. As part of the original survey, the General Health Questionnaire-28 (GHQ-28) was randomly administered to half of these participants. We focused our analysis on data from 3,759 participants who completed all items of the GHQ-28. OSS was evaluated using education, occupation, wealth, and a combined OSS index, while SSS was measured using the MacArthur Scale. We examined how SSS mediates the associations between OSS factors and GHQ scores, including its four dimensions-somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression- while adjusting for demographic variables and conducting gender-stratified analyses. Among the 3759 respondents, 2157 (57.4%) were women, 2110 (56.1%) lived in urban areas, with an average age of 33.1 years (SD=12.1). SSS mediated the associations between wealth and the overall GHQ score (mediation percentage: 92.3%), education (75.4%), OSS index (66.7%), and occupation (34.0%) on the GHQ score. The most significant mediation effects were observed for wealth on the somatic symptoms, social dysfunction, and depression dimensions, with SSS accounting for more than 80% of these associations. The findings indicate a significant mediating role of SSS in the relationship between OSS and mental health. Enhancing our comprehension of the social determinants that moderate the relationship between objective and subjective socioeconomic status may contribute to a more nuanced understanding of the impact of SES on mental health outcomes.

Impact of Digital Health Interventions on Birth Equity: A Review.

The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.

Sleep Health Disparity and Race/Ethnicity, Socioeconomic Status, and Gender: A Systematic Review

Despite improvement in US healthcare, racial and ethnic minorities have experienced health disparities including sleep health disparities. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three electronic databases (PubMed, Embase, Web of Science) from the earliest available date to September 2023 using the keywords sleep inequity, gender, race, and socioeconomic status. Studies published in languages other than English were excluded. Meta analysis, case reports, and editorials were also excluded. Medical Subject Headings (MeSH) of the National Library of Medicine and Keywords were used to search PubMed, Embase, and Web of Science. We also searched the reference lists of the selected articles. Using the search strategy, we identified 52 articles. After excluding 11 duplicate studies, we screened 41 articles. The studies not relevant to our search were further excluded and we finally assessed 16 full-text articles. Twelve of the 16 studies were cross sectional and 4 were prospective studies. Compared to Whites, increased prevalence of shorter sleep duration was found among people of diverse racial background. Similarly, individuals with lower socioeconomic status have been shown to have a disproportionate increase in insufficient sleep (1.62 times). Additionally, compared to White women, Black women were more likely to report short sleep (37% vs. 27%) and were less likely to obtain the recommended amount of sleep (52% vs. 64%). This review demonstrates disparities in sleep based on race/ethnicity as well as the effect of gender and socioeconomic status on the quality of sleep.

Determining the effectiveness of basic first aid training provided to secondary school students

Aims: The aim of this study is to evaluate the effectiveness of first aid training provided to middle school students from diverse socio-demographic backgrounds, and to examine how these differences influence the outcomes of the training. Methods: The study was conducted in three middle schools located in the eastern part of Turkiye between April and July 2016. The population of the study consisted of 7th-grade students (n=391) attending these schools during the spring semester of the 2015-2016 academic year. All students were included in the sample without any selection, as participation was obtained through parental and student consent. Data were collected using the “Descriptive Information Form” and the “First Aid Education Knowledge Evaluation Form”. First aid knowledge levels were assessed before the training, after the training, and two weeks post-training. Results: The study found that the average first aid knowledge scores of students based on socioeconomic status were 58.61±6.26 for high, 60.86±5.86 for middle, and 56.44±6.26 for low socioeconomic status. Post-training, the average scores increased across all groups. These findings indicate that socioeconomic status affects first aid knowledge, but the training programs benefit all students and improve their knowledge levels. Conclusion: The findings of this study indicate that while socioeconomic status exerts a significant influence on first aid knowledge, the training programmes implemented have resulted in notable improvements in the knowledge levels of all students.

Lower social vulnerability is associated with a higher prevalence of social media-involved violent crimes in Prince George’s County, Maryland, 2018–2023

BackgroundSocial vulnerability may play a role in social media-involved crime, but few studies have investigated this issue. We investigated associations between social vulnerability and social media-involved violent crimes.MethodsWe analyzed 22,801 violent crimes occurring between 2018 and 2023 in Prince George’s County, Maryland. Social media involvement was obtained from crime reports at the Prince George’s County Police Department. Social media application types included social networking, advertising/selling, ridesharing, dating, image/video hosting, mobile payment, instant messaging/Voice over Internet Protocol, and other. We used the Centers for Disease Control and Prevention’s Social Vulnerability Index to assess socioeconomic status (SES), household characteristics, racial and ethnic minority status, housing type and transportation, and overall vulnerability. Modified Poisson models estimated adjusted prevalence ratios (aPRs) among the overall sample and stratified by crime type (assault and homicide, robbery, and sexual offense). Covariates included year and crime type.ResultsRelative to high tertile areas, we observed a higher prevalence of social media-involved violent crimes in areas with low SES vulnerability (aPR: 1.82, 95% CI: 1.37-2.43), low housing type and transportation vulnerability (aPR: 1.53, 95% CI: 1.17-2.02), and low overall vulnerability (aPR: 1.63, 95% CI: 1.23-2.17). Low SES vulnerability areas were significantly associated with higher prevalences of social media-involved assaults and homicides (aPR: 1.64, 95% CI: 1.02-2.62), robberies (aPR: 2.00, 95% CI: 1.28-3.12), and sexual offenses (aPR: 2.07, 95% CI: 1.02-4.19) compared to high SES vulnerability areas. Low housing type and transportation vulnerability (vs. high) was significantly associated with a higher prevalence of social media-involved robberies (aPR: 1.54, 95% CI:1.01-2.37). Modified Poisson models also indicated that low overall vulnerability areas had higher prevalences of social media-involved robberies (aPR: 1.71, 95% CI: 1.10-2.67) and sexual offenses (aPR: 2.14, 95% CI: 1.05-4.39) than high overall vulnerability areas.ConclusionsWe quantified the prevalence of social media-involved violent crimes across social vulnerability levels. These insights underscore the need for collecting incident-based social media involvement in crime reports among law enforcement agencies across the United States and internationally. Comprehensive data collection at the national and international levels provides the capacity to elucidate the relationships between neighborhoods, social media, and population health.

Elucidating disparities in sunscreen coverage among state Medicaid preferred drug lists.

Regular application of over-the-counter (OTC) sunscreen is considered the foundation of skin cancer prevention, yet OTC sunscreen is not eligible for reimbursement in almost all state Medicaid benefit plans. On review of 111 Medicaid preferred drug lists (PDLs) across 50 states and the District of Columbia (DC), only five plans were identified that incorporate coverage of sunscreen. Thus, many recipients of Medicaid, the majority of whom are individuals and families of lower socioeconomic status, may encounter financial difficulty and thus forego utilizing sun protective measures due to financial constraints. Here, we compare current Medicaid coverage of OTC sunscreen and discuss calculated and theoretical annual costs of this skin cancer prevention method.