Lower Levels Of Educational Attainment Research Articles

Examining the Gender Disparities in Health Service Utilization Among Older Adults Managing Cognitive Impairments

Comorbid conditions can complicate healthcare access, yet little is known about the impact of cognition on accessing those services. This study aims to examine the effect of gender on health service utilization among the aging population. Data from the National Health Interview (2019) Survey (n=3,058) were utilized to assess the impact of gender on the use of physician and dental services among older adults managing cognitive impairments. We estimated logistic regression models controlling for demographic, health/physical functioning, and psychological predictors. Findings indicated older male respondents managing cognitive impairments were less inclined to utilize both physician (p<.05) and dental (p<.01) health services on a yearly basis as compared to their female counterparts. Household income (aOR = 0.62 [-0.91, -0.06]; aOR = 0.34 [-1.25, -0.90]) and health insurance coverage (aOR = 0.18 [-2.31, -1.13]; aOR = 0.32 [-1.68, -0.62]) respectively were the strongest structural factors limiting access to both physician and dental services, with lower levels of educational attainment (aOR = 0.46 [-1.00, -0.55]) being an additional barrier for dental service utilization. Respondents with low self-rated health were inclined to utilize physician more than dental services (aOR = 2.31 [0.38, 1.29]; aOR = 0.73 [-0.50, -0.14]). It is imperative geriatric practitioners adopt a more integrative approach to health, especially among the aging population managing chronic disabilities, where additional community supports are warranted to promote and maintain physical and oral health.

Is consanguineous marriage related to spousal violence in India? Evidence from the National Family Health Survey, 2015-16.

Violence against women is a global phenomenon, and intimate partner violence is the most common form of violence faced by women in the world. Around 30% of women in the world, on average, and 33% in India experience intimate partner violence during their lifetime. The main aim of this study was to investigate whether consanguinity protects women from spousal violence. National Family Health Survey 2015-16 (NFHS-4) data were used. The study sample comprised 60,824 currently married women aged 15-49 years. The results of the logistic regression model showed that the likelihood of all types of spousal violence against women was higher among consanguineous unions compared with non-consanguineous unions in India. The association between consanguineous marriage and spousal violence was found to be positive and significant in the southern and eastern regions of India and among Scheduled Castes and Scheduled Tribes. The association was not significant among Muslims. Differences in socio-cultural norms and practices across the regions of India, and among different socio-cultural groups, can perhaps explain these variations. Women belonging in higher age groups, from Other Backward Castes, those who were working and those with a low level of educational attainment and socioeconomic standing had a higher risk of experiencing intimate partner violence. Couples in a consanguineous marriage should be given adequate counselling to reduce intimate partner violence in India, and similarly culturally diverse countries. This would also help reach Target 5.2 of the Sustainable Development Goals by 2030.

Dynamics of social corrections to peers sharing COVID-19 misinformation on WhatsApp in Brazil.

ObjectiveOnline COVID-19 misinformation is a serious concern in Brazil, home to the second-largest WhatsApp user base and the second-highest number of COVID-19 deaths. We examined the extent to which WhatsApp users might be willing to correct their peers who might share COVID-19 misinformation.Materials and MethodsWe conducted a cross-sectional online survey using Qualtrics among 726 Brazilian adults to identify the types of social correction behaviors (SCBs) and health and technological factors that shape the performance of these behaviors.ResultsBrazil’s WhatsApp users expressed medium to high levels of willingness to engage in SCBs. We discovered 3 modes of SCBs: correction to the group, correction to the sender only, and passive or no correction. WhatsApp users with lower levels of educational attainment and from younger age groups were less inclined to provide corrections. Lastly, the perceived severity of COVID-19 and the ability to critically evaluate a message were positively associated with providing corrections to either the group or the sender.DiscussionThe demographic analyses point to the need to strengthen information literacy among population groups that are younger with lower levels of educational attainment. These efforts could facilitate individual-level contributions to the global fight against misinformation by the World Health Organization in collaboration with member states, social media companies, and civil society.ConclusionOur study suggests that Brazil’s WhatsApp users might be willing to actively respond with feedback when exposed to COVID-19 misinformation by their peers on small-world networks like WhatsApp groups.

Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis

BackgroundOur aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults.MethodStudies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD.ResultOut of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity.ConclusionThis systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.

Analysis of Sociodemographic, Clinical, and Genomic Factors Associated With Breast Cancer Mortality in the Linked Surveillance, Epidemiology, and End Results and Medicare Database

Understanding interactions among health service, sociodemographic, clinical, and genomic factors in breast cancer disparities research has been limited by a disconnect between health services and basic biological approaches. To describe the first linkage of Surveillance, Epidemiology, and End Results (SEER)-Medicare data to physical tumor samples and to investigate the interaction among screening detection, socioeconomic status, tumor stage, tumor biology, and breast cancer outcomes within a single context. This population-based cohort study used tumor specimen blocks from a subset of women aged 66 to 75 years with newly diagnosed nonmetastatic, estrogen receptor-positive invasive breast cancer from January 1, 1993, to December 31, 2007. Specimens were obtained from the Iowa and Hawaii SEER Residual Tissue Repositories (RTRs) and linked with Medicare claims data and survival assessed through December 31, 2015. Data were analyzed from August 1, 2018, to July 25, 2021. Screening- vs symptom-based detection of tumors was assessed using validated claims-based algorithms. Demographic factors and zip code-based educational attainment and poverty socioeconomic characteristics were obtained via SEER. Molecular subtyping and exploratory genomic analyses were completed using the NanoString Breast Cancer 360 gene expression panel containing the 50-gene signature classifier. Factors associated with overall and breast cancer-specific (BCS) survival were analyzed using Cox proportional hazards regression models combining sociodemographic, clinical, and genomic data. SEER-Medicare data were available for 3522 women (mean [SD] age, 70.9 [2.6] years; 3049 [86.6%] White), of whom 1555 (44.2%) were diagnosed by screening mammogram. In the SEER-Medicare cohort, factors associated with increased BCS mortality included symptomatic detection (hazard ratio [HR], 1.49 [95% CI, 1.16-1.91]), advanced disease stage (HR for stage III, 2.33 [95% CI, 1.41-3.85]), and high-grade disease (HR, 1.85 [95% CI, 1.46-2.34]). The molecular cohort of 130 cases with luminal A/B cancer further revealed increased all-cause mortality associated with genomic upregulation of transforming growth factor β activation and p53 dysregulation (eg, p53 dysregulation: HR, 2.15 [95% CI, 1.20-3.86]) and decreased mortality associated with androgen receptor, macrophage, cytotoxicity, and Treg signaling (eg, androgen receptor signaling: HR, 0.23 [95% CI, 0.12-0.45]). Symptomatic detection (HR, 2.49 [95% CI, 1.19-5.20]) and zip codes with low levels of educational attainment (HR, 5.17 [95% CI, 2.12-12.60]) remained associated with mortality after adjusting for all clinical and demographic factors. Linkage of SEER-Medicare data to physical tumor specimens may elucidate associations among biology, health care access, and disparities in breast cancer outcomes. The findings of this study suggest that screening detection and socioeconomic status are associated with survival in patients with locally advanced, estrogen receptor-positive tumors, even after incorporating clinical and genomic factors.

A hospital-based self-harm register in Mysore, South India: Is follow-up of survivors feasible in low and middle income countries?

Background: In high-income countries, dedicated self-harm surveillance systems are regarded as a key component in suicide prevention strategies, which suggests they may be important in low- and middle-income countries where rates of suicide are higher and risk factors for self-harm are different, provided they can be shown to be feasible in those settings.Methods: We established a hospital based self-harm register in Mysore, South India. A subset of participants was followed-up after two years. Results: Of the 453 who were examined at baseline, the vast majority (80%) were from rural areas, nearly a quarter were illiterate and 65 (14%) were diagnosed with depression. Compared to men, women tended to be younger, single, from rural areas, unemployed, with lower levels of educational attainment and higher levels of disability. Of the 453, 371 (80%) were successfully contacted by cellphone at 2 years. There were no significant differences in baseline variables between those followed-up and those who were not, including sociodemographic features, rates of depression, severity of disability and severity of suicidal intent. All participants reported that psychosocial assessment offered at baseline was helpful and that they would recommend assessment to othersConclusions: Findings from this study indicate that our self-harm register was a feasible and useful resource, and that contact and follow up are acceptable and feasible.

Strategies to support the growth and evolution of nursing and midwifery education in Tasmania

There is a prediction of significant nursing workforce shortfalls across Australia. Tasmania, as an island state of Australia, is more sensitive to such a shortage due to the existing challenges associated with pre-service and postgraduate nurse education, training, recruitment and retention. This paper describes strategies adopted by the School of Nursing (SoN), University of Tasmania to ensure the preparation and sustainability of the registered nurse workforce that is pivotal for state-wide healthcare. Due to lower levels of educational attainment amongst Tasmanian school leavers, the SoN has developed alternative pathway programs that offer entry for students who do not meet standardised entry. Staged progression to pedagogically sound online teaching platforms, pre-requisite limitations and uncoupling subject contents are strategies that have been incorporated in new undergraduate curriculum. The SoN’s postgraduate program includes a suite of 24 specialisations including a post-registration midwifery specialisation and students have the flexible option to exit the program at a graduate certificate, graduate diploma or finish at a master’s level. Partnerships with local industry, nursing associations, healthcare consumers, other health disciplines and students ensure that the SoN is responsive to sector needs and regulatory authority requirements to graduate qualified registered nurses serving in highly-demanding healthcare environments.

The roles of built environment and social disadvantage on the geography of property crime

The neighborhood environment plays an essential role in shaping the geography of property crime. However, criminologists and planners hold different views on the role of built environmental characteristics such as neighborhood permeability. Meanwhile, the consequence of social disadvantage has not been adequately considered along with built environmental measurements. We revisit the debate using the 2017 data from Dallas and Fort Worth, TX. Following a context-based theoretical framework, we use enhanced measurements of neighborhood characteristics to examine the relationship between neighborhood characteristics and property crime. The results of the geographically weighted negative binomial regression show that commercial and mixed land-use development, number of transit facilities, and alcohol-related establishments are positively associated with property crime rate, all else being equal. Neighborhoods with a higher per capita income exhibit a higher property crime rate. Neighborhoods with a higher percentage of Blacks/African Americans and a lower level of educational attainment tend to register a higher property crime rate. This research points to several areas for future studies.

Versengeni és együttműködni? Egy reprezentatív felmérés tanulságai

In this study, we use two representative surveysto investigate how competition and cooperation relate on the individual level and whether (and how) they associate with educational attainment. Our first result is that the correlation between competition and cooperation is positive and significant, even if we take into account the respondent's age, gender, settlement type and region of residency. We also find that competition and cooperation relate in a nonlinear way to educational attainment. Higher levels of competition and cooperation associate with more years in school, but at a decreasing rate. Moreover, too high levels of competition and cooperation correlate with lower levels of educational attainment.

A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes.

Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone.Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals.Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9–25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12–26) vs. 13 (IQR 7–22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6–73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0–7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65–6.75), pneumonia (OR 3.75, 1.82–7.76), subarachnoid haemorrhage (OR 43.1, 6.70–277.4) and undetermined stroke types (OR 6.35, 2.17–18.60) were associated with higher risk of in-hospital death.Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.

Socio-economic differences in the uptake of HIV testing and associated factors in South Africa

BackgroundImproved understanding of barriers to HIV testing is important for reaching the first of the UNAIDS 90–90-90 targets, which states that 90% of HIV positive individuals ought to know their HIV status. This study examined socio-economic status (SES) differences in HIV testing uptake and associated factors among youth and adults 15 years and older in South Africa.MethodsThis study used data from a national cross-sectional, population-based household survey conducted in 2017 using a multi-stage sampling design. A composite SES score was created using multiple correspondence analyses of household assets; households were classified into wealth quintiles and dichotomised into low SES/poorest (lowest 3 quintiles) and high SES/less-poor (highest 2 quintiles). Bivariate and multivariate logistic regression models were used to examine factors associated with the uptake of HIV testing in low and high SES households.ResultsHIV testing uptake was 73.8 and 76.7% among low and high SES households, respectively, both of which were below the first 90 targets. Among both low and high SES households, increased HIV testing uptake was significantly associated with females than males. The decreased likelihood was significantly associated with residing in rural formal areas than urban areas, those with no education or low levels of educational attainment and alcohol drinkers among low SES households. Whites and Indians/Asians had a decreased likelihood than Black Africans in high SES households.ConclusionsHIV testing interventions should target males, residents in rural formal areas, those with no or low education and those that consume alcohol in low SES households, including Whites and Indians/Asians from high SES households in order to bridge socio-economic disparities in the uptake of HIV testing. This should entail expanding HIV testing beyond traditional centres for voluntary counselling and testing through outreach efforts, including mobile testing and home-based testing.

Equity and access to maternal and child health services in Ghana a cross-sectional study

BackgroundInequities in the distribution of and access to maternal and child health care services is pervasive in Ghana. Understanding the drivers of inequity in maternal and child health (MCH) is important to achieving the universal health coverage component of the Sustainable Development Goals (SDGs) and poverty reduction in developing countries. However, there is increasing disparities in MCH services, especially in rural -urban, and income quintiles. The study aimed to examine the disparities in maternal and child health care services in Ghana for policy intervention.MethodsData for this study was extracted from the nationally representative Ghana Statistical Service (GSS) Multiple Indicator Cluster Survey (MICS) round 4, 2011. Respondents of this survey were women of reproductive age 15–49 years with a sample size of 10,627 households. The models were estimated using multivariate regression analysis together with concentration index (CI) and risk ratio (RR) to assess the distribution of MCH indicator groups across the household wealth index.ResultsThe results show that women with secondary school level and above were more likely to receive family planning, prenatal care, and delivery by a skilled health professional than those without formal education. Mothers with low level of educational attainment were 87% more likely to have their first pregnancy before the age of 20 years, and 78% were more likely to have children with under-five mortality, and 45% more likely to have children who had diarrhoea. teenage pregnancy (CI = − 0.133, RR =0.679), prenatal care by skilled health worker (CI = − 0.124, RR =0.713) under five mortality, child underweight, reported diarrhoea, and suspected pneumonia, though not statistically significant, were more concentrated in the poorer than in the richer households, The RR between the top and bottom quintiles ranged from 0.77 for child underweight to 0.82 for child wasting.ConclusionGeographic location, income status and formal education are key drivers of maternal and child health inequities in Ghana. Government can partner the private sector to implement health policies to address inequalities in MCH services through primary health care, and resource allocation skewed towards rural areas and the lower wealth quintile to bridge the inequality gaps and improve MCH outcomes. The government and the private sectors should prioritize female education, as that can improve maternal and child health.

COVID-19 in Rural America: Impacts of Politics and Disadvantage.

Early in the COVID‐19 pandemic, people living in cities were much more likely than rural residents to become infected with and die from the virus. Beginning in the summer of 2020, however, the proportional increase in virus spread became much greater in rural areas. By March 2021, per capita cases and deaths were greater in nonmetro than in metro areas. Multi‐variate regression analysis found that political views were the most important variable explaining per capita COVID‐19 cases, while measures of disadvantage were the best predictors of COVID‐19 deaths. Counties with high proportions of Trump voters had higher per capita cases, and in nonmetro areas, these counties had higher death rates. Overall, the best predictor of COVID‐19 death rates is low levels of educational attainment, high poverty rates, and high minority populations.

Do high childcare costs and low access to Head Start and childcare subsidies limit mothers’ employment? A state-level analysis

Access to affordable childcare is crucial to mothers’ employment. Yet, childcare costs and access to Head Start, childcare subsidies, and state-funded preschool vary dramatically across U.S. states. Using data from the 2016 American Community Survey five-year estimates, we apply hierarchical logistic regression models to show mothers are more likely to work in states with inexpensive childcare, higher Head Start enrollment and childcare subsidy participation, and increased availability of state-funded preschool. Childcare subsidy access is associated with higher maternal employment amongst those with lower levels of educational attainment, whereas state-funded preschool is associated with higher employment primarily among the college educated. Additionally, our analysis revealed that Head Start has a stronger association with maternal employment in states where childcare costs are high, reducing the negative relationship of employment with expensive childcare. As national discussions continue to center on the importance of childcare, our research adds evidence that public programs support maternal employment through reducing out-of-pocket childcare costs.

The Relationship between US Adults' Misconceptions about COVID-19 Vaccines and Vaccination Preferences.

While mass vaccination has blunted the pandemic in the United States, pockets of vaccine hesitancy remain. Through a nationally representative survey of 1027 adult Americans conducted in February 2021, this study examined individual misconceptions about COVID-19 vaccine safety; the demographic factors associated with these misconceptions; and the relationship between misconceptions and willingness to vaccinate. Misconceptions about vaccine safety were widespread. A sizeable minority (40%) believed that vaccine side effects are commonly severe or somewhat severe; 85% significantly underestimated the size and scale of the clinical trials; and a sizeable share believed either that the vaccines contain live coronavirus (10%) or were unsure (38%), a proxy for fears that vaccination itself may cause infection. These misconceptions were particularly acute among Republicans, Blacks, individuals with lower levels of educational attainment, and unvaccinated individuals. Perceived side effect severity and underestimating the size of the clinical trials were both significantly associated with vaccine hesitancy.

Health Beliefs and Preventive Behaviors Among Adults During the Early COVID-19 Pandemic in the United States: a Latent Class Analysis.

The objectives of this study are to (1) characterize patterns of preventive behaviors 3 months after the COVID-19 pandemic was declared a national emergency in the USA and (2) identify how health beliefs (e.g., perceived risk of infection, perceived risk of death upon infection, and perceived effectiveness of CDC-recommended preventive behaviors) and sociodemographic characteristics are associated with preventive behaviors. Data were obtained from two waves of the Understanding America Study (UAS) conducted in March (wave 1) and May to June of 2020 (wave 2) (n = 4445); UAS is a nationally representative panel of US adults. We conducted a latent class analysis (LCA) using wave 2 data to identify our outcome, patterns of 10 COVID-preventive behaviors (e.g., wearing a facemask, handwashing, social distancing), and then used a three-step regression (R3STEP) to test associations between the likelihood of class membership with (1) health beliefs and sociodemographic characteristics (age, sex, race/ethnicity, and educational attainment) in bivariate models and (2) health beliefs adjusted for sociodemographic characteristics in multivariate models. The LCA identified a three-class model of preventive behaviors characterized by high likelihood of engagement in the set of preventive behaviors (“high”), low likelihood of the preventive behaviors (“low”), or engagement in some behaviors (“mixed”). Respondents of older age (i.e., age 50 or older) and those with higher levels of educational attainment (i.e., a 4-year college degree or higher) were less likely to be in the low engagement versus the mixed engagement class compared to those who are younger (18–29) and have lower levels of educational attainment (i.e., high school), respectively. Women (compared to men) and respondents who were Black and/or Hispanic/Latinx (compared to White) were more likely to be in the high (vs. mixed) engagement class. In separate models adjusted for sociodemographic characteristics, respondents with a high perceived risk of infection, high perceived risk of death, and high perceived effectiveness of COVID-preventive behaviors were statistically significantly less likely to be in the low engagement relative to the mixed engagement class. Engagement in COVID-preventive behaviors varies by sociodemographic characteristics (i.e., age, sex, race/ethnicity and educational attainment) and health beliefs (i.e., perceived risk of infection, perceived risk of death, and perceived effectiveness of CDC-recommended behaviors). Our findings highlight the potential utility of using health beliefs to inform targeted prevention efforts to help reduce the spread of COVID-19 and future pandemics.

Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study

ObjectiveThis study examines whether there is an independent association between mental difficulties in adolescence and educational attainment at age 16.DesignLongitudinal study.SettingNationally representative data from the UK Household Longitudinal Study (UKHLS)...

P-134 Social determinants of health are risk factors for early onset colorectal cancer in Appalachia

The Appalachian mountain range encompasses 420 counties and parallels the eastern seaboard of the United States (US). This region is characterized as being predominantly rural with poverty rates that exceed the national average. Recently, areas in southern and central Appalachia were identified as geographical hot-spots for EOCRC mortality in men. The purpose of this investigation is to describe the relationship between social determinants of health, including educational attainment, poverty, income, unemployment, and access to cancer screening, and the incidence of EOCRC in Appalachia. This is a retrospective cohort analysis of the National Cancer Institutes’ Surveillance, Epidemiology, and End Results (SEER) program. 4,724 patients age 20-49 who were diagnosed with colorectal cancer in Appalachia from 2000-2016 met inclusion criteria and were analyzed. 105 of the 420 Appalachian counties designated by the Appalachian Regional Commission were represented in this study. County-level incidence of EOCRC was calculated (n=105) and the counties in the top (n=25) and bottom (n=27) quartiles for incidence of EOCRC were separated into two cohorts for comparison. County characteristics reported by the American Community Survey from 2012-2016 Census and the National Health Interview Survey (2008-2011) were compared between the cohorts. Appalachian counties above the top quartile for EOCRC incidence were found to have significantly lower levels of educational attainment with significant differences seen at all cutoffs (< 9th grade, < high school, < bachelor’s degree). Appalachian counties above the 75th percentile for EOCRC also have a significantly higher unemployment rates and greater levels of poverty defined as percentage of the population living under 200% of the federal poverty level. Moreover, county-level median household income was found to be inversely related to county incidence of EOCRC. Appalachian counties above the 75th percentile incidence of EOCRC have significantly higher percentage of residents who identify as current smokers or ever smokers. Furthermore, EOCRC incidence in Appalachia inversely correlated with utilization of health screens. Specifically, the top quartile for EOCRC incidence had significantly lower rates of endoscopy use and CRC testing for screening-aged adults. While it is known that social determinants of health play a key role in colorectal cancer morbidity, mortality, and survival, this study shows that social determinants of health are also risk factors for the incidence of EOCRC. We hypothesize that counties with poor social determinants of health (high poverty rates, low educational obtainment, and decreased access to preventative healthcare) may also have higher rates of independent risk factors for EOCRC such as obesity and processed meat consumption. Interestingly, this study demonstrates that EOCRC incidence inversely corelated with county utilization of CRC testing for screening age adults. These results provide data to strongly support public health initiatives in Appalachia aimed at improving these social determinants of health at a county-level. We further hypothesize that tobacco use, processed meat consumption, obesity, and limited access to primary care are some of the likely many factors driving the increased incidence of EOCRC in Appalachia and therefore provide targets for future interventions at the regional level.

How variation in internet access, digital skills, and media use are related to rural student outcomes: GPA, SAT, and educational aspirations

Some have pointed to divides in the availability of fixed home broadband Internet access as a contributor to rural students’ lower levels of educational attainment. Based on standardized exams (SAT Suite) and a survey of rural Michigan students in grades 8–11, we find that rural students with broadband home Internet access are more interested in school and leave homework incomplete less often. However, the relationship to classroom grades (GPA) is relatively trivial. Yet, we find that students who are not dependent on a cell phone for Internet access and those with higher digital skills, especially social media skills, rank considerably higher on the SAT. Rural students with broadband Internet access are able to participate in a more diverse array of online media activities, which supports building digital skills. Any negative relationship between time spent on social media, video games, other digital media and educational outcomes is outweighed by the benefit to digital skills. However, aspects of rural culture; including the emphasis on activities such as sports, as a path to postsecondary schooling and upward, social mobility; may be stunting the positive relationship between access, digital skills, and educational aspirations. Whereas extra-curricular sports have no direct relationship to SAT performance, students who spend more time on sports receive higher grades and have higher educational aspirations than those with more digital skills. We discuss the implications for rural students’ access to human capital and how the unequal relationship between digital skills and performance in the classroom and on the SAT may perpetuate inequalities.

Uneven Distribution of Socio-economic Status and Housing Outcomes in Depopulating Towns of Rural Korea

In the wake of demographic cliff, this research is a longitudinal study that examines socio-economic status and housing outcomes of households in depopulating towns of Jeolla and Gyeonngbuk Provinces, and figures out factors affecting their residential assessment. After 1,213 households were selected from two waves of Korea Welfare Panel Study, the statistical analysis revealed that most of the households were elderly couples headed by men aged over 70 with lower level of educational attainment, and owned a small-sized single-family-home with 3 bedrooms. Not surprisingly, the number of single elderly women between old-old and oldest-old age groups sharply increased, especially in Gyeonngbuk Province. where a sizable number of either substandard housing or houses with structural problems were identified, lowering housing satisfaction. While a vast majority of households suffered from digital isolation, a growing of number of households relied on social services, particularly cash transfer such as social security and medicaid. Further, the regression analysis indicated that overall satisfaction with rural settlement was largely influenced by satisfaction with housing and residential environment in its entirety. Thus, this research implies that since depopulating towns are mainly small and physically islolated, digital inclusion helps elderly residents to stay connected and adequately get in-home services.