Moderate Income Research Articles

Suicide Risk among the Octogenarian Age Group: A Comparative Study

We aimed to investigate the factors that affect the likelihood of suicide in the elderly, with a focus on individuals aged 80 and older. This is a cross-sectional study conducted in 7 nursing homes in the Manisa province, Turkiye. The data has been collected through face-toface using a socio-demographic data form, the life satisfaction scale, and the suicide probability scale. Data were analyzed using IBM SPSS Statistics 26.0, non-parametric statistical methods have been employed. The study included 278 elderly participants, 5 outliers were removed from the analysis. Among the included elderly participants (n=273), the anger score averages of males were higher. Low, high, and moderate income were found to have a higher suicide probability respectively. Those who resided in a nursing home for 3 years or more had higher anger scores. Elderly individuals residing in publicly funded nursing homes had higher averages in suicide probability, negative self, exhaustion, and anger scores. Further analyses were performed among the octogenarian population (n=149). Octogenarian males had higher scores in Suicide Probability, Disconnection from Life, and Anger Scale than the female octagenarian participants. Octogenarians with low income were found to experience a lack of attachment to life and higher levels of anger. In publicly funded nursing homes, octogenarians had higher suicide probability and anger scores compared to those in private nursing homes. The risk of suicide in octogenarians should be taken seriously. Factors such as gender, income level, and type of nursing home can influence this risk.

The Prevalence of Refractive Errors Among Middle-Class Kids in and Around Dehradun

Background: Children living in countries with moderate income levels, such as India, who are born with untreated refractive abnormalities continue to face significant challenges. Despite the availability of low-cost remedial techniques like eyeglasses, uncorrected refractive defects cause vision loss for many children in India. This persists even though glasses may correct the problem. Aim: The aim of the present study is to investigate whether children from middle-income families exhibit any refractive errors. Materials & methods: The researchers conducted the present study after receiving approval from the institution’s ethics board. The research was carried out at Gautam Budha Chikitsa Mahavidyalaya, Jhajra, Dehradun, India. The study enrolled children from middle-income groups in and around the Dehradun city area. Results & Conclusions: The study revealed that refractive errors are the leading cause of visual impairment among school-age children, particularly those from middle-income families. Given that most refractive defects can be corrected with glasses, there is a need for cost-effective strategies to safeguard children’s eyesight. Such disabilities might impede a child’s development and education. There is compelling evidence supporting this treatable cause of blindness.

THE RELATIONSHIP BETWEEN POSTPARTUM ANXIETY AND MATERNAL FUNCTION IN MOTHERS

This descriptive, cross-sectional, and relationship-seeking study aimed to determine the relationship between postpartum anxiety and maternal function in mothers with 6-10 weeks old babies.
 The study was carried out with 258 mothers who were 6-10 weeks postpartum. The data were collected using the Personal Information Form, Postpartum Specific Anxiety Scale (PSAS), and Barkin Index of Maternal Functioning (BIMF).
 It was determined that the majority of the mothers participating in the study were between the ages of 27-34, high school graduates, not working, having health insurance, having a moderate income, living with a nuclear family, and married for 2-6 years. The majority of mothers had babies who were 8-9 weeks old, had a vaginal delivery, experienced 2-3 pregnancies, had assistance with postpartum care, and received education/information about postpartum care. The mean PSAS score for the mothers was determined to be at a moderate level (83.71±21.71), while the mean BIMF score was above a moderate level (71.49±13.89). It was found that there was a moderate, negative significant relationship between the PSAS total score and the BIMF total score, and it was determined that the level of maternal functioning decreased as postpartum anxiety increased (p

Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis.

Machine learning clustering offers an unbiased approach to better understand the interactions of complex social and clinical variables via integrative subphenotypes, an approach not studied in out-of-hospital cardiac arrest (OHCA). We conducted a cluster analysis for a cohort of OHCA survivors to examine the association of clinical and social factors for mortality at 1 year. We used a retrospective observational OHCA cohort identified from Medicare claims data, including area-level social determinants of health (SDOH) features and hospital-level data sets. We applied k-means clustering algorithms to identify subphenotypes of beneficiaries who had survived an OHCA and examined associations of outcomes by subphenotype. We identified 27,028 unique beneficiaries who survived to discharge after OHCA. We derived 4 distinct subphenotypes. Subphenotype 1 included a distribution of more urban, female, and Black beneficiaries with the least robust area-level SDOH measures and the highest 1-year mortality (2375/4417, 53.8%). Subphenotype 2 was characterized by a greater distribution of male, White beneficiaries and had the strongest zip code-level SDOH measures, with 1-year mortality at 49.9% (4577/9165). Subphenotype 3 had the highest rates of cardiac catheterization at 34.7% (1342/3866) and the greatest distribution with a driving distance to the index OHCA hospital from their primary residence >16.1 km at 85.4% (8179/9580); more were also discharged to a skilled nursing facility after index hospitalization. Subphenotype 4 had moderate median household income at US $51,659.50 (IQR US $41,295 to $67,081) and moderate to high median unemployment at 5.5% (IQR 4.2%-7.1%), with the lowest 1-year mortality (1207/3866, 31.2%). Joint modeling of these features demonstrated an increased hazard of death for subphenotypes 1 to 3 but not for subphenotype 4 when compared to reference. We identified 4 distinct subphenotypes with differences in outcomes by clinical and area-level SDOH features for OHCA. Further work is needed to determine if individual or other SDOH domains are specifically tied to long-term survival after OHCA.

THE EFFECT OF COVID-19 PANDEMIA ON HEALTH ANXIETY AND QUALITY OF LIFE: THE CASE OF FEMALE STUDENTS OF FOREIGN NATIONALITY IN TURKEY

This study was conducted to determine the health anxiety and quality of life of female students of foreign nationality due to Covid-19 pandemia.The present study had a cross-sectional content analysisdesign.The Personal Information Form, Health Anxiety Scale, SF-36 Quality of Life Scale and Semi-Structured Interview Form were used as the data collection tools in the study.A total of 28 female students from Syria and Palestine, Iraq, Afghanistan, Uganda, Thailand, Kazakhstan, Georgia, Morocco, Indonesia, Sudan, Algeria, Albania, Bosnia-Herzegovina, Kyrgyzstan and Somalia are included in this research. The average age of the students was 21.9±2.1. All the students were single. A total of 71.4% of the students thought that they had moderate income, 46.4% had sufficient knowledge on Covid-19, and 28.6% thought they had Covid-19-originated symptoms. It was found in the study that the majority of students were constantly anxious about Covid-19 pandemia; and therefore, they tried to follow hygienic rules. As a result, it was determined that the Covid-19 pandemic negatively affected the health anxiety and quality of life of young people.

Self-reported sleep status and influencing factors: a web-based national cross-sectional survey in China

Objectives To investigate self-reported sleep duration, sleep timing, sleep status and influencing factors in the Chinese population. Methods This web-based cross-sectional survey was conducted in 2022, covering 31 provinces (91%) in China. 11,000 questionnaires were collected, of which 8970 were valid for analysis. Self-reported sleep habits, problems and quality were investigated. Good or fair sleep ratings, enough duration, regular, with no sleep disturbances and <30 min sleep latency was defined as a composite variable: ‘Good sleep’. Factors influencing sleep patterns and ‘Good sleep’ were analyzed by multivariate logistic regression. Results Most participants sleep less than 7 h per night (55.13%), usually go to bed at 10–12 pm (47.99%), wake up at 6–8 am (49.86%), and take less than 30 min to fall asleep (66.30%) with regular sleep schedule (76.01%). Only 12.36% have ‘Good sleep’. In the past 3 months, 46.80% of the participants reported symptoms of insomnia, and 21.54% had snoring problems. Among the adults, the young, males, college students, freelancers, and those who resided in urban areas and pandemic-free areas slept later, and the northerners woke up earlier. The adults with low-moderate and moderate income and the minors at elementary and middle school slept earlier and woke up earlier. Mid-aged adults who often napped at noon were more likely to have ‘Good sleep’ than any other age group, and urban dwellers with the same habit were more likely to have ‘Good sleep’ than people dwelled in other regions. While people who slept late, woke up too early or too late, slept too little or too much, resided at GMT 7–8 area or pandemic area, had high income, or took up some occupations (entrepreneurs/individuals, professionals, manual and non-manual workers, housewives) were less likely to get a ‘Good sleep’. Conclusions The national survey provided a sleep profile of the Chinese population. Both socio-economic status and personal sleep hygiene habits had an impact on ‘Good sleep’.

Abstract B036: Trends in disparities in clinical trial accrual: An analysis of National Cancer Institute (NCI)-sponsored early phase clinical trials over the last 22 years

Abstract Using the NCI Cancer Therapy Evaluation Program (CTEP)-sponsored early phase oncology clinical trials database, we evaluated trends in disparities in patient enrollment over the last 22 years. Counts and percentages of enrolled patients were calculated directly from the full population of patients enrolled to CTEP-sponsored Phase 1, 2, and 1/2 trials during 2000-22. Trends in enrollment were assessed based on single-year data, four-year periods, and using a three-year rolling average. Analyses of patient residential ZIP code were restricted to patients residing and enrolled at institutions within the United States. Geographical data corresponding to patient ZIP codes was obtained using the zipcodeR package, including geographical region and median household income corresponding to each ZIP, and distance between patient residential and enrolling institution ZIPs. A total of 14,877 patients were enrolled in CTEP-sponsored early phase trials evaluated during 2000-22, with 14,342 residing and enrolled within the US. The proportion of patients aged 40-64 at enrollment decreased from 59.8% in 2000-03 to 47.5% in 2020-22, with corresponding increases in ages 65-74 (24.2% to 32.9%) and 75-84 (5.9% to 12.3%). There were fluctuations in gender, most likely based on the specific agents being studied in clinical trials enrolling at a given time. In 2020-22, 72.9% of the population was non-Hispanic white when compared to 2000-03 when enrollment of non-Hispanic whites was 83.7%. Hispanic/Latino population enrollment increased from 4.2% in years 2000-03 to 6.9% in years 2020-22. Asian/Pacific Islander population increased from 2.5% in 2000-03 to 5.4% in 2020-22. Enrollment of non-Hispanic Black patients increased slightly over the last 20 years (6.3% to 7.1%), as did the proportion with unknown or unspecified race/ethnicity (3.3% to 7.6%). Trial enrollment trends by geographic regions revealed that enrollment in South and West overall increased (29.1% to 40.9%; 7.9% to 18.2%), Northeast representation remained static (23.9% to 20.8%) and Midwest representation decreased (24.4% to 19.4%) from 2000-03 to 2020-22. Most early phase participants in our database were from localities with a moderate median household income ($52,200 - $156,600; 51.9% to 59.4%), with an increase in representation from low-income localities (income &amp;lt; $52,000; 31.1% to 37.7%) over the last 22 years. We observed an overall increase in patients enrolling within a 50-mile radius of their residence over the 22-year period (46.5% to 64.5%) and an overall decrease in patients traveling over 200 miles to enroll in clinical trials (16.1% to 8.3%). We also examined trends in disparities during the COVID-19 pandemic and saw no significant differences in trial enrollment by race/ethnicity and gender when compared to pre-pandemic enrollment. Disparities in patients enrolled in early-phase clinical trials have marginally improved over the span of two decades, and outreach and inclusion efforts for enrollment of underrepresented patients should be continued to sustain these observed trends. Citation Format: Maria Farooq, Elad Sharon, Naoko Takebe, Ana F. Best, Shanda Finnigan. Trends in disparities in clinical trial accrual: An analysis of National Cancer Institute (NCI)-sponsored early phase clinical trials over the last 22 years [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B036.

Heart sound classification based on bispectrum features and Vision Transformer mode

In regions with limited resources and moderate incomes, the relentless spectre of cardiovascular diseases (CVDs) continues to loom large. Amidst this challenge, the precise classification of heart sounds is emerging as a pivotal linchpin in the realm of early CVD diagnosis and intervention. Manual heart sound auscultation efficacy remains tethered to the expertise of physicians, but the tides are shifting. With deep learning algorithms, heart sound classification reaches new heights. In this paradigm-shifting article, we unveil an ingenious model fortified by bispectrum-inspired feature extraction and the cutting-edge prowess of the Vision Transformer (ViT) model. This model spearheads the binary classification of heart sounds, labelling them as either 'normal' or 'abnormal.' Our model uses data from the PhysioNet Challenge 2022 database, which contains 3163 data points from 942 patients. The model showcases an adept classification process with a remarkable consistency, notably holding its own when distinguishing between heart sounds of pregnant and nonpregnant patients. Moreover, we dare to challenge the status quo. This article boldly pits the performance of our model against that of seasoned cardiologists. Our model emerges as the triumphant frontrunner, eclipsing the proficiency of even the most seasoned cardiologists. In a world where health resources are unevenly distributed, this pioneering work offers a beacon of hope, unlocking a future where advanced algorithms not only match but surpass human expertise. Step into the forefront of transformative cardiac care—where artificial intelligence becomes the key to unravelling the secrets of heart sounds.

The impact of the Tax Cut and Jobs Act on IRA choice for moderate income investors

While the choice of appropriate individual retirement account (IRA) type involves many factors, it is well known that differences in tax rates during the working and retirement years impact the optimal choice. Lower rates of return on investment may cause an investor to prefer a Traditional IRA whereas higher rates of return often result in higher after-tax future wealth for the Roth IRA. The lower statutory tax rates for individuals resulting from the 2018 Tax Cut and Jobs Act raises the breakeven rate of return where the Roth becomes preferable for many moderate income individuals who invest the amount of the deduction generated by the Traditional IRA. The new tax law significantly increases the breakeven rates for investors who begin investing at an older age. Moderate income investors are defined as those who will be in the 22% marginal tax bracket during their working years. Many investors do not invest the tax savings generated by a qualifying Traditional IRA. For these individuals a spreadsheet model is used to compare contribution and retirement real consumption. The Traditional IRA can be a better choice for many moderate income individuals who want to maximize their total lifetime real consumption rather than retirement consumption, and the compression in tax rates of the new tax law increases the number of outcomes where the Traditional IRA yields higher total consumption.

POSTPARTUM DEPRESSION AND ANXIETY: A COMMUNITY-BASED STUDY ON RISK FACTORS BEFORE, DURING AND AFTER PREGNANCY

Postpartum anxiety and depression are a significant public health concern as it is the leading cause of maternal morbidity. It is associated with adverse effects on the cognitive and social development of the infant. The primary aim of the study is to find postpartum depression and anxiety as a community-based study on risk factors before, during, and after pregnancy. The prospective cohort study was conducted in Khyber Teaching Hospital Peshawar from April 2023 to July 2023. A total of 320 pregnant women were recruited for this study. Participants were enrolled during their antenatal visits to healthcare facilities within the community, ensuring representation across diverse demographic and socio-economic backgrounds. Data collection for this community-based study on postpartum depression and anxiety was executed meticulously across three distinct phases: before, during, and after pregnancy. Data was collected from 320 pregnant females. The mean age of participants was 28.5±4.2 years. Most participants had at least a high school education (65%) and reported a moderate household income (55%). 18% of participants had a history of previous episodes of depression or anxiety. 35% reported experiencing significant life stressors before pregnancy, with financial concerns being the most common (62%). 24% had a family history of mental health disorders. It is concluded that this study has revealed a significant prevalence of postpartum depression (22%) and anxiety (18%) among participants. The identified risk factors, including prior mental health history and high prenatal stress, emphasize the need for early intervention and targeted support systems during the perinatal period.

Health-related quality of life and its associated factors in patients with chronic obstructive pulmonary disease.

The present study aimed to evaluate HRQOL and to explore the factors associated with poor HRQOL among patients with COPD. In the present cross-sectional study, the validated St George's Respiratory Questionnaire for COPD patients (SGRQ-C) was used to evaluate HRQOL among 702 patients with COPD at two major hospitals in Jordan in the period between January and April 2022. Quantile regression analysis was used to explore the factors associated with HRQOL among the study participants. According to SGRQ-C, the HRQOL of the study participants was greatly impaired with a total SGRQ of 55.2 (34-67.8). The highest impairment in the HRQOL was in the impact domain with a median of 58.7 (29-76.3). Increased number of prescribed medications (β = 1.157, P<0.01), older age (β = 0.487, P<0.001), male gender (β = 5.364, P<0.01), low education level (β = 9.313, P<0.001), low and moderate average income (β = 6.440, P<0.05, and β = 6.997, P<0.01, respectively) were associated with poorer HRQOL. On the other hand, being married (β = -17.122, P<0.001), living in rural area (β = -6.994, P<0.01), non-use of steroids inhalers (β = -3.859, P<0.05), not receiving long acting muscarinic antagonists (LAMA) (β = -9.269, P<0.001), not receiving LABA (β = -8.243, P<0.001) and being adherent to the prescribed medications (β = -6.016, P<0.001) were associated with improved HRQOL. Furthermore, lower disease severity (stage A, B, and C) (β = -23.252, -10.389, and -9.696 respectively, P<0.001), and the absence of comorbidities (β = -14.303, P<0.001) were associated with better HRQOL. In order to maximize HRQOL in patients with COPD, future COPD management interventions should adopt a multidisciplinary approach involving different healthcare providers, which aims to provide patient-centered care, implement personalized interventions, and improve medication adherence, particularly for patients who are elderly, males, have low socioeconomic status, receive multiple medications and have multiple comorbid diseases.

Income loss and subsequent poor psychological well-being among the Chinese population during the early COVID-19 pandemic

BackgroundThe COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic.MethodsData were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants’ recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health.ResultsThis study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = − 0.603, P < 0.001; severe income loss: B = − 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = − 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19.ConclusionsIncome loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible.

Does population aging coexist with income inequality in the long run? Evidence from selected Asia-Pacific countries

Advanced countries have experienced a general rise in income inequality, whereas the outlook for income inequality in developing countries is mixed. As such, reduction in income inequality continues to be an important socio-economic development goal in many countries in the twenty-first century. Furthermore, it remains unclear whether the slow progress in reducing income inequality is a manifestation of the prevailing aging population. Using a sample of countries that are currently considered aging, aged, and super-aged countries in the Asia-Pacific region, the paper empirically examines whether a long-run nexus exists between population aging and income inequality. The methodology adopted includes the augmented autoregressive distributed lag (A-ARDL) bounds test. The key results show that aging and income inequality have a long-run relationship among aged and super-aged countries. In contrast, recently graying countries show no evidence of cointegration due to their relatively early transition to aging. Some other control variables also reveal a significant impact on income inequality. Increases in the real gross domestic product per capita worsen the income distribution, but higher government expenditure can help moderate income inequality. In light of rapid population aging, the findings are useful for policy makers in designing and targeting appropriate socioeconomic policies to help mitigate income inequality in the long run based on the intensity of the share of the elderly population in the countries studied.

Taxing cryptocurrencies

AbstractPolicy-makers are struggling to accommodate cryptocurrencies within tax systems not designed to handle them; this paper reviews the issues that arise. The greatest challenges are for implementation: crypto’s pseudonymity is an inherent obstacle to third-party reporting. Design problems arise from cryptocurrencies’ dual nature as investment assets and means of payment: more straightforward is a compelling case for corrective taxation of carbon-intensive mining. Ownership is highly concentrated at the top, but many crypto investors have only moderate incomes. The capital gains tax revenue at stake worldwide may be in the tens of billions of dollars, but the more profound risks may ultimately be for VAT/sales taxes.

Virtually Administered Intervention Through Telerehabilitation for Chronic Non-specific Low Back Pain: A Review of Literature.

The most frequent reason for individuals to seek medical attention in both primary care settings and immediate care centersis low back pain (LBP). Over a duration of time, the disability caused by lower back pain has risen enough, particularly in countries with low or moderate incomes. In the coming years, there may be an increase in LBP-related impairment and expenses in countries with low or medium incomes, particularly when fragile medical systems are unable to handle this growing load. Hence, this review focuses on the effectiveness of telerehabilitation (TR) on LBP. The significant advantages of TR may include greater interaction and remote accessibility to medical treatments.The exchange of knowledge and health information is made possible through a more effective interaction, which benefits patients, families, carers, physicians, and researchers. People who live in distant places now have the opportunity to get medical attention assisting families in caring for patients with poor responsiveness. In addition, it provides the potential for prompt detection, the beginning of treatment in the midst of an emergency, a shorter stay in the hospital, ongoing monitoring of those at risk, and overall time and expense savings. Therefore, this study supports the application of TR in conditions of LBP for early management and relief of pain for patients in low-resource areas.

AFFORDABILITY OF AFFORDABLE HOUSING IN NORTHERN REGION OF MALAYSIA

The problem of housing affordability has emerged as a significant concern in urban centers, particularly in emerging countries. Whileeach country defines affordability differently, housing affordability refers to the capacity to possess a residential property or dwellingthat satisfies fundamental living requirements in relation to its price, standard, and whereabouts. However, the majority of generallycomprised of individuals and families with lower to moderate incomes, residing in various urban areas across Malaysia find itdifficult to purchase a home. The aim of this research is to evaluate the housing affordability index in Malaysia’s Northern Region (Kedah, Pulau Pinang, Perak, and Perlis) by proposing a maximum affordable housing cost determined by income level. The findings revealed that the housing affordability index has deteriorated as a result of growing income-price inequalities. It is suggested that government or housing policy makers to be responsible to establish a fair housing price that is determined through convincing and widely accepted judgments. Establishing prices could be based on genuine supply and demand dynamics, rather than being influenced by unfair trading practices, manipulation, or exploitation.

Unhealthy lifestyles and clusters status among 3637 adolescents aged 11–23 years: a school-based cross-sectional study in China

BackgroundUnhealthy lifestyles are risk factors for non-communicable diseases (NCDs) and tend to be clustered, with a trajectory that extends from adolescence to adulthood. This study investigated the association of diets, tobacco, alcohol, physical activity (PA), screen time (ST) and sleep duration (SD) in a total of six lifestyles, separately and as cumulative lifestyle scores, with sociodemographic characteristics among school-aged adolescents in the Chinese city of Zhengzhou.MethodsIn the aggregate, 3,637 adolescents aged 11–23 years were included in the study. The questionnaire collected data on socio-demographic characteristics and lifestyles. Healthy and unhealthy lifestyles were identified and scored, depending on the individual score (0 and 1 for healthy and unhealthy lifestyles respectively), with a total score between 0 and 6. Based on the sum of the dichotomous scores, the number of unhealthy lifestyles was calculated and divided into three clusters (0–1, 2–3, 4–6). Chi-square test was used to analyze the group difference of lifestyles and demographic characteristics, and multivariate logistic regression was used to explore the associations between demographic characteristics and the clustering status of unhealthy lifestyles.ResultsAmong all participants, the prevalence of unhealthy lifestyles was: 86.4% for diet, 14.5% for alcohol, 6.0% for tobacco, 72.2% for PA, 42.3% for ST and 63.9% for SD. Students who were in university, female, lived in country (OR = 1.725, 95% CI: 1.241–2.398), had low number of close friends (1–2: OR = 2.110, 95% CI: 1.428–3.117; 3–5: OR = 1.601, 95% CI: 1.168–2.195), and had moderate family income (OR = 1.771, 95% CI: 1.208–2.596) were more likely to develop unhealthy lifestyles. In total, unhealthy lifestyles remain highly prevalent among Chinese adolescents.ConclusionIn the future, the establishment of an effective public health policy may improve the lifestyle profile of adolescents. Based on the lifestyle characteristics of different populations reported in our findings, lifestyle optimization can be more efficiently integrated into the daily lives of adolescents. Moreover, it is essential to conduct well-designed prospective studies on adolescents.

PEMBERIAN EDUKASI KEPADA IBU DALAM UPAYA PENCEGAHAN STUNTING PADA BALITA

A child's growth and development may be stunted, which is what we mean when we speak about the concept of stunting. Stunting can be caused by a number of factors, including malnutrition, recurrent illnesses, and/or a lack of psychosocial stimulation. Stunting is a significant problem for the general health of the population in countries of low and moderate income, which have high rates of malnutrition. There is a correlation between growth retardation and both physical and mental health problems, including an increased likelihood of being ill, worse cognitive function, and decreased levels of productivity in adulthood. Expanded opportunities for early childhood education and stimulation, improved access to nutrient-dense foods, increased availability of adequate health care, and promotion of suitable hygiene and sanitation practises are all essential components of an all-encompassing plan to combat stunting. Because of this, the parents of young children in the village of Melati Jaya, which is located in the Rt 001 Rw 001 Semendawai Timur District of the East Oku Regency, are getting counselling that is targeted at avoiding stunting. In order to carry out this action, education was made available in the form of counselling, and media was made available in the form of flyers. The educational events were effective, attracting favourable comments and engagement from the audience members who were the intended recipients of the content. It is clear from a comparison of the results of the pre-test and the post-test that the education provided was successful in raising the respondents' awareness of stunting.

Disparities in disruptions to public drinking water services in Texas communities during Winter Storm Uri 2021

Winter Storm Uri of February 2021 left millions of United States residents without access to reliable, clean domestic water during the COVID19 pandemic. In the state of Texas, over 17 million people served by public drinking water systems were placed under boil water advisories for periods ranging from one day to more than one month. We performed a geospatial analysis that combined public boil water advisory data for Texas with demographic information from the 2010 United States Census to understand the affected public water systems and the populations they served. We also issued a cross-sectional survey to account for people’s lived experiences. Geospatial analysis shows that the duration of boil water advisories depended partly on the size of the public water system. Large, urban public water systems issued advisories of intermediate length (5–7 days) and served racially diverse communities of moderate income. Small, mostly rural public water systems issued some of the longest advisories (20 days or more). Many of these systems served disproportionately White communities of lower income, but some served predominantly non-White, Hispanic, and Latino communities. In survey data, “first-generation” participants (whose parents were not college-educated) were more likely to be placed under boil water advisories, pointing to disparate impacts by socioeconomic group. The survey also revealed large communication gaps between public water utilities and individuals: more than half of all respondents were unsure or confused about whether they were issued a boil water advisory. Our study reinforces the need to improve resilience in public water services for large, diverse, urban communitiesandsmall, rural communities in the United States and to provide a clear and efficient channel for emergency communications between public water service utilities and the communities they serve.

EPH154 Assessing Impact of the Affordable Care Act on Measles-Mumps-Rubella (MMR) Vaccination Rates Using the National Ambulatory Medical Care Survey

Affordable Care Act (ACA), enacted in 2010, creates new opportunities to cover individuals with low-to- moderate income and provides access to preventive health services, such as CDC recommended childhood vaccinations. The US CDC recommends all children get two doses of Measles-Mumps-Rubella (MMR) vaccine (first dose:12-15 months; second dose 4-6 years). This study assessed the impact of the Affordable Care Act (AFC) on MMR vaccination rates among children 7 years and younger.