Neighborhood Education Research Articles

Sociodemographic disparities in targeted therapy in ovarian cancer in a national sample.

The treatment landscape for ovarian cancer has changed in recent years with the introduction of targeted therapies to treat patients with advanced disease. We investigated patient demographic and clinical factors associated with use of targeted therapies as a part of the first-line treatment for ovarian cancer. This study included patients diagnosed with stage I-IV ovarian cancer between 2012 and 2019 from the National Cancer Database. Information on demographic and clinical characteristics were collected and described using frequency and percent across receipt of targeted therapy. Logistic regression was used to compute the odds ratios (ORs) and 95% confidence intervals (CI) associating patient demographic and clinical factors with receipt of targeted therapy. Among 99,286 ovarian cancer patients (mean age 62 years), 4.1% received targeted therapy. The rate of targeted therapy receipt across racial and ethnic groups over the study period was fairly similar; however, non-Hispanic Black women were less likely to receive targeted therapy than their non-Hispanic White counterparts (OR=0.87, 95% CI: 0.76-1.00). Patients who received neoadjuvant chemotherapy were more likely to receive targeted therapy than those who received adjuvant chemotherapy (OR=1.26; 95% CI: 1.15-1.38). Moreover, among patients who received targeted therapy, 28% received neoadjuvant targeted therapy, with non-Hispanic Black women being most likely to receive neoadjuvant targeted therapy (34%) compared with other racial and ethnic groups. We observed differences in receipt of targeted therapy by factors such as age at diagnosis, stage, and comorbidities present at diagnosis, as well as factors related to healthcare access-including neighborhood education level and health insurance status. Approximately 28% of patients received targeted therapy in the neoadjuvant setting, which could negatively impact treatment outcomes and survival due to the increased risk of complications associated with targeted therapies that may delay or prevent surgery. These results warrant further evaluation in a cohort of patients with more comprehensive treatment information.

Residential segregation and prenatal depression in a non-Hispanic Black and Hispanic cohort in North Carolina

PurposeInvestigate residential segregation and prenatal depression in a non-Hispanic (NH) Black and Hispanic North Carolina pregnancy cohort. MethodsDemographics, prenatal depression (Center for Epidemiological Studies Depression scale ≥16), and residence from the 2006–2009 Newborn Epigenetic Survey were linked to Census-tract levels of racial and economic segregation (Index of Concentration at the Extremes) from the American Community Survey 2005–2009 5-year estimates. Adjusted prevalence ratios (aPR) for prenatal depression compared living in Index of Concentration at the Extremes tertiles 1 and 2 (higher proportion NH Black or Hispanic and/or low income) to 3 (higher proportion NH white and/or high-income), accounting for neighborhood clustering, age, education, employment, parity, and marital status. ResultsAmong the 773 survey participants (482 NH Black and 291 Hispanic), 35.7% and 27.2% of NH Black and Hispanic participants had prenatal depression, respectively. For NH Black participants, depression prevalence was 17% lower for tertile 1 versus 3 for the NH Black/white (aPR=0.83; 95% CI=0.62–1.10), low/high income (aPR=0.83; 95% CI=0.62–1.11), and low-income NH Black/high-income NH white (aPR=0.82; 95% CI=0.61–1.09) measures. For Hispanic participants, estimates were weaker in the opposite direction for the Hispanic/NH white (aPR=1.02; 95% CI=0.71–1.47), low/high income (aPr=1.14; (95% CI=0.76–1.69), and low-income Hispanic/high-income NH white (aPR=1.12; 95% CI=0.78–1.60) measures. ConclusionsResidential segregation’s impact on prenatal depression may differ by race/ethnicity and level of segregation, but findings are imprecise due to small sample sizes. Longitudinal research spanning greater geographic areas is needed.

Factors Associated With Firearm Injury Among Pediatric Members of a Large Integrated Healthcare System.

Few studies have tested multiple socio-ecological risk factors assocated with firearm injury among pediatric populations and distinguished self-inflicted from non-self-inflicted injury. To address this gap, the current study examined demographic, individual psychosocial, and neighborhood variables as risk factors for firearm injury among a large cohort of children and adolescents. Retrospective cohort study. Data were obtained from the electronic health records of a large integrated healthcare system. The cohort included children <18 years with at least one clinical encounter between January 1, 2010 and December 31, 2018. Poisson regression was used to examine demographic (age, gender, race and ethnicity, Medicaid status), psychosocial (depression, substance use disorder, medical comorbidities), and neighborhood education variables as potential risk factors for non-self-inflicted and self-inflicted firearm injuries. For non-self-inflicted injury, the highest relative risk was found for children age 12-17 years old compared to 0-5 year olds (RR=37.57); other risk factors included male gender, Black and Hispanic race and ethnicity (compared to White race), being a Medicaid recipient, lower neighborhood education, and substance use disorder diagnosis. For self-inflicted injury, only age 12-17 years old and male gender were associated with increased risk. These results reinforce the established higher risk for firearm injury among adolescent males, highlight differences between self-inflicted and non-self-inflicted injuries, and the need to consider demographic, psychosocial, and neighborhood variables as risk factors to inform interventions aimed to reduce firearm injuries among children and adolescents.

NEIGHBORHOOD QUALITY AS IT RELATES TO HEALTH AND WELL-BEING IN OLDER AFRICAN AMERICANS

Abstract With the burgeoning older adult population, there will be an increased demand for neighborhood environments that are conducive to successful aging. For example, the need for affordable and usable housing developments for older adults that provide greater opportunities for social engagement, social services, and convenience to neighborhood resources (e.g., grocery stores, healthcare) will continue to rise. Several initiatives have sought to develop age-friendly neighborhoods, which focused on improving accessibility and affordability of community resources. However, limited effort has focused on the health and cognitive effects of neighborhood-level socioeconomic disadvantage, with respect to neighborhood income, education, employment, and housing quality. This symposium will include presentations from two studies that explored how neighborhood disadvantage (measured by the Area Deprivation Index) relates to health and cognition. The objectives of the proposed symposium are the following: (1) discuss how neighborhood disadvantage relates to subjective and objective measures of physical health; and (2) discuss how neighborhood disadvantage relates to cognitive functioning. Allan and colleagues explored the association between neighborhood disadvantage as it relates to changes in self-reported health and objective measures (i.e., blood pressure) of health among older Black adults. Wright and colleagues explored the association between neighborhood disadvantage and measures of subclinical cardiovascular disease in older Black and White adults. Aiken-Morgan and colleagues examined associations between neighborhood disadvantage and cognitive functioning among Black older adults. Lastly, McCain and colleagues explored associations between neighborhood disadvantage and mobility among Black older adults.

Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada.

There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications.

Factors associated with meeting physical activity guidelines during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic impacted individual physical activity levels. Less is known regarding how factors such as sociodemographic and built environment were associated with physical activity engagement during the pandemic. Understanding these factors is critical to informing future infectious disease mitigation policies that promote, rather than hinder physical activity. The purpose of this study was to assess predictors of physical activity levels during the beginning of the pandemic (April-June 2020), including Stay-at-Home length and orders, neighborhood safety, and sociodemographic characteristics.MethodsData included 517 participants who responded to an anonymous online survey. Physical activity was assessed with a modified Godin Leisure-time exercise questionnaire. We used logistic regression models to estimate unadjusted and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) for the associations between independent variables (e.g., demographic variables, neighborhood safety, COVID Stay-at-Home order and length of time) and physical activity levels that did not meet (i.e., < 600 metabolic equivalents of task [MET]-minutes/week) or met guidelines (i.e., ≥ 600 MET-minutes/week). We used R-Studio open-source edition to clean and code data and SAS V9.4 for analyses. ResultsMost participants were 18–45 years old (58%), female (79%), Hispanic (58%), and college/post-graduates (76%). Most (70%) reported meeting physical activity guidelines. In multivariate-adjusted analyses stratified by income, in the highest income bracket (≥ $70,000) pet ownership was associated with higher odds of meeting physical activity guidelines (aOR = 2.37, 95% CI: 1.23, 4.55), but this association did not persist for other income groups. We also found lower perceived neighborhood safety was associated with significantly lower odds of meeting physical activity guidelines (aOR = 0.15, 95% CI:0.04–0.61), but only among individuals in the lowest income bracket (< $40,000). Within this lowest income bracket, we also found that a lower level of education was associated with reduced odds of meeting physical activity guidelines.DiscussionWe found that perceived neighborhood safety, education and pet ownership were associated with meeting physical activity guidelines during the early months of the COVID-19 pandemic, but associations differed by income. These findings can inform targeted approaches to promoting physical activity during subsequent waves of COVID-19 or future pandemics.

Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis.

Background:In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods:We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results:In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions:We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.

The impact of maternal and geographical factors on the uptake of non-invasive prenatal testing: A retrospective cohort study.

The objectives of this study were to investigate recent trends in non-invasive prenatal testing (NIPT) utilisation, including factors associated with geographical variation, and to determine whether maternal or regional characteristics are associated with uptake the of NIPT. This retrospective cohort study included pregnant individuals in Ontario with an expected date of delivery from August 1st, 2016 to March 31st, 2020. Modified Poisson regression was used to estimate rate ratios for NIPT use adjusted for maternal and healthcare covariates. We found substantial variation in NIPT uptake between regions within the province. The highest uptake was found in urban areas, highest quintile of neighbourhood income and education, for those who were ≥40years of age and had a history of previous aneuploidy, for those with a prenatal care visit in the first trimester, multiple pregnancy, multigravidity and body mass index within the normal range (18.5-24.9kg/m2 ). Our study demonstrated significant regional and maternal differences in NIPT uptake across Ontario. Given the large sample size and diverse population, our study may have implications for other jurisdictions with large, socio-demographically and geographically diverse populations.

Healthy aging index and its link with relative education between individual and neighborhood: a population-based, cohort study

ObjectivesThere is increasing recognition of the importance of neighborhood socioeconomic status (SES) for establishing an age-friendly society. Despite the benefits of improved neighborhood SES, little is known about the link of relative education between individuals and neighborhoods with healthy aging. This study aims to construct a healthy aging index (HAI) accounting for indicators’ interlinkages and to test the association of the HAI with relative education between neighborhoods and individuals.MethodsThe study used data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including middle-aged and older adults (≥ 45 years). The final sample comprised 11633 participants residing in 443 neighborhoods with 34123 observations. Based on 13 health indicators, a hybrid method integrating network analysis with TOPSIS was applied to construct a HAI accounting for health interlinkages. Weighted multilevel linear and ordered logistic models were used to estimate the effects of neighborhood education.ResultsAmong the 11633 participants (mean [SD] age, 58.20 [8.91] years; 6415 women [52.82%]), the mean (SD) HAI was 48.94 (7.55) at baseline, showing a downward trend with age. Approximately 10% of participants had a HAI trajectory characterized by a low starting point and fast decline. A one-year increase in neighborhood education was independently associated with a 0.37-point increase (95% CI, 0.23–0.52) in HAI. Regardless of individual education, each participant tended to gain benefits from a neighborhood with higher education. However, the effects of increased neighborhood education were weaker for individuals whose education was lower than the neighborhood average.ConclusionsThe HAI is an interaction system. Improving neighborhood education was beneficial to healthy aging, but individuals with lower education relative to the neighborhood average may experience poor person–environment fit and obtain fewer benefits from improved neighborhood education. Thus, in the process of improving neighborhood SES, individual-based interventions should be conducted for individuals whose education level is lower than the neighborhood average to achieve person–environment fit.

Enhancing Administrative Claims Data: Feasibility, Validation and Application of Linking Medicare Claims Data and National Marrow Donor Program Search Data.

Administrative claims data provide real-world service utilization of acute myeloid leukemia (AML) treatment, but lacks insight into treatment delays or barriers. The National Marrow Donor Program (NMDP)/Be The Match Search (Search) data contains information on donor search, but lacks information on treatment received if allogeneic hematopoietic cell transplant (HCT) is not performed. We hypothesized that linking these two data sets would create a rich resource to define factors associated with receiving HCT that could not be evaluated with either data set alone. A subset of 2010-2016 Medicare administrative claims data was linked with Search data. A total of 5,351 patients with AML age 65-74 years (HCT = 607, no HCT = 4,744) were identified using Medicare. These patients were then linked to 93,800 records with a donor search between 2009 and 2016. Patient date of birth, sex, disease, ZIP code, transplant center/hospital, and diagnosis date were used for matching. Exploratory analysis was conducted to identify predictors associated with receiving HCT for patients with AML who received a search. The data sets were successfully linked, showing high sensitivity and specificity. The final cohort included 5,085 patients with AML (HCT = 533, no HCT = 4,552). Of 97 patients who received HCT without a matched search, more than 85% received a related donor HCT. Of those not receiving HCT, 609 had a matched NMDP search and 3,943 did not have a matched NMDP search. Multivariate analysis showed time to search, age, diagnosis year, race/ethnicity, and neighborhood education status associated with receiving HCT. Methods herein demonstrate the feasibility of linking Search and Medicare data. Similar methods may be applied to answer critical questions regarding barriers to HCT, thereby identifying areas to improve access to care.

Tenant-Based Housing Voucher Programs: A Community Guide Systematic Review.

Context:Unaffordable or insecure housing is associated with poor health in children and adults. Tenant-based housing voucher programs (voucher programs) limit rent to 30% or less of household income to help households with low income obtain safe and affordable housing.Objective:To determine the effectiveness of voucher programs in improving housing, health, and other health-related outcomes for households with low income.Design:Community Guide systematic review methods were used to assess intervention effectiveness and threats to validity. An updated systematic search based on a previous Community Guide review was conducted for literature published from 1999 to July 2019 using electronic databases. Reference lists of included studies were also searched.Eligibility Criteria:Studies were included if they assessed voucher programs in the United States, had concurrent comparison populations, assessed outcomes of interest, were written in English, and published in peer-reviewed journals or government reports.Main Outcome Measures:Housing quality and stability, neighborhood opportunity (safety and poverty), education, income, employment, physical and mental health, health care use, and risky health behavior.Results:Seven studies met inclusion criteria. Compared with low-income households not offered vouchers, voucher-using households reported increased housing quality (7.9 percentage points [pct pts]), decreased housing insecurity or homelessness (−22.4 pct pts), and decreased neighborhood poverty (−5.2 pct pts).Adults in voucher-using households had improved health care access and physical and mental health. Female youth experienced better physical and mental health but not male youth. Children who entered the voucher programs under 13 years of age had improved educational attainment, employment, and income in their adulthood; children's gains in these outcomes were inversely related to their age at program entry.Conclusion:Voucher programs improved health and several health-related outcomes for voucher-using households, particularly young children. Research is still needed to better understand household's experiences and contextual factors that influence achievement of desired outcomes.

Racial and Ethnic Differences in All-Cause and Cardiovascular Disease Mortality: The MESA Study.

Despite improvements in population health, marked racial and ethnic disparities in longevity and cardiovascular disease (CVD) mortality persist. This study aimed to describe risks for all-cause and CVD mortality by race and ethnicity, before and after accounting for socioeconomic status (SES) and other factors, in the MESA study (Multi-Ethnic Study of Atherosclerosis). MESA recruited 6814 US adults, 45 to 84 years of age, free of clinical CVD at baseline, including Black, White, Hispanic, and Chinese individuals (2000-2002). Using Cox proportional hazards modeling with time-updated covariates, we evaluated the association of self-reported race and ethnicity with all-cause and adjudicated CVD mortality, with progressive adjustments for age and sex, SES (neighborhood SES, income, education, and health insurance), lifestyle and psychosocial risk factors, clinical risk factors, and immigration history. During a median of 15.8 years of follow-up, 22.8% of participants (n=1552) died, of which 5.3% (n=364) died of CVD. After adjusting for age and sex, Black participants had a 34% higher mortality hazard (hazard ratio [HR], 1.34 [95% CI, 1.19-1.51]), Chinese participants had a 21% lower mortality hazard (HR, 0.79 [95% CI, 0.66-0.95]), and there was no mortality difference in Hispanic participants (HR, 0.99 [95% CI, 0.86-1.14]) compared with White participants. After adjusting for SES, the mortality HR for Black participants compared with White participants was reduced (HR, 1.16 [95% CI, 1.01-1.34]) but still statistically significant. With adjustment for SES, the mortality hazards for Chinese and Hispanic participants also decreased in comparison with White participants. After further adjustment for additional risk factors and immigration history, Hispanic participants (HR, 0.77 [95% CI, 0.63-0.94]) had a lower mortality risk than White participants, and hazard ratios for Black participants (HR, 1.08 [95% CI, 0.92-1.26]) and Chinese participants (HR, 0.81 [95% CI, 0.60-1.08]) were not significantly different from those of White participants. Similar trends were seen for CVD mortality, although the age- and sex-adjusted HR for CVD mortality for Black participants compared with White participants was greater than all-cause mortality (HR, 1.72 [95% CI, 1.34-2.21] compared with HR, 1.34 [95% CI, 1.19-1.51]). These results highlight persistent racial and ethnic differences in overall and CVD mortality, largely attributable to social determinants of health, and support the need to identify and act on systemic factors that shape differences in health across racial and ethnic groups.

Association between Dietary Patterns and the 5-year Progression of Periodontal Disease

ObjectivesThis study aims to examine the association between dietary pattern scores and the 5-year progression of periodontal disease among participants in the Buffalo Osteoporosis and Periodontal Disease Study (OsteoPerio).MethodsWe conducted analyses among 920 postmenopausal women with complete data and a mean age of 67 (SD = 7) at baseline 1997–2000. Average scores for the Healthy Eating Index-2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH), and alternate Mediterranean Diet Score (aMed) were calculated using data from two FFQs administered 1994–1998 and 1997–2001. Periodontal assessments were conducted at baseline and the 5-year follow-up (2002–2005) to obtain whole mean mouth alveolar crestal height (ACH) in mm, percentage of gingival sites bleeding on probing (%BOP), pocket probing depth (PPD) in mm, and clinical attachment level (CAL) in mm. Linear regression models were used to examine the association between each score (10 points for HEI and AHEI [possible range 0 to 100 points], 4 points for DASH [possible range 8 to 40 points], and 1 point for aMed [possible range 0 to 10 points]) and these periodontal measures at follow-up with adjustment for baseline periodontal measures, age, race, recreational physical activity (metabolic equivalent-hours/week), neighborhood socioeconomic status, smoking, education, and dental hygiene. Sensitivity analyses were run after adding 10 mm to the baseline values of ACH and CAL to define the 5-year measure for each tooth lost over follow-up due to periodontal disease.ResultsHigher AHEI, DASH, and aMed were associated with higher whole mean mouth ACH (indicative of greater oral bone loss) with adjusted βs (95%CI) of 0.037 (0.003, 0.072), 0.075 (0.003, 0.147), and 0.019 (0.001, 0.037), respectively. In sensitivity analyses, no statistically significant association was found after accounting for tooth loss due to periodontal disease.ConclusionsAHEI, DASH, and aMed were found to have a modest and positive association with ACH. However, after accounting for tooth loss due to periodontal diseases, no association was found between dietary patterns and periodontal measures.Funding SourcesNational Heart, Lung, and Blood Institute, National Institute of Dental and Craniofacial Research, and the Department of Defense.

In search of lost time: Delays in adjuvant therapy for pancreatic adenocarcinoma among under-resourced patient populations

BackgroundThe initiation of adjuvant chemotherapy for pancreatic adenocarcinoma within 12 weeks after surgery is recommended by the National Comprehensive Cancer Network. This study seeks to identify factors associated with delayed adjuvant chemotherapy and whether delays impact survival in under-resourced populations. MethodsPatients with nonmetastatic pancreatic adenocarcinoma who received a definitive resection followed by adjuvant chemotherapy between 2006 and 2017 were queried from the National Cancer Database. Multivariate logistic regression models were constructed to determine the relationship between socioeconomic/clinical variables and delayed adjuvant chemotherapy. Kaplan Meier curves compared survival between under-resourced patients receiving delayed versus timely adjuvant chemotherapy. ResultsAmong 25,008 patients, timely adjuvant chemotherapy varied by stage (stage 1: 67.9% vs stage 2: 75.8% vs stage 3: 89.2%; P < .001). Older age (odds ratio 1.02, 95% confidence interval 1.02–1.03; P < .001), Non-Hispanic Black race (odds ratio 1.25, 95% confidence interval 1.11–1.41; P < .001), increasing comorbidity score (odds ratio 1.18, 95% confidence interval 1.12–1.23; P < .001), 30-day readmission (odds ratio 1.45, 95% confidence interval 1.28–1.63; P < .001), and undergoing a Whipple (odds ratio 1.30, 95% confidence interval 1.16–1.44; P < .001) were associated with delayed adjuvant chemotherapy. Conversely, the highest neighborhood median income quartile (odds ratio 0.84, 95% confidence interval 0.73–0.97; P = .021), private insurance (odds ratio 0.59, 95% confidence interval 0.46–0.76; P < .001), Medicare (odds ratio 0.68, 95% confidence interval 0.52–0.88; P = .003), and receipt of neoadjuvant therapy (odds ratio 0.05, 95% confidence interval 0.04–0.06; P < .001) were associated with timely adjuvant chemotherapy. Non-Hispanic Black patients and patients with the lowest neighborhood education had worse overall survival when receiving delayed versus timely adjuvant chemotherapy. ConclusionTimely adjuvant chemotherapy for pancreatic adenocarcinoma was only achieved in 73.3% of patients. Age, race, comorbidities, median income, and insurance were identified as barriers. Delayed adjuvant chemotherapy was associated with worse survival among under-resourced populations.

How local partisan context conditions prosocial behaviors: Mask wearing during COVID-19

Does local partisan context influence the adoption of prosocial behavior? Using a nationwide survey of 60,000 adults and geographic data on over 180 million registered voters, we investigate whether neighborhood partisan composition affects a publicly observable and politicized behavior: wearing a mask. We find that Republicans are less likely to wear masks in public as the share of Republicans in their zip codes increases. Democratic mask wearing, however, is unaffected by local partisan context. Consequently, the partisan gap in mask wearing is largest in Republican neighborhoods, and less apparent in Democratic areas. These effects are distinct from other contextual effects such as variations in neighborhood race, income, or education. In contrast, partisan context has significantly reduced influence on unobservable public health recommendations like COVID-19 vaccination and no influence on nonpoliticized behaviors like flu vaccination, suggesting that differences in mask wearing reflect the publicly observable and politicized nature of the behavior instead of underlying differences in dispositions toward medical care.

Compensation for Compulsory Land Acquisition; Does Social Sustainability Matters on Satisfaction

Payment of compensation for different types of losses are continuously experiencing in Sri Lanka. One of the typical aspects is the compulsory land acquisition. Government acquires the lands from private landowners for providing infrastructure in terms of public interest and proceeds to pay the monetary compensation recovering the losses while the National Involuntary Resettlement Policy (NIRP) intends to address involuntary resettlement because of land acquisition. However, distrusting is arising on satisfaction of the victims of this process and no evidence how far the social sustainability concept is addressed. Therefore, this paper aims to analyze the determinants of satisfaction while focusing on the factors representing the social sustainability concept in compensation procedure of compulsory land acquisition of Sri Lanka. For acquiring data, questionnaire survey was conducted with 30 re-settlers who were the victims of government land acquisition for a reservoir project and an interview was carried out with prominent community leaders on 09 factors. Data were analyzed using descriptive statistics and a content analysis. The findings reveal that social sustainability aspects of neighborhood environment, education, market availability, electricity, and public health services were successful to some extent, while there were significant inconsistencies amongst assessed components within individual cases. Hence, the study reveals that pure monetary compensation process was unsuccessful since it represents the inadequacy to cover all losses of victims. Thus, for a total loss a resettling strategy is essential along with high concentration on the social sustainability aspects. Keywords: Compulsory Land Acquisition, Involuntary Resettlement Policy, Payment of Compensation, Social Sustainability Concept, Satisfaction

Survival in Orthotopic Heart Transplant Recipients: Influence of Neighborhood Income, Education, and Employment

<h3>Purpose</h3> Due to the limited supply of donor heart, orthotopic heart transplant (OHT) programs are tasked with selecting organ recipients who will have good outcomes. Previous studies looking at socioeconomic level and transplant outcomes, have suggested that patients with low socioeconomic level have worse survival. No study has looked at the individual factors comprising socioeconomic status and their effects on survival of OHT patients. <h3>Methods</h3> A retrospective review all patients in Philadelphia County who underwent OHT at a tertiary care center from 1984 to 2015 was done. Data on patient demographics, survival, and zip code demographics were collected. Continuous variables were compared by ANOVA and categorical variables by chi-square test. Survival after OHT was determined by Kaplan-Meier survival analysis and log-rank test was used to analyze the differences in survival by Kaplan-Meier analysis. Cox regression analysis was used to adjust the survival for confounding variables <h3>Results</h3> Of the 456 patients who underwent OHT, 121 (26.5%) were transplant in Philadelphia County. The hazard ratio (HR) for survival in patient who underwent OHT was higher for patients with income < $33,000 (HR 1.35, 95% CI 0.88 to 2.07, p = 0.17) compared to > $66,000 (HZ 0.73, 95% CI 0.39 to 1.35, p = 0.31), but neither had a significant difference. Poverty rate above the mean (23.73%) was associated with a higher HR (HR 1.45, 95% CI 0.98 to 2.12), but this difference was also not significant (p =0.06). Patients in zip codes with lower rates of education had a HZ of 1.45 (95%, CI 0.82 to 1.78). This difference was not significant (p = 0.35). Higher unemployment rates were the only significant (p = 0.04) factor with a HR 1.51 (95% CI 1.02 to 2.23). <h3>Conclusion</h3> There is no significant difference in the survival outcomes of patients who live in areas with lower income, higher poverty rates, or lower levels of education. Higher rate of unemployment may a predictor survival.

The impact of social disadvantage on autonomic physiology of latinx adolescents: The role of environmental risks.

The experience of poverty embodies complex, multidimensional stressors that may adversely affect physiological and psychological domains of functioning. Compounded by racial/ethnic discrimination, the financial aspect of family poverty typically coincides with additional social and physical environmental risks such as pollution exposure, housing burden, elevated neighborhood unemployment, and lower neighborhood education levels. In this study, we investigated the associations of multidimensional social disadvantage throughout adolescence with autonomic nervous system (ANS) functioning at 17 years. Two hundred and twenty nine low-income Mexican-American adolescents (48.6% female) and their parents were assessed annually between the ages of 10 and 16. Participants' census tracts were matched with corresponding annual administrative data of neighborhood housing burden, education, unemployment, drinking water quality, and fine particulate matter. We combined measures of adolescents' electrodermal response and respiratory sinuses arrhythmia at rest and during a social exclusion challenge (Cyberball) to use as ANS indices of sympathetic and parasympathetic activity, respectively. Controlling for family income-to-needs, youth exposed to greater cumulative water and air pollution from ages 10-16 displayed altered patterns of autonomic functioning at rest and during the social challenge. Conversely, youth living in areas with higher housing burden displayed healthy patterns of autonomic functioning. Altogether, results suggest that toxin exposure in youths' physical environments disrupts the ANS, representing a plausible mechanism by which pollutants and social disadvantage influence later physical and mental health.

A Review of Racial Disparities in Infant Mortality in the US.

Racial disparities in infant mortality have persisted, despite the overall decline in the United States’ overall infant mortality rate (IMR). The overall IMR of the entire United States (5.58 per 1000 live births) population masks significant disparities by race and ethnicity: the non-Hispanic Black population experienced an IMR of 10.8 followed by people from Native Hawaiian or Other Pacific Islander populations at 9.4 and American Indians at 8.2. The non-Hispanic White and Asian populations in the United States have the lowest IMR at 4.6 and 3.6, respectively, as of 2018. A variety of factors that characterize minority populations, including experiences of racial discrimination, low income and education levels, poor residential environments, lack of medical insurance, and treatment at low-quality hospitals, demonstrate strong correlations with high infant mortality rates. Identifying, acknowledging, and addressing these disparities must be performed before engaging in strategies to mitigate them. Social determinants of health play a major role in health disparities, including in infant mortality. The study and implementation of programs to address neighborhood factors, education, healthcare access and quality, economic stability, and other personal and societal contexts will help us work towards a common goal of achieving health equity, regardless of racial/ethnic background.

Association of maternal socioeconomic status and race with risk of congenital heart disease: a population-based retrospective cohort study in Ontario, Canada

ObjectiveTo investigate the interrelationships between maternal socioeconomic status (SES), race and congenital heart diseases (CHD) among infants.DesignRetrospective cohort study.Study settingOntario, Canada.Study populationAll singleton stillbirths and live births born in hospitals...