Non-urban Residents Research Articles

The impact of household registration system reform: evidence from China

ABSTRACT We construct a DSGE model with three sectors: households which are divided into urban registered residents and non-urban residents, firm, and government, calibrate and estimate the model with data of China. This study aims to evaluate the impact of household registration system (HRS) reform of China, and provides a theoretical thought to understand this reform. Impulse response analysis and counterfactual simulation show the short-term and long-term effects of the reform on output, consumption, and labour supply. The shock (1%) in public goods consumption increases labour supply and private consumption of non-urban registered residents by 0.21% and 0.42%, decreases by about 0.13% and 0.14% in urban registered residents, and increases in overall labour supply, consumption, and output levels by approximately 0.08%, 0.26% and 0.36%, respectively. While the impact of wage level increases labour supply and private consumption of non-urban registered residents by about 0.03% and 0.6%, about 0.03% and 0.25% of urban registered residents. This leads to increases of overall labour supply, consumption, and output levels by approximately 0.03%, 0.28% and 0.12%, respectively. Transfer payment shocks has a very weak effect. Overall, the economic effects of the household registration system reform policy are significant.

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Rheumatoid arthritis (RA) has severe functional and economic consequences. The implications of the Patient Protection and Affordable Care Act (ACA) and demographic factors for access to surgical treatment are unclear. To investigate factors associated with time to RA hand surgery, surgical incidence, and cost after implementation of the ACA. This cross-sectional study used insurance data from the IBM MarketScan Research Databases from 2009 through 2020 to compare time to surgery, surgical incidence, and treatment cost for RA of the hand before and after ACA implementations. Included patients were 18 years or older with a new diagnosis for RA of the hand and at least 1 procedural code for arthroplasty, arthrodesis, tenolysis, tendon repair, or tendon transfer. Patients with coexisting inflammatory arthritis diagnoses were excluded. Demographic variables analyzed included patient sex, age at index date, residence within or outside a metropolitan statistical area (MSA; hereafter urban or nonurban), insurance and health plan type, Social Deprivation Index, Elixhauser Comorbidity Index score, and Rheumatic Disease Comorbidity Index. Data analysis occurred from October 2022 to April 2023. Surgery for RA of the hand during the pre-ACA (before 2014) vs post-ACA (2014 or later) periods. Time to surgery, surgical incidence, and cost of treating RA in patients undergoing hand surgery for RA. Among 3643 patients (mean [SD] age, 57.6 [12.3] years) who underwent hand surgery for RA, 3046 (83.6%) were women. Post-ACA passage, 595 (86.2%) patients who resided in urban areas had a significantly lower time to surgery than those who did not (-70.5 [95% CI, -112.6 to -28.3] days; P < .001). Among urban patients, the least socially disadvantaged patients experienced the greatest decrease in time to surgery after ACA but the change was not statistically significant. For all patients, greater social disadvantage (ie, a higher SDI score) was associated with a longer time to surgery in the post-ACA period; for example, compared with the least socially disadvantaged group (SDI decile, 0-10), patients in SDI decile 10 to 20 waited an additional 254.0 days (95% CI, 65.2 to 442.9 days; P = .009) before undergoing surgery. Compared with the pre-ACA period, the mean surgical incidence in the post-ACA period was 83.4% lower (162.3 vs 26.9 surgeries per 1000 person-years; P < .001), and surgical incidence was 86.3% lower in nonurban populations (27.2 vs 3.7 surgeries per 1000 person-years; P < .001) but only 82.8% lower in urban populations (135.1 vs 23.2 surgeries per 1000 person-years; P < .001). Per capita total costs of all treatment related to RA of the hand decreased in the post-ACA period but the change was not statistically significant. Insurer-paid costs were lower in the post-ACA period but the change was not statistically significant. Out-of-pocket expenses did not change. Findings of this cross-sectional study suggest that after ACA passage, disparities exist in access to timely, cost-effective hand surgery for RA. Increased access to surgical hand specialists is needed for nonurban residents and those with greater social deprivation, along with insurance policy reforms to further decrease out-of-pocket spending for RA hand surgery.

Residential Interior Design for People with Special Needs in Thailand Based on Physical Abilities: Age, Gender, and Living Environment Considerations

Residential interior design for people with special needs necessitates more specific research, especially with respect to physical abilities. Previous studies, as opposed to general people, have overlooked the nuanced requirements generated by age, gender, and living environment differences. This study aims to examine physical abilities across different ages, genders, and residencies and identify relationships between in-home mobility and physical abilities among people with special needs. A total of 384 participants (eight different types of disabilities) completed electronic questionnaires. Among young, adult, and older groups, physical abilities and self-support showed statistical differences. Males demonstrated higher physical ability levels but decreased hand–arm movements than females. Greater physical abilities and subjective health were found in urban residents compared to non-urban residents. Additionally, in-home mobility was positively associated with out-of-home mobility, physical abilities, independence, and subjective health (all p values &lt; 0.05). Thus, physical abilities revealed disparities across ages, genders, and resident settings. Also, the greater the mobility inside the house, the more possibilities there are to enhance physical abilities both inside and outside the house, independence, and subjective health. Design recommendations are provided regarding layout, furniture, flooring, and lighting. The consideration of these specific requirements in residential interior design is encouraged.

Travel-based residential dissonance as a motivation for relocation: An analysis of movers in Germany

Residential self-selection potentially influences both the built environment at the residential location and travel behavior. However, the impact of (travel-related) residential self-selection on residential relocation is not yet clear. We analyzed a sample of 3,629 German respondents planning to relocate. This allows us to examine the relationship between the motivation to relocate, residential satisfaction and residential dissonance as a mismatch between travel attitudes and the structure of the neighborhood. We develop a binary and a continuous indicator of residential dissonance. The binary indicator classifies 35% of respondents as dissonant. Two logistic regression analyses model the probability of indicating the neighborhood as a reason for a planned move among urban and non-urban residents. Residential dissonance is found to have an impact on the satisfaction with the neighborhood, but there are other characteristics that make residents want to leave their current neighborhood, such as dissatisfaction with the neighbors, safety and cleanliness and quietness. In non-urban areas, the satisfaction with the quality of transit motivates relocations, while dissatisfaction with the accessibility of the workplace, shopping facilities and leisure activities for young people are important reasons for urban residents. The results suggest that dissatisfaction toward travel-related characteristics of a neighborhood has a significant, though small influence on the desire to leave the current neighborhood but the more general ‘dissonance’ does not. Hence, characteristics respondents value may be more specific, rather than reflecting a general preference for urban vs. non-urban areas. We draw some conclusions for transport policies in urban and non-urban areas.

The 3P’s of place-making: Measuring place-making through the latent components of person, procedures and place

Place-making is a concept used to describe and understand how meaningful places emerge from interactions between people and their environments. We present a first attempt at describing and measuring place-making through latent variable modelling, based on a large and representative sample (N = 7′035) in the Netherlands and two field surveys in the Netherlands and Switzerland (N = 191 and N = 129 respectively). We show that a three-factor structure of person, procedures and place, can be used to characterise neighbourhood place-making. We found the scale to be measurement invariant, only differences in question interpretation between urban vs. non-urban residents were found relating to the use and presence of green-space. Additionally, evidence of other factors affecting place-making scores, such as social cohesion or place-attachment, was detected across the different studies. We present possible implications of the place-making framework and its potential to be operationalised for deliberate place change in the context of unprecedented urbanisation rates.

Patient Support Program Enhancements In Patients Diagnosed With Generalized Myasthenia Gravis Facing Social Determinants of Health Challenges (P4-9.006)

<h3>Objective:</h3> To better understand the needs of patients living with generalized Myasthenia Gravis (gMG) and impacted by Social Determinants of Health (SDOH) challenges in terms of Patient Support Program (PSP) services to improve patient outcomes. <h3>Background:</h3> SDOH challenges are factors of the environment or patients’ lives that affect health, functioning, and quality of life outcomes. <h3>Design/Methods:</h3> Phase One – Qualitative research was conducted with 11 patients and 2 Patient Advocacy Groups (PAGs) to understand PSP awareness, experience, and unmet needs. Phase Two – Quantitative research was conducted with 38 patients, the majority were people of color, non-urban residents and low-income women. We identified SDOH challenges, assessed current utilization of services and unmet needs for PSP services to be addressed through new offerings. Phase three – Qualitative research was conducted with 11 Health Care Professionals (HCPs) to understand how they address SDOH challenges in treating patients with gMG. <h3>Results:</h3> In Phase Two, four prioritized PSP solutions were identified: 1) Expand current PSP services, including a medication information hotline, symptom tracking app, and updated educational resources; 2) Develop a personalized “human touch”, e.g., 1:1 patient mentoring program for people initiating treatment or experiencing medical complications; 3) Create an innovative giving strategy and establish a long-term financial commitment to support patients living with gMG, 4) Increase PAGs awareness of Nurse Case Manager services. In Phase Three, we found most HCPs are not adequately trained to identify patients with SDOH challenges, have limited training on educating patients on gMG, and often depend on social workers and nurses for these tasks. <h3>Conclusions:</h3> For patients living with gMG encountering SDOH challenges, there are opportunities to bolster PSP offerings to improve patient outcomes. HCPs receive limited training on educating patients about potential solutions to SDOH challenges. <b>Disclosure:</b> Dr. Hughes has received personal compensation for serving as an employee of Argenx . Dr. Hughes has stock in argenx. Cecilia Zvosec has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for argenx. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunovant. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Habib has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Habib has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH/NINDS. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for argenx. The institution of Dr. Habib has received research support from Alexion. The institution of Dr. Habib has received research support from RA pharmaceuticals. The institution of Dr. Habib has received research support from Immunovant. The institution of Dr. Habib has received research support from UCB. The institution of Dr. Habib has received research support from argenx. The institution of Dr. Habib has received research support from CabalettaBio. The institution of Dr. Habib has received research support from Genentech. The institution of Dr. Habib has received research support from Regeneron. Mrs. Suchotliff has received personal compensation for serving as an employee of ZS. Kathy Perez has received personal compensation for serving as an employee of argenx. Kathy Perez has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for argenx. Kathy Perez has stock in argenx. Kathy Perez has received personal compensation in the range of $100,000-$499,999 for serving as a VP Global Patient Advocacy with argenx. Cathleen Bergin has stock in argenx. Dr. Phillips has received personal compensation for serving as an employee of argenx. Dr. Phillips has stock in argenx.

Ligurian Internal Areas and Demand Responsive Transport: an innovative approach to tackle social exclusion and to re-design sustainable accessibility

Making public transport more flexible, sustainable and efficient has been one the main goals of the last decades for Public Administrations in order to improve urban performances in mobility sector, that is responsible for a big share of pollutant emissions and deeply affects quality life level. Anyway, recently, attention grew on the fact that this topic does not belong to urban areas only and needs tailored measures to be effective: accessibility for peripherical and scarcely populated areas represents the pre-requisite of citizenship rights itself. Basic services (health, education above all) are getting more and more concentrated in order to reduce costs and this means that non-urban residents have to make long trips to reach them. Public Transport itself has become no longer sustainable in these territories because of the small population and low-density levels of transport demand (the so-called “low-demand areas”). That is the reason why flexible and customizable solutions (Demand Responsive Transport-DRT, for instance) could meet the needs of these remote inhabitants, thus improving social inclusion and being the first step to more complex regeneration processes. Italian National Internal Areas Strategy (SNAI) focuses on mobility actions, too. Many flexible transport services have been proposed in order to balance accessibility rights of local residents and economical and environmental sustainability of the service itself. This paper presents the Ligurian Internal Areas experiences (and specifically Antola-Tigullio strategy), where DRT services implementation is currently taking place to tackle marginalization process: referring to these areas non-traditional transport services allow to cover larger areas and longer parts of the day, without adding new costs (service is active only when users need it), thus developing a new mobility scheme.

Association between Residential Greenness and Incidence of Parkinson's Disease: A Population-Based Cohort Study in South Korea.

It is widely known that exposure to residential greenness is beneficial for health. However, few studies have analyzed the association between greenery and Parkinson’s disease (PD). We selected 313,355 participants who matched the inclusion criteria from the National Health Insurance Service-National Sample Cohort, followed up from 2007 to 2015. Residential greenness, represented by the normalized difference vegetation index (NDVI), was obtained from satellite measurements. We estimated hazard ratios of PD associated with a 0.1-unit increase in long-term greenness exposure at the district level for the previous 1 year of each year until a censoring/event occurred, using time-varying Cox proportional hazard models, adjusted for individual- and area-level characteristics. During the 2,745,389 person-years of follow-up, 2621(0.8%) participants developed PD. Exposure to higher levels of residential greenness was found to be associated with a decreased risk of PD incidence (21% per 0.1-unit increase, 95% confidence interval (CI): 0.74–0.84). In subgroup analyses, stronger protective effects were observed in participants aged over 50 years, females, overweight/obese participants, non-urban residents, non-smokers, alcoholics, and those with comorbidities. Long-term exposure to greenness was beneficial to incident PD, and our findings could aid in the development of public-health strategies.

INTERACTION OF TOBACCO ABUSE WITH OTHER CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR RISK - SYNERGISTIC IMPACT OR AN INDEPENDENT MENACE?

Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.

Which qualities should built environment possess to ensure satisfaction of higher-education students with remote education during pandemics?

The COVID-19 pandemic has suddenly switched most education processes from face-to-face to remote mode, obliging millions of students to utilize their residences as study spaces. However, the characteristics of their residential built environments differ in terms of regional, social, cultural, and technological aspects. These differences should impact the students' performance and satisfaction which needs to be measured and studied. The present study aims to identify the effect of the residential built environment on students' satisfaction and academic performance during the COVID-19 pandemic. It was conducted in two countries, Kazakhstan (KZ) and Norway (NO), using a comprehensive online survey to gather data. An empirical assessment based on the structural equation model was employed to identify links between health, safety, and comfort of students' facilities and academic performance and satisfaction. We conclude that the built environment affects both satisfaction for remote education and their learning performance. Significant differences in readiness for remote education have been observed between urban and non-urban living areas: (1) The role of health-and-safety convenience seems to increase with the urbanization level of the respondents’ living spaces; (2) in contrast, for non-urban residents, the provision of comfort facilities is dominant. In the meantime, an analysis “by regions” revealed that health-and-safety-related facilities in residences are more critical for remote education in Central Asia (KZ). In contrast, the comfort features of residences being more important for the students studying remotely in Northern Europe (NO). These results provide an understanding that would assist in improving remote education and preparing pandemic-ready living areas.

Violence Exposure and Mental Health Consequences Among Urban Youth.

Urban residents are disproportionately affected by violence exposure and mental health consequences as compared to non-urban residents. The present study examined the prevalence of violence exposure and associated mental health consequences among urban and non-urban youth. Urban participants were drawn from Detroit, Michigan, a city that has led the nation for most of the last decade as one of the most violent big cities in the U.S. Participants included 32 Detroit youth and 32 youth recruited from the surrounding non-urban areas, matched on age (M=10.4±2.8 years) and sex (49% male). Youth completed validated measures of violence exposure, anxiety, and depression symptoms. Urban youth reported more violence exposures than their non-urban counterparts, including hearing gunshots (69% vs. 19%, respectively), witnessing a shooting (24% vs. 6%), and witnessing an arrest (58% vs. 27%). Overall, greater violence exposure was associated with more anxiety symptoms, particularly among urban youth. Although violence exposure was not associated with depressive symptoms overall, urban youth reported significantly higher depressive symptoms than non-urban youth. Exposure to specific violence types, particularly hearing gunshots, was associated with higher anxiety and depressive symptoms among urban but not non-urban youth. Being beat up predicted depressive symptoms among non-urban but not urban youth. Household income and community distress did not predict mental health outcomes. Taken together, urban youth have more exposure to violence, particularly firearm violence, and associated mental health problems than their non-urban counterparts. Targeted community-wide initiatives to prevent violence and identify exposed youth are needed to improve mental health in at-risk communities.

Prevalence of acute kidney injury in myeloma patients visiting U.S. emergency departments: A nationwide analysis.

e20548 Background: Patients diagnosed with multiple myeloma (MM) frequently visit emergency departments (ED) with complications, commonly with kidney disease. However, data regarding the prevalence of acute kidney injury (AKI) and its effects on patient outcome, economic burden, length of hospital stay and mortality among these patients are lacking. Methods: From the Nationwide Emergency Department Sample, we obtained 7-year (2010-2016) data of myeloma patients who visited ED. Baseline characteristics of these patients with and without AKI were compared. The multivariable regression model was used to estimate hospital admission, length of stay, healthcare burden and in-hospital mortality in patients with and without AKI. Results: Between 2010-2016, 657,392 adult myeloma patients visited ED at an increased rate from 35 to 45 per 100,000 census population. The prevalence of AKI was 22.5% (n = 147,743) with a stable trend over the study period. AKI was more common in patients with relapsed MM (33.5%) than those in remission (18.6%) or never achieving remission (22.4%) (P &lt; 0.001), male (24.1 vs 20.6% in female, P &lt; 0.001), age ≥65 years (24.1%) vs 18-44 years (12.9%), or 45-64 years (19.3%)(P &lt; 0.001) and urban (23.3%) vs non-urban residents (17.9%)(P &lt; 0.001). The majority patients with AKI were hospitalized (96.5%) compared with those without AKI (69.6%) (P &lt; 0.001). In multivariable analysis, odds of hospitalization was higher in patients with AKI (OR: 8.8, P &lt; 0.001) after adjusting age, gender, co-morbidities and other demographics. Median hospital stay was longer in patients with AKI compared to those without (6 vs 4 days, P &lt; 0.001). Median ED and total hospitalization charges were higher in patients with AKI (ED: $2,057; total: $45,414) vs without AKI (ED: $1,853; total: $29,299) (P &lt; 0.001). In the multivariable adjusted-model, odds of in-hospital mortality was significantly higher in patients not in remission (OR: 1.8), patients with relapse (OR: 2.3), AKI (OR: 2.2), age ≥ 65 years (OR: 1.4), male (OR: 1.1) and urban residents (OR:1.2). Conclusions: In this largest national study of MM patients visiting ED, patients with AKI had higher in-hospital admission, ED and total charges, length of hospital stays, and mortality, both by univariate and multivariate analysis. Prevalence of AKI and mortality were highest in patients with MM relapse.

Use of cell phone adapters is associated with reduction in disparities in remote monitoring of cardiac implantable electronic devices.

Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is standard of care. However, it is underutilized. In July 2012, our institution began providing cell phone adapters (CPAs) to patients free of charge following CIED implantation to improve remote transmission (RT) adherence. Patients in our institution's RM database from January 1, 2010, thru June 30, 2015, were retrospectively reviewed. There were 2157 eligible patients. Remote transmission proportion (RTP) and time to transmission (TT) were compared pre- and post-implementation of free CPA. Chi-squared analysis and Kruskal-Wallis tests were performed to compare RTP and TT. There was a significant increase in RTP (134 [18.4%] vs 99 [54.7%]; p < 0.001) and decrease in median TT in days (189[110-279] vs 58 [10-149]; p < 0.001) after CPAs were provided to patients. Caucasian patients were more likely than African Americans and Hispanics to use RM prior to CPAs (p = 0.04). After the implementation of CPAs, there was a significant increase in RTP for all racial groups (< 0.001) with no difference in RTP among racial groups (p = 0.18). The RTP for urban residents was significantly greater than non-urban residents with CPAs (p = 0.008). Patients greater than 70years of age were significantly less likely to participate in RT before and after CPAs were provided (p = 0.03, p = 0.01, respectively). CPAs significantly improve RTP and reduce median TT for all patients regardless of race, geographic residence, and age (> 70years old to lesser extent). Broad institution of CPAs following ICD implantation could potentially reduce disparity in RTP and deserves more study.

Abstract P130: Disparities in Out-of-hospital Cardiac Arrest Rates Among Adults, Aged ≥18 Years Old, With 9-1-1 Emergency Medical Service Activation’s in the United States, 2016

Introduction: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Hypothesis: This study aims to assess whether patients’ age, sex, race/ethnicity, and urban/non-urban status are associated with the rate of OHCA events among adults who accessed 9-1-1 emergency medical services (EMS) in 2016. Methods: We conducted a cross-sectional analysis using the 2016 National Emergency Medical Services Information System (NEMSIS), a national EMS database. OHCA events among adults aged ≥18 years were extracted by sex, age group, race/ethnicity, urban and non-Urban categories. Those with unknown race/ethnicity (45.8%) or of other race (1.3%) were excluded. Rates of OHCA events were calculated and Chi-square tests were used to assess associations. Results: We identified 205,461 OHCA events with EMS activations among non-Hispanic (NH) whites (68.1%), NH blacks (23.2%), and Hispanics (8.7%) in the 2016 NEMSIS dataset. Of the OHCA events, 59.5% were among males, 81.1% among urban residents, and 15.4% among non-urban residents. The overall OHCA rate was 19.6 per 1,000 EMS activations. OHCA rates per 1,000 EMS activations increased with age for adults until age 74, ranging from 11.2 (18-34 years) to 25.1 (65-74 years), then decreased with age for older adults ≥75 ranging from 22.3 (75-84 years) to 20.8 (≥85 years) ( p &lt;.0001). OHCA rates were higher among males 25.3, Hispanics 20.9, and urban residents 21.7 than females 15.6, other race ethnicities (NH whites 19.8 and NH blacks 18.7), and non-urban residents 17.6 ( p &lt;.0001) respectively. Conlusions: OHCA incidence rates among EMS activations increased with age until age 74. Adult males, Hispanics, and urban patients had statistically significant higher EMS activations for OHCA rates. Findings can be incorporated in community planning for improving EMS services.

Geographic Variation in Compliance With FOBT Colorectal Cancer Screening Programs: The Role of Attitudes Toward Health and Help Seeking

Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

The Sex-Differential Relationship between Metabolic Syndrome and Health-Related Quality of Life in Non-Urban Residents

The Sex-Differential Relationship between Metabolic Syndrome and Health-Related Quality of Life in Non-Urban Residents

2475 - A Multidimensional Understanding of Older Adult Mobility Needs: A Survey to Improve Mobility, Health, and Social Inclusion among Older Adults in California

Background By 2030 the older adult population in California is expected to nearly double to over 8.6 million people (from 2012). This population will experience a number of specialized needs that includes health care, housing, and transportation due to reduced physical and cognitive function. In particular, older adults will reduce and eventually stop driving for medical and non-medical reasons. This reduced mobility, as a result of driving reduction, can impact mental health and activities including accessing needed medical care. Study Objective In order to plan for these mobility changes and to support healthy aging and social inclusion, the pilot project aims to understand different dimensions of the mobility needs of older adults in California. One’s household transportation opportunities, community transportation opportunities, and neighborhood characteristics will impact individual mobility. Therefore, the study aims are as follows: Aim 1: To describe the mobility needs of older adult by region and demographic characteristics Aim 2: To describe how emerging technologies impact mobility for older adults Aim 3: To describe how mobility and neighborhoods impact residential choices, particularly aging in place. Project Description This project is led by a multidisciplinary center, UC Berkeley’s Safe Transportation Research and Education Center (SafeTREC), and is funded by the University of California at Berkeley’s Institute for Transportation Studies through the Road Repair and Accountability Act. The survey will be administered in May 2018 by Ewald & Wasserman, a survey research group, using Computer-Assisted Telephone Interviewing Software. The sample will be representative of specific locations that include urban and non-urban areas. The proposed dimensions include: • Individual and household characteristics • Aging-in-the-right place • Mobility status, patterns and needs • Readiness for driving cessation • Driving transition readiness • Consequences of reduced mobility • Access and comfort with driving alternatives • Knowledge of transportation opportunities in one’s community Summary Addressing the mobility needs of the growing older adult population will require a multidisciplinary approach and likely different interventions for urban and non-urban residents and by age cohort. This presentation will focus on the conceptual framework and emerging issues.

Psychotic Experiences, Depressive Symptoms, Anxiety Symptoms and Common Mental Health Risk Factors of Urban and Non-Urban Dwellers in Indonesia

The prevalence of risk factors and symptoms of mental-health problems has been found to be higher in urban than non-urban areas. However, most studies are conducted in developed countries, and we are unsure whether a similar pattern can be observed in a developing country. In the present study, we compared rates of common mental health risk-factors and symptoms of psychosis, depression, and anxiety between urban and non-urban residents. A community sample of 844 participants completed an anonymous cross-sectional online survey. T-tests and Mann-Whitney U Test were used to compare participants’ scores on mental health-risk factors and symptoms based on their area of residence. Our analyses showed that participants living in urban areas experienced a higher frequency of loneliness, being bullied at home, positive symptoms of psychosis, depression, and stronger beliefs of negative schemas. These results reveal a similar pattern of higher frequencies of risk factors and symptoms of mental-health problems among people living in urban areas was found in a developing country. Urban living may be linked exposure to mental health risk factors and thus, increase the risk of having symptoms of mental health problems. Future research should investigate this mechanism in a longitudinal data.

What is the value of a driver licence? A contingent valuation study of Australian adults

BackgroundHolding a driver licence is a vital part of life for many Australians, facilitating social connections and enabling access to employment, education and health services. There is a lack of evidence, however, about the value the community attaches to driver licences. This study investigates the monetary value that a sample of Australian adults place on holding a driver licence and how such valuations vary on the basis of individual characteristics. MethodologyA contingent valuation study of 1054 Australian adult licence holders (with an oversampling of Indigenous Australians) was carried out to derive the sample’s willingness to pay (WTP) to avoid losing their driver licence for a period of one year. Interval regression analyses were undertaken to determine the association between a range of demographic and driving-related characteristics of respondents and their WTP valuations. ResultsThe sample was representative of the Australian population in terms of state of residence and gender. Mean WTP based on the base model was $2290 to avoid losing a driver licence for a year (95% CI $2156–$2431). Indigenous participants had a mean WTP higher than other respondents ($2789 as opposed to $2240, p < .001). Once individual characteristics were controlled for, there was no significant difference in the WTP results between Indigenous and non-Indigenous participants. WTP was significantly higher for respondents who drove multiple times a week ($396 higher WTP, p = .012) than those who did not and who required a car for work compared to those who did not ($520 p = .002). WTP increased with higher incomes and was greatest for those earning over $120,000 annually ($1352 higher than those earning under $40,000 per year, p < .001). Those living in urban areas had a significantly lower WTP compared to non-urban residents ($407 lower than other respondents, p = .012) and WTP decreased with age ($14 lower per additional year of age, p = .03). Those who had incurred a licence suspension in the past 5 years had significantly higher WTP ($1686 p < .001), than those who had not, and those who had incurred a traffic fine in the past 5 years reported a higher WTP than those who had not ($358 p = .032). ConclusionsHolding a driver licence was found to be of substantial value to participants. While support for alternative methods of transport is important, these results highlight the importance of programs to support driver licensing, and those addressing known disparities in licensing status across population groups, such as those faced by Australia’s Indigenous communities. Given the link between licensing and wider social and economic opportunities, such programs can potentially play a broad role in addressing social disadvantage and exclusion.

Letter re: Reducing costs while enhancing quality of care in MS.

I read with interest the article by Drs. Kister and Corboy,1 the accompanying editorial by Drs. Bourdette and Whitham,2 and the online correspondence by Dr. Yanofsky.3 Is it a good solution to propose lower doses of medicine or off-label prescribing for patients with multiple sclerosis (MS)?1 The unbridled rise in the cost of MS drugs resulted in a focus on drug prices.4 In countries facing economic crisis, the fear of high-cost medicine restricts health care access and makes health a prevalent problem, directly shaking the foundation of democracies.5 The cost of MS disease-modifying therapies has especially increased substantially over time, thus rendering nonurban uninsured residents in poor countries worldwide excluded from treatment. Two solutions seem more appropriate: (1) refocus on how to improve patient care by examining the expectations and perceptions of patients regarding the quality of health care they want; and (2) demand more government price controls and clarity regarding the so-called financial alliances. As the ancient philosopher Protagoras said, “Of all things the measure is Man.”