Rural Dwelling Research Articles

P883 Parental and perinatal risk factors associated with onset of Inflammatory Bowel Disease: A systematic literature review and meta-analysis

Abstract Background Several risk factors have been associated with the onset of Inflammatory Bowel Disease (IBD), including pre and early life exposures occurring during gestation and up to the end of an infant’s first year of life. Perinatal factors linked to the subsequent development of IBD include parental and environmental exposures. It is postulated that exposure to such factors impacts immune system development leading to alterations in immune responses and increased susceptibility to disease. Limited evidence evaluates this association systematically whilst focusing specifically on the perinatal period. The purpose of this review was to systematically determine whether parental and perinatal factors are associated with IBD onset. Methods We searched the following electronic databases: Ovid MEDLINE, Web of Science, and the Cochrane Library. Searches were conducted from 01/01/2002 until 26/01/2022. Keywords and search terms related to ‘perinatal’ and ‘inflammatory bowel disease’ were applied. Case control studies, RCTs and cohort studies evaluating the association between parental and perinatal factors and IBD were included. Study protocol details have been published on the International Prospective Register of Systematic Reviews (PROSPERO). Available from: http://https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290798Databases Results Our initial search identified 14,989 potentially relevant articles to include (see Figure 1). After title and abstract screening there were 119 articles that met the eligibility criteria. After full-text review and further assessment of these 119 articles, 18 articles were deemed suitable for study synthesis based on the eligibility criteria. Across the 18 articles, a range of parental and perinatal factors were included: family history IBD (n=8), breastfeeding (n=7), disease during pregnancy (n=4), maternal age (n=4), birth delivery method (n=4), antibiotic exposure (n=3), pre-term birth (n=3), birth weight (n=2), environmental exposures in infancy (e.g. pet exposure, rural dwelling) (n=2), diet (n=1), vaccination (n=1) and maternal smoking (n=1). Conclusion This review provides a detailed summary of parental and perinatal factors associated with the onset of IBD. The evidence generated will influence the development of diagnostic risk assessment tools and detailed patient pathway paradigms to address current shortcomings within the delivery of IBD care, providing opportunities to improve efficiency and reduce healthcare costs. The findings will inform on key targets for primary prevention strategies at this early life stage and provide valuable insight on IBD onset to academics, clinicians, patients and policy makers.

Multiple-Level Fall Risks Associated with Socioeconomic Factors Among Community-Dwelling Older Adults: A Systematic Review

Falls among the community-dwelling elderly is a significant challenge to individual, community, and public health, and is a leading cause of fatal and non-fatal injuries among older adults. The aim of this review study was to identify and synthesize the relevant peer-reviewed literature on multi-level fall risks associated with socioeconomic factors among community-dwelling older adults. A systematic search was conducted across six electronic databases from 2001-2022. Of the retrieved 235 articles, 146 articles were excluded at the title and abstract screening. Fifty-six articles underwent full-text screening and further narrowed to 36 studies matching the expected criteria. The review study findings revealed that individual and socioeconomic factors contributing to older adults falling or risk of falls were sociodemographic, education, income, literacy, marital status, employment, medication, physical/cognitive functions, and frailty phenotype. Females with limited literacy, low-moderate family income, depression symptoms, lower/upper extremity functional limitation, and balance limitation had a higher prevalence of falls. Community and built environmental features can also affect the fall risks of community-dwelling older adults beyond the contributions of individual-level fall risk factors including neighborhood, built environment, housing, home-living environment, and residence (urban or rural dwelling). Understanding the relevant multi-level (individuals and community, etc.) related risks of falls associated with socioeconomic factors can be tremendously important and beneficial. The findings from this review study can be useful for the healthcare systems engineers and related community health professionals for the development and design of future research and intervention strategies.

SUPPORTING DEMENTIA CAREGIVERS DURING COVID-19 WITH CAREHEROES IT: USAGE PATTERNS AND OUTCOMES

Abstract Caregivers of people with dementia often experience negative physical and mental health outcomes due to the complex challenges posed by dementia symptoms and navigating care systems. The COVID-19 pandemic posed even greater hurdles for caregivers as many health care and support services transferred to virtual formats and required increased use of information technologies (IT). This research examined usage data and psychosocial outcomes of dementia caregivers who used a new mobile-enabled web-based app that was offered as an adjunct to clinical care at two memory clinics (Birmingham, AL; Miami, FL) during the pandemic. This app, called CareHeroes: (1) allows caregivers to self-assess their emotional and mental health; (2) offers a secure platform for tracking and communicating patient-related information among caregivers and providers; and (3) offers caregiver education. CareHeroes is also available in Spanish. Effort was made to recruit digitally underserved populations of caregivers (e.g., rural dwelling, underserved racial/ethnic groups). This presentation will review caregiver outcomes (e.g., burden, depression, user data) at baseline and 3-month follow-up. Among the 22 caregivers who enrolled in the study, 17 completed baseline and 3-month follow-up interviews. Over a 14-month period, participants logged onto CareHeroes 131 times, which varied by month. Caregivers most often used CareHeroes to complete assessment tools. Findings indicate that depression and burden were lower at 3-month follow-up compared to baseline, though this reduction was not statistically significant. The presentation will also review challenges of integrating a new technology intervention designed to promote telehealth during the COVID-19 pandemic.

Transformation of rural housing in Western Siberia (Kemerovo region, the 20th century)

Purpose: To suggest factors of transformation (formation) of rural dwelling architecture in Western Siberia. Identification of factors that determine changes in the dwelling archi tecture. Identification of the specifics of the factor interaction, which determine changes in architecture. Methodology: The analysis of the literature in the field, a comparative historical analysis of the main changes in the architectural solutions of a rural dwelling in Primorye at the end of the 20th century, ethnographic methods of the field research to collect materials for conducting research (interviewing, expert surveys, measurements, photo fixation). Study of works of Siberian historians, architects and ethnographers, namely A.Yu. Mainicheva, V.A. Ilinykh, E.A. Ashchepkov, O.N. Shelegina, L.A. Scriabin, V.M. Kimeev, B.R. Rubanenko, K.K. Kartashova. Research findings: The transformation of rural housing on the example of the Kemerovo region at the beginning of the 20th century. Determined are the main transformation factors, their interaction and hierarchy. Originality : Determination of relationships between sociocultural, economic and other changes as well as changes in the dwelling architecture.

The Effectiveness of the Otago Exercise Program on Fall Prevention in Rural-Dwelling Older Adults

<h3>Research Objectives</h3> To develop a sustainable, outcomes-based fall prevention program for rural Michigan older adults using the evidence-based Otago Exercise protocol in collaboration with community-based agencies serving older adults. <h3>Design</h3> Rural dwelling older adults have a higher prevalence of falls compared to non-rural older adults. In Michigan, Over 26% of older adults live in rural communities. Additionally, Isabella, Clare, and Gratiot counties are designated as medically underserved. Otago Exercise protocol is implemented to provide free fall prevention education resources to reduce falls and promote independence. Participants are screened before beginning the exercise protocol and complete balance assessments at baseline, three, six, nine, and twelve months to assess strength and balance as an outcome. <h3>Setting</h3> Classes are instructed by exercise trainers virtually via Zoom and at sites across Isabella, Clare, and Gratiot counties. <h3>Participants</h3> Criterion for inclusion are age 60 years or older, low to moderate assessed fall risk and living independently in the community. There are 68 participants enrolled in the program. <h3>Interventions</h3> Evidence-based Otago Exercise Program that incorporates seventeen strength and balance exercises over a year. <h3>Main Outcome Measures</h3> The primary outcome measurement is the comparison of baseline balance assessment to progression throughout the program. Score averages of the participants' peer group are utilized to analyze results. Below average scores indicate increased fall risk. <h3>Results</h3> Assessment of the Otago protocol utilizes the three-step balance assessment consisting of the Chair Stand Test, Four-Stage Balance Test, and Timed Up-and-Go. After six months of the program, average improvement of about 29.40% in the Four-Stage Balance Test, 2.40% in the Timed Up-and-Go test, and 20.30% in the Chair Stand test has been shown. <h3>Conclusions</h3> Results from participants who have completed six months within the program show improvement on balance assessment scores. It can be concluded that compliance with the Otago Exercise Program results in increased balance in participants and overall decreased fall risk. <h3>Author(s) Disclosures</h3> This program received funding from Region VII Area Agency on Aging. Institutional IRB provided a determination of "not research". We are declaring no conflicts of interest.

Association between health inequalities, antibiotic use and antibiotic-resistant infections in high-income countries: a scoping review

Abstract Introduction Health inequalities and antimicrobial resistance (AMR) present public health challenges. National guidance highlights the role of pharmacy professionals in reaching patients at risk of health inequalities.1 Pharmacy teams have the opportunity to involve their patients in shared decision-making and promote antimicrobial stewardship.2 An evidence gap exists regarding the association between factors that commonly contribute to health inequalities and antibiotic use amongst populations and risk of developing antibiotic-resistant infections. Aim To investigate the association between health inequalities, antibiotic use and risk of antibiotic-resistant infections in high-income countries, allowing pharmacy professionals to better understand the challenges and their role in tackling health inequalities and AMR. Methods Factors that commonly contribute to health inequalities and included in this review were: (i) Protected characteristics (age, ethnicity, disability, gender, sexual orientation); (ii) Socio-economic characteristics (employment status, deprivation, education, income, insurance); (iii) Vulnerable groups (migration status, sex workers, people who inject drugs (PWID), the homeless); (iv) Geography (region, urban or rural dwelling). The PRISMA-ScR was followed. Systematic literature searches were performed on OVID Embase and Medline and included published papers between January 2010 and April 2021. Exclusion criteria were research undertaken in low- or middle-income countries, viral (including COVID-19) and fungal infections and tuberculosis. Regular co-author meetings provided second checking of extracted data. Results Antibiotic use: Fifty-eight of 402 papers were included; most were from the USA (n=34) followed by the UK (n=12). Fifty papers focused on one or more protected characteristics, 37 on socio-economic characteristics, 21 on geography and 6 on migration status. Sample findings: In England, areas of high deprivation had increased antibiotic prescribing, with most deprived areas showing increased rates of broad-spectrum antibiotic use. In the USA, patients from rural areas were more likely to have nitrofurantoin for urinary tract infections inappropriately prescribed compared to urban dwellers. Antibiotic-resistant infections: Ten of 137 papers were included; the majority from the USA (n=6). Six papers focused on ethnicity, three on age and one each on deprivation, income, migration status, PWID and geography. Sample findings: In the USA, African American and Hispanic patients had higher rates of methicillin-resistant Staphylococcus aureus (MRSA) compared to patients of other ethnicities. Immigrants had lower rates of MRSA infections, but higher rates of methicillin-susceptible S. aureus wound infections, compared to USA-born citizens. Across Europe, E. coli infections resistant to aminoglycosides had strong association with income inequality. Discussion/Conclusion There is evidence for an association between health inequalities and antibiotic use, and health inequalities and risk of antibiotic-resistant infections. Further research is needed to understand how differences in antibiotic use affect AMR spread amongst populations. A study limitation includes addressing each health inequality individually without investigating how they may interact together to affect antibiotic use and infection resistance patterns. A strength is use of the PRISMA-ScR reporting guideline and systematic literature search. The pharmacy profession is trusted by the public3 and ideally placed in community and hospital settings to raise awareness of how health inequalities impact infection management and resistance rates, as well as advocate for equity of access in Core20PLUS populations.

Abstract 15361: Rurality and Characteristics of Participants With Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (Regards) Study

Introduction: Individuals living with heart failure (HF) in rural settings have higher age-adjusted mortality than urban dwelling individuals. Thus, we sought to examine sociodemographic and clinical differences between rural and urban populations with HF to better understand this disparity. Methods: We examined participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) population-based cohort who completed a computer-assisted telephone interview (CATI) 10-years following initial recruitment, and who either self-reported a history of HF or had an adjudicated HF hospitalization prior to the CATI. Rural and urban designations utilized a dichotomized adaption of the Rural Urban Commuting Area. We compared sociodemographic and clinical characteristics between rural/urban participants. Logistic regression was used to examine the association between depression and health literacy with urban dwelling. Results: A total of 1002 participants had self reported HF or an adjudicated HF hospitalization during approximately 10 years of follow-up, of which 195 (19%) were classified as rural. Rural dwelling participants with HF were younger (73.5 vs 75.4 years; p=0.004) and more likely to live in the stroke belt (45% vs 33%; p&lt;0.001), earn &lt;$20,000/year (27% vs 20%; p=0.030), experience depressive symptoms (52% vs 45%; p=0.05), and have low health literacy (24% vs 16%; p=0.02). Rural dwelling was associated with higher odds of low health literacy (aOR 1.79, CI 1.07-3.01; p=0.017) and depressive symptoms (aOR 1.13, CI 0.78-1.63; p=0.52). Conclusions: Rural dwelling participants with HF have a lower income and education than urban dwellers. Living in a rural setting was associated with a higher odds of having low health literacy, and half of rural dwelling participants with HF experience depressive symptoms. Addressing these factors may reduce rural/urban disparities in HF outcomes.

Laboratory life cycle of Ornithodoros puertoricensis (Ixodida: Argasidae) collected in the Colombian Caribbean.

Three studies on the biology of Ornithodoros puertoricensis are available in the literature, using different hosts and incubation temperatures. In a previous study, we identified O. puertoricensis in the Colombian Caribbean. The aim of the present work was to analyze life cycle data along one generation from these specimens under laboratory conditions. Eggs of O. puertoricensis were collected in between fragments of bahareque material in a rural dwelling in the municipality of Planeta Rica (Córdoba Department, Colombia), and transported to the laboratory. All post-egg stages (i.e., larvae, nymphs, and adults) were incubated at 27°Cand 85% RH and fed on laboratory mice (Mus musculus). Sixteen engorged larvae were obtained to start a laboratory colony. Average feeding period for larvae was 4.6 days (4-5). The first nymphal instar (N1) did not require feeding and the subsequent nymphal stages (N2, N3, and N4) and adults had feeding periods ranging from 55 to 75min. Average pre-molting period in nymphs was 15 days (10-21). Most of the N3 molted to males and all N4 molted to females. Two gonotrophic cycles were recorded: the first had a preoviposition period of 12 days (7-18) and produced 190 eggs (171-223), the second lasted 6.6 days (6-7) and produced 146 eggs (104-201). The mean life cycle duration (from parental eggs to F1 eggs) was 70.7 days (58.7-82.7) without fasting periods. The collected data agree with previous studies even with differences in hosts and maintenance conditions.

Oral anticoagulation use in non-valvular atrial fibrillation patients in rural setting

BackgroundThe 2019 ACC/AHA/HRS guidelines established direct oral anticoagulants (DOACs) as first line therapy over warfarin for non-valvular atrial fibrillation (AF). MethodsAmbulatory clinic patients with non-valvular AF or atrial flutter seen between 10/1/2019-7/12/2020 included. High-risk AF defined as males CHA2DS2-VASc score ≥2 and females ≥3. Patients were separated into: warfarin, DOAC, or no oral anticoagulation (OAC). ATRIA bleed score calculated. A provider survey assessing knowledge and barriers to anticoagulation completed via REDCap between 3/5-4/16/2020. ResultsOf 12,014 subjects with AF, 8,032 were high risk (mean age 75.9 ± 9.8 years; 57.5% male). There were 4,619 (57.1%) ≥ 75 years and 63.4% were rural dwelling. There was no significant difference between the number of subjects on anticoagulation before and after the guideline publication (75.6% vs. 75.7%, p = 0.79). Warfarin use decreased 2.3% over 1 year (39.3% to 37.0%), while DOACs increased 2.4% (36.2% to 38.7%, p < 0.001 for both). At 1-year, age, male gender, CHA2DS2-VASc score 4-6, hypertension, stroke and cardiology consult increased prescription of OAC (p<0.05). Vascular disease, high risk ATRIA bleed, renal disease, prior hemorrhage, and left atrial appendage occlusion were associated with decreased OAC use (p < 0.05). Left atrial appendage occlusion device use was low (<1%). In a survey, majority of providers noted bleeding risk (35.1%) and cost (25.0%) to be the biggest barriers to DOAC use. ConclusionsThe new guidelines caused a slight increase in DOACs over time. Significant barriers to DOAC use exist in rural areas; one in four high risk AF patient remains without OAC therapy.

Eating sustainably: Conviction or convenience?

Environmentally sustainable food consumption is one component of addressing climate change. Previous research has largely approached sustainable food consumption by investigating individual behaviors, without a broader conceptualization of what motivates food consumers to act sustainably. Using a representative sample of Indiana consumers, we explore sustainability across a range of food behaviors through latent class analysis, controlling for environmental attitudes, spatial access to food, and consumer demographics. This approach allows us to go beyond consumer segmentation analysis to explore how consumers conceptualize sustainable food behavior. The largest class of consumers (44% of the sample) appear either unwilling or unable to pay more for sustainability but are more likely to engage in sustainable behaviors that intersect with self-oriented attributes such as health benefits and lower cost. A second class (34%) consists of consumers who seem to be primarily motivated by the single issue of buying organic, are on average higher income, more educated, have better access to food, and are not opposed to paying for sustainability. Consumers in the smallest and most highly motivated group (9%) in terms of sustainability attitudes and self-perceived sustainability focus on local food production and are generally rural dwelling with less income. Only 13% of consumers engage in few to no sustainable behaviors, and these people notably exhibit the least sustainable attitudes. These findings illustrate the ways in which food sustainability is more nuanced than often characterized—much of it is driven by convenience and self-interest rather than reputation with respect to sustainability or conviction about environmental outcomes. This work also highlights how a combination of social, psychological, and spatial barriers exists and shape how different consumer groups conceptualize sustainable food consumption.

Indoor thermal comfort in a rural dwelling in southwest China.

Recently, indoor thermal comfort has received more scholarly attention than ever due to the COVID-19 pandemic and global warming. However, most studies on indoor thermal comfort in China concentrated on urban buildings in the east and north. The indoor thermal comfort of rural dwellers in southwest China is insufficiently investigated. Hence, this study assesses residents' indoor thermal comfort in a rural dwelling in Linshui, obtains the thermal neutral temperature of the rural area, and analyzes the thermal adaptation behavior of rural dwellers. The results reveal that the thermal neutral temperature of rural dwellers is 29.33°C (operative temperature), higher than that presented in previous studies based on the same climate region. Indoor thermal conditions in rural dwellings are relatively harsh, but various thermal adaptation behavior of rural dwellers significantly improve their ability to withstand the harsh conditions. When people live in an environment with a (relatively) constant climate parameter (e.g., humidity), their perception of that parameter seems compromised. Most rural dwellers are unwilling to use cooling equipment with high energy consumption. Therefore, more passive cooling measures are recommended in the design and renovation of rural dwellings.

Prepregnancy Emergency Department Use and Risks of Severe Maternal and Neonatal Morbidity in Canada

Emergency department (ED) use during pregnancy may be associated with worse obstetrical outcomes, possibly because of differences in access to health care. It is not known whether ED use before pregnancy is associated with serious adverse maternal and perinatal outcomes. To study the association between prepregnancy ED use and adverse maternal and perinatal outcomes. This population-based cohort study was conducted in Ontario, Canada, and included all livebirths and stillbirths from April 2003 to January 2020. Main exposure was any ED encounter within 90 days preceding the start of the index pregnancy. Primary outcome was a composite of severe maternal morbidity (SMM) from 20 weeks' gestation to 42 days' post partum. Secondary outcomes included severe neonatal morbidity (SNM) from 0 to 27 days, neonatal death, and stillbirth. Relative risks (RRs) were adjusted for maternal age, income, and rurality. Of 2 130 245 births, there were 2 119 335 livebirths (99.5%) and 10 910 stillbirths (0.5%). The mean (SD) maternal age was 29.6 (5.4) years, 212 478 (9.9%) were rural dwelling, and 498 219 (23%) had 3 or more comorbidities. Among all births, 218 011 (9.7%) had a prepregnancy ED visit. The rate of SMM was higher among women with a prepregnancy ED visit than those without (22.3 vs 16.5 per 1000 births), with an RR of 1.34 (95% CI, 1.30-1.38) and an adjusted RR (aRR) of 1.37 (95% CI, 1.33-1.42). Compared with no prepregnancy ED visit, the aRR was higher in those with 1 (1.29; 95% CI, 1.24-1.34), 2 (1.51; 95% CI, 1.42-1.61), and 3 or more (1.74; 95% CI, 1.61-1.90) ED visits. Prepregnancy ED visits for a hematological (aRR, 13.60; 95% CI, 10.48-17.64), endocrine (aRR, 4.96; 95% CI, 3.72-6.62), and circulatory (aRR, 2.27; 95% CI, 1.68-3.07) conditions were associated with the highest aRRs for SMM. The rate of SNM was higher among newborns whose mother visited the ED within 90 days before pregnancy (68.2 vs 55.4 per 1000 births; aRR, 1.24; 95% CI, 1.22-1.26) as was the risk of neonatal death (aRR, 1.26; 95% CI, 1.16-1.37) and stillbirth (aRR, 1.18; 95% CI, 1.11-1.25). In this study, ED use was common before pregnancy. These findings suggest that ED use may not only reflect a woman's access to prepregnancy care but also higher future risk of severe maternal and perinatal morbidity, potentially offering a useful trigger for health system interventions to decrease adverse pregnancy outcomes.

Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents.

Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.

Diffusion Characteristics of PM2.5 in Rural Dwelling under Different Daily Life Behavior: A Case Study in Rural Shenyang of China

The highest concentration of PM2.5 in cold rural dwellings of Northeast China is often generated by using mini stoves for cooking and heating, which can directly influence human health. As of yet, little is known about the impact of different daily life behavior on PM2.5 diffusion and residents’ exposure in rural dwellings. In this study, the characteristics of indoor PM2.5 variation and diffusion in rural dwellings was described by measuring some rural dwellings and establishing a multi-zone network model. The calculated results indicated that the relative errors between theoretical calculated results and experimental measured results are within 10%. PM2.5 diffusion in a rural dwelling can be predicted. Furthermore, the impacts of daily life behavior on PM2.5 diffusion and exposure assessment can be analyzed. Through discussion, heating behavior is the most important factor causing high concentrations of PM2.5 in each room, followed by cooking, smoking, and cleaning. Door opening time can lead to different interzonal airflows and PM2.5 diffusion rates. By reducing the inner door opening time to less than 1 min, PM2.5 could decrease to 300 μg/m3. Door closing behavior could decrease risk that PM2.5 diffuses to bedrooms by more than 50%, and exposure of residents in bedrooms could reduce to 100 (μg·h)/m3 effectively.

O23 Perceived Stress in Rural and Suburban Dwelling Participants After a Meal Kit Intervention

<h3>Background</h3> Stress is associated with unhealthy eating behaviors, which increases risk for chronic disease. People with low income face many stressors, such as decreased access to healthy food. Recent research suggests that providing healthy meal kits may decrease perceived stress (PS) of main preparers of food with low income, but more research is needed. <h3>Objective</h3> To evaluate the impact of a healthy, meal kit intervention on PS of main preparers of food from diverse families with low income in different communities. <h3>Study Design, Setting, Participants</h3> Two waves of participants from rural (N = 23) and suburban (N = 36) communities completed a six-week meal kit intervention that provided three meals per week. Demographic data were collected at baseline, and PS surveys were collected at baseline and post-intervention. <h3>Measurable Outcome/Analysis</h3> Demographic data were analyzed using descriptive statistics. Frequency statistical analysis evaluated changes in PS overall and per site. Paired sample t-tests were run to ascertain if there was a significant difference in PS from baseline to post-intervention. <h3>Results</h3> Participants were primarily female (89.8%), on average 46.21 ± 13.1 years old, primarily non-Hispanic (98.3%) and black (37.3%) or white (33.9%) with an average household size of 4.4 ± 1.6. Most (98.3%) fell below 200% of the federal poverty line for a household size of four. At post-intervention, most participants (67.8%) reported a decrease in overall PS. Participants experienced a decrease in PS from baseline (19.17 ± 7.34) to post-intervention (16.17 ± 6.85), t(58) = 3.964, <i>P</i> < 0.001. When split by community, suburban participants (72.2%) had a higher reduction of PS than rural participants (60.9%). There was no difference in PS between communities. <h3>Conclusions</h3> The overall reduction of PS from baseline to post-intervention suggests that the meal kit intervention positively impacted PS and did so similarly between the two communities. Future research should seek to explore the mechanism behind the decrease in PS. <h3>Funding</h3> Walmart Foundation.

Socioeconomic and Geographic Predictors of Poor Diet Quality in a Large U.S. Cohort of Adult Men and Women

Purpose: Poor diet quality is an important determinant of obesity and chronic disease risk. A better understanding of social, economic and geographic factors associated with diet quality can inform public health and policy efforts for advancing health equity. Methods: This cross-sectional analysis of 155,331 adult men and women in the American Cancer Society (ACS) Cancer Prevention Study-3 examined race/ethnicity, socioeconomic (individual-level education and income), and geographic (metropolitan to rural dwelling, residence in food desert) predictors of poor diet quality, mutually adjusted using multivariable logistic regression models. A diet score reflecting concordance with the 2020 ACS dietary recommendations for cancer prevention based on intake of fruit, vegetables, whole grains, red and processed meats, sugar-sweetened beverages (SSBs) and highly processed foods was calculated from responses to a validated food frequency questionnaire, with scores ranging from 0 (worst) to 12 (best) diet quality, and scores 0-3 representing poor diet quality. Results: All socioeconomic and geographic characteristics assessed were statistically significant, independent predictors of poor diet quality. Compared to White participants, Black participants had a 16% higher likelihood of poor diet quality, while Hispanic/Latino and Asian/Native Hawaiian/Pacific Islander participants had 16% and 33% lower risk of poor diet quality, respectively. Higher income and education were linearly associated with better diet quality among White participants, but not among other racial/ethnic groups. Even after controlling for other characteristics, non-metropolitan residence was associated with a 61% higher risk of poor diet quality. Additionally, residence in a food desert was associated with a 17% higher risk. All diet score components contributed to disparities observed, particularly red and processed meat and SSBs. Conclusions: Race/ethnicity, socioeconomic and geographic factors independently predicted risk of poor diet quality among a large, diverse adult U.S. population. These findings contribute information to more effectively target behavioral interventions, programs, and policies to improve diet quality for populations at highest risk.

Nonfatal drowning-related hospitalizations and associated healthcare expenditure in India: An analysis of nationally representative survey data

Background: Drowning is a global public health challenge, with significant burden in low- and middle-income countries. There are few studies exploring nonfatal drowning, including the economic and social impacts. This study aimed to quantify unintentional drowning-related hospitalization in India and associated healthcare expenditure. Method: Unit level data on unintentional drowning-related hospitalization were obtained from the 75th rounds of the National Sample Survey of Indian households conducted in 2018. The outcome variables were indices of health care cost such as out of pocket expenditure (OOPE), health care burden (HCB), catastrophic health expenditure (CHE), impoverishment, and hardship financing. Descriptive statistics and multivariate analysis were conducted after adjusting for inflation using the pharmaceutical price index for December 2020. The association of socio-demographic characteristics with the outcome variable was reported as relative risk with 95% CI and expenditure reported in Indian Rupees (INR) and United States dollars (USD). Results: 174 respondents reported drowning-related hospitalization (a crude rate of 15.91–31.34 hospitalizations per 100,000 population). Proportionately, more males (63.4%), persons aged 21–50 years (44.9%) and rural dwelling respondents (69.9%) were hospitalized. Drowning-related hospitalization costs on average INR25,421 ($345.11USD) per person per drowning incident. Costs were higher among older respondents, females, urban respondents, and longer lengths of hospital stays. About 14.4% of respondents reported hardship financing as a result of treatment costs and 9.0% of households reported pushed below the poverty line when reporting drowning-related hospitalization. Conclusions: Drowning can be an economically catastrophic injury, especially for those already impacted by poverty. Drowning is a significant public health problem in India. Investment in drowning prevention program will reduce hospitalization and economic burden. Practical Applications: This study provides support for investment in drowning prevention in India, including a need to ensure drowning prevention interventions address the determinants of health across the lifespan.

Skin cancer risk factors among Black South Africans-The Johannesburg Cancer Study, 1995-2016.

BackgroundThe Black population has lower skin cancer incidence compared to White, Indian/Asian, and Mixed‐race populations in South Africa; however, skin cancer still exists in the Black population. The aim of this study is to identify risk factors associated with skin cancer among Black South Africans.Materials and MethodsA case‐control study was conducted. Cases were patients with keratinocyte cancers (KCs) and/or melanoma skin cancers (MSCs) and controls were cardiovascular patients. Sociodemographic exposures, environmental health variables, smoking, and HIV status were assessed. Stepwise logistic regression was used to identify risk factors associated with KCs and MSCs.ResultsThe KCs histological subtypes showed that there were more squamous cell carcinomas (SCCs) (78/160 in females, and 72/160 in males) than basal cell carcinomas (BCCs). The SCC lesions were mostly found on the skin of the head and neck in males (51%, 38/72) and on the trunk in females (46%, 36/78). MSC was shown to affect the skin of the lower limbs in both males (68%, 27/40) and females (59%, 36/61). Using females as a reference group, when age, current place of residency, type of cooking fuel used, smoking, and HIV status were adjusted for, males had an odds ratio (OR) of 2.04 for developing KCs (confidence interval [CI]: 1.08–3.84, p = .028). Similarly, when age, current place of residency, and place of cooking (indoors or outdoors) were adjusted for, males had an OR of 2.26 for developing MSC (CI: 1.19–4.29, p = .012).ConclusionsDifferences in the anatomical distribution of KCs by sex suggest different risk factors between sexes. There is a positive association between being male, smoking, rural dwelling, and a positive HIV status with KCs and being male and rural dwelling with MSC. The rural dwelling was a newly found association with skin cancer and warrants further investigation.

Leisure and Leisure Education as Resources for Rehabilitation Supports for Chronic Condition Self-Management in Rural and Remote Communities.

The potential of leisure (enjoyable free time pursuits) to be a resource for chronic condition self-management (CCSM) is well-established. Because leisure pursuits are often self-determined, they have the potential to allow people to not only address self-management goals (e.g., managing symptoms through movements or stress-reducing activities) but meet important psychosocial needs (e.g., affiliation, sense of mastery) as well as support participation in a range of meaningful life situations. In this “Perspective” piece, we advocate for the ways leisure and leisure education can be resources for rehabilitation professionals to support CCSM, especially in rural and remote communities. In particular, we focus on aspects of the Taxonomy of Everyday Self-Management Strategies [TEDSS (1)] to highlight ways that embedding leisure and leisure education into supports for CCSM can strengthen rehabilitation services offered to rural and remote dwelling adults living with chronic conditions. Recognizing the breadth of leisure-related resources available in rural and remote communities, we recommend the following strategies to incorporate a focus on leisure-based self-management within rehabilitation services: (a) enhance the knowledge and capacity of rehabilitation practitioners to support leisure-based CCSM; (b) focus on coordinated leadership, patient navigation, and building multi-sectoral partnerships to better link individuals living with chronic conditions to community services and supports; and (c) educate individuals with chronic conditions and family/carers to develop knowledge, skills, awareness and confidence to use leisure as a self-management resource.

Challenges and opportunities for breast cancer early detection among rural dwelling women in Segamat District, Malaysia: A qualitative study.

IntroductionBreast cancer patients in low- and middle-income countries often present at an advanced stage. This qualitative study elicited views regarding the challenges and opportunities for breast cancer screening and early detection among women in a low-income semi-rural community in Segamat district, Malaysia.MethodsIndividual semi-structured interviews with 22 people (health professionals, cancer survivors, community volunteers and member from a non-governmental organization) and four focus group discussions (n = 22 participants) with women from a local community were conducted. All participants were purposively sampled and female residents registered with the South East Asia Community Observatory aged ≥40 years were eligible to participate in the focus group discussions. Data were transcribed verbatim and analyzed using thematic analysis.ResultsThe thematic analysis illuminated barriers, challenges and opportunities across six domains: (i) personal experiences and barriers to help-seeking as well as financial and travel access barriers; (ii) primary care challenges (related to delivering clinical breast examination and teaching breast-self-examination); (iii) secondary care challenges (related to mammogram services); (iv) disconnection between secondary and primary care breast cancer screening pathways; and (v) opportunities to improve breast cancer early detection relating to community civil service society activities (i.e. awareness raising, support groups, addressing stigma/embarrassment and encouraging husbands to support women) and vi) links between public healthcare personnel and community (i.e. improving breast self-examination education, clinical breast examination provision and subsidised mammograms).ConclusionThe results point to a variety of reasons for low uptake and, therefore, to the complex nature of improving breast cancer screening and early detection. There is a need to adopt a systems approach to address this complexity and to take account of the socio-cultural context of communities in order, in turn, to strengthen cancer control policy and practices in Malaysia.