Segment Of Population Research Articles

Exploring the barriers to the development of organizational health literacy in health institutions to meet the needs of older patients from multiple perspectives: a mixed-methods study

BackgroundThe latest evidence on health literacy in China revealed that only 8% of individuals aged 65–69 years, a segment of the geriatric population, possess adequate health literacy levels, indicating a low level in China. Studies have demonstrated that improving the organizational health literacy of healthcare institutions is a crucial approach to addressing low health literacy among older patients.ObjectiveTo explore the obstacles hindering the advancement of organizational health literacy in healthcare institutions in meeting the needs of older patients.DesignA mixed-methods approach was employed to investigate both the status and barriers to the establishment of organizational health literacy within two healthcare institutions.ParticipantsParticipants included older individuals aged over 60, clinical staff, and managerial personnel from these two health institutions.MethodsThis research utilized the social-ecological model as its theoretical foundation and utilized a mixed-methods approach to examine the current status and challenges in developing organizational health literacy within healthcare institutions. Initially, a survey using a questionnaire (n = 178) was conducted among older patients to evaluate the establishment of organizational health literacy from their perspective. Following this, interviews (n = 22) were carried out with administrators, clinical personnel, and elderly patients to identify the barriers hindering the development of organizational health literacy within healthcare institutions.ResultsQuantitative research indicates that health institutions have been less accommodating to the requirements of older patients, with health information dissemination and communication emerging as the weakest areas. Qualitative investigations revealed three key influencing factors: patient-related factors, including physiological and cognitive decline, as well as low educational attainment among older patients; organizational factors, including inadequate clinical staff numbers, deficient long-term systematic training, and a digital divide resulting from health institutions’ digital advancements; and policy-related factors indicating a lack of regulations governing the establishment of organizational health literacy within healthcare institutions.ConclusionThe two most vulnerable aspects of OHL in medical institutions regarding the needs of older patients are health information and communication. The factors influencing the construction of OHL in medical institutions are multifaceted, encompassing micro, meso, and macro levels. At the macro level, it is essential for medical institutions to enhance leadership awareness of OHL and to incorporate its development into institutional strategic plans. At the meso-level, medical institutions should be made to optimize the medical environment for elderly patients and to prioritize health literacy training for medical staff. At the micro level, attention must be given to the characteristics and needs of elderly patients. Ultimately, by implementing a comprehensive construction of intervention strategies, the response ability of medical institutions to the needs of elderly patients can be enhanced.

Multimodal AI/ML for discovering novel biomarkers and predicting disease using multi-omics profiles of patients with cardiovascular diseases

Cardiovascular diseases (CVDs) are complex, multifactorial conditions that require personalized assessment and treatment. Advancements in multi-omics technologies, namely RNA sequencing and whole-genome sequencing, have provided translational researchers with a comprehensive view of the human genome. The efficient synthesis and analysis of this data through integrated approach that characterizes genetic variants alongside expression patterns linked to emerging phenotypes, can reveal novel biomarkers and enable the segmentation of patient populations based on personalized risk factors. In this study, we present a cutting-edge methodology rooted in the integration of traditional bioinformatics, classical statistics, and multimodal machine learning techniques. Our approach has the potential to uncover the intricate mechanisms underlying CVD, enabling patient-specific risk and response profiling. We sourced transcriptomic expression data and single nucleotide polymorphisms (SNPs) from both CVD patients and healthy controls. By integrating these multi-omics datasets with clinical demographic information, we generated patient-specific profiles. Utilizing a robust feature selection approach, we identified a signature of 27 transcriptomic features and SNPs that are effective predictors of CVD. Differential expression analysis, combined with minimum redundancy maximum relevance feature selection, highlighted biomarkers that explain the disease phenotype. This approach prioritizes both biological relevance and efficiency in machine learning. We employed Combination Annotation Dependent Depletion scores and allele frequencies to identify variants with pathogenic characteristics in CVD patients. Classification models trained on this signature demonstrated high-accuracy predictions for CVD. The best performing of these models was an XGBoost classifier optimized via Bayesian hyperparameter tuning, which was able to correctly classify all patients in our test dataset. Using SHapley Additive exPlanations, we created risk assessments for patients, offering further contextualization of these predictions in a clinical setting. Across the cohort, RPL36AP37 and HBA1 were scored as the most important biomarkers for predicting CVDs. A comprehensive literature review revealed that a substantial portion of the diagnostic biomarkers identified have previously been associated with CVD. The framework we propose in this study is unbiased and generalizable to other diseases and disorders.

Estimating Demographic Parameters for Bearded Seals, Erignathus barbatus, in Alaska Using Close‐Kin Mark‐Recapture Methods

ABSTRACTReliable estimates of population abundance and demographics are essential for managing harvested species. Ice‐associated phocids, “ice seals,” are a vital resource for subsistence‐dependent coastal Native communities in western and northern Alaska, USA. In 2012, the Beringia distinct population segment of the bearded seal, Erignathus barbatus nauticus, was listed as “threatened” under the US Endangered Species Act requiring greater scrutiny for management assessments. We sought to estimate requisite population parameters from harvested seals by using close‐kin mark‐recapture (CKMR) methods, the first such application for marine mammals. Samples from 1758 bearded seals harvested by Bering, Chukchi, and Beaufort Sea communities during 1998–2020 were genotyped, genetically sexed, and aged by tooth annuli. After rigorous quality control, kin relationships were established for 1484 seals including two parent–offspring pairs (POPs) and 25 potential second‐order kin pairs. Most of the second‐order kin were half‐sibling pairs (HSPs), but four were potential grandparent‐grandchild pairs (GGPs). There were no full sibling pairs, suggesting a lack of mate fidelity. Mitochondrial DNA analysis identified 17 potential HSPs as paternally related, providing substantial evidence of persistent heterogeneity in reproductive success among adult males. The statistical CKMR model incorporates probabilities associated with POPs, HSPs, and GGPs and assumes known ages and a stable population. Our top model accommodates heterogeneity in adult male breeding success and yields an abundance estimate of ~409,000 with a coefficient of variation (CV) = 0.35, which is substantially greater than the “non‐heterogeneity” model estimate of ~232,000 (CV = 0.21), an important difference for managing a harvested species. Using CKMR methods with harvested species provides estimates of abundance with the added opportunity to acquire information about adult survival, fecundity, and breeding success that could be applied to other species of concern, marine and terrestrial.

ETHICAL DILEMMAS IN MEDICAL CARE FOR WOMEN IN SITUATIONS OF SOCIAL VULNERABILITY: EXPANDING THE DEBATE ON MARGINALIZED POPULATIONS IN EDUCATION

This paper addresses reflections and discussions on the female figure in the context of social marginalization, linked to threats to human rights, with a focus on access to health care and quality longitudinal monitoring. This debate analyzes the historical process of marginalization and oppression amplified when women are inserted as street dwellers, enhancing the weaknesses of helplessness and substance abuse, thus aggravating violence and stigma. This is a narrative review of literature, of a reflective nature, associated with a report of an educational experience in the construction of a teaching methodology based on a fictitious case that triggers discussion and resolution of problems linked to human rights violations of marginalized women, in the light of philosophies of law and the study of public policies for undergraduate medical students. The development of the work shows the importance of expanding studies on this topic, focusing on historically invisible people, in a problematizing narrative, using the construction of clinical cases containing not only health needs for a resolution of medicalization, based strictly on biological diagnoses, but that challenge the reflective thinking of social medicine, directing the debate towards human rights lines, in a context of interprofessional dialogues and studies of public policies, as essential in the training of doctors committed to guaranteeing equity and access to the most neglected population segments in Brazil.

Population Health Management effectiveness in the primary healthcare setting: a systematic review

Abstract Background Population Health Management (PHM) has shown promise as a tool in the improvement of health at scale. It works by; harnessing health-related datasets, allowing for population segmentation and risk stratification, and targeting interventions to yield positive health impact. Prior reviews on PHM, have sought to define PHM and assess feasibility. To date, there have been no systematic reviews that assess the effectiveness of PHM in achieving some or all of the quintuple aims of PHM (WHO 2023). The aim of this study is to determine the value and impact of a PHM approach in managing ambulatory care sensitive conditions (ACSCs) in the primary healthcare setting. Methods This systematic review is underpinned by a Population-Intervention-Comparator-Outcome (PICO) framework. The PROSPERO-registered study commenced in February 2024 for papers published since January 2000. Pubmed, Cinahl and Web of Science databases were used. Titles and abstracts of studies were reviewed using agreed eligibility criteria to select studies for inclusion and risk of bias assessment. Data abstraction and synthesis determined the effectiveness of PHM against agreed outcome measures. Results The search yielded 427 articles of which 19 were included. Studies addressed diabetes, hypertension, atrial fibrillation, asthma and comorbid conditions. Nearly all studies were based in the U.S.A. Almost 50% of studies showed a significant improvement in health outcomes following PHM. Study features that corresponded with positive health outcomes included; the use of population management tools, the employment of disease/population health managers and the mobilisation of medication reviews/education. Conclusions The challenges facing communities and health services require an alternative innovative approach to health such as a PHM approach. The results of this study will inform a larger body of work which seeks to establish a PHM approach to the delivery of services in the Mid-West region of Ireland. Key messages • Population health management (PHM) could be a viable mechanism for health services to serve increasing need and multi-morbid populations. • This is the first systematic review of PHM against the quintuple aims of PHM, specifically in the management of ambulatory care sensitive conditions in primary healthcare.

Enhancing Urban Mobility with Aerial Ropeway Transit (ART): Future Accessibility Impacts of Multimodal Transit Expansion Scenarios

Aerial ropeway transit (ART) systems are emerging alternatives to augment existing transit systems in congested cities in the Global South, especially in urban areas with limited transit coverage because of road width constraints or topography. Integration of aerial cable car stations to an existing transit network can improve the overall accessibility of various population segments with significant positive benefits in relation to reducing transport-related social exclusion. This study evaluated the impact of introducing ART in the city of Varanasi (India) and assessed the spatial accessibility improvements to critical facility locations such as heritage sites, educational institutions, hospitals, and employment centers. Several multimodal transit expansion scenarios were considered in this study and the potential benefits of each case were quantified using the two-step floating catchment area (2SFCA) method. A multi-criteria decision-making (MCDM) approach was subsequently employed for identifying the optimal locations of ART stops. Microlevel analysis findings suggest that the mean accessibility values could increase up to 10.92% in the first phase of the ART implementation, which could subsequently increase to 24.7% and 49.8% for the subsequent transit expansion scenarios. The study also investigated the Varanasi ART DPR prepared by Varanasi Development Authority (VDA) and showed that a significant increase of 16% in accessibility levels could be achieved if optimal stop locations identified in this study were implemented. The proposed two-step (2SFCA+MCDM) method for identifying the optimal locations of ART stations in a multimodal transit network is expected to be an effective tool for transit system redesign using place-based accessibility measures.

Social and Behavioural Change Communication Challenges, Opportunities and Lessons from Past Public Health Emergencies and Disease Outbreaks: A Scoping Review.

Background: Documentation of social behavioural change communication (SBCC) regarding challenges, opportunities and lessons drawn from past public health emergencies is worthwhile to inform priorities for future response efforts. Aim: The aim of this review is to scope the evidence on social behavioural change communication regarding challenges, opportunities and lessons drawn from Ebola, coronavirus disease 2019 (COVID-19), monkeypox and cholera outbreaks from studies published before March 2024, and suggest priorities for future response efforts. Methods: A Boolean strategy was used to search electronic databases for relevant published articles, complemented by relevant studies identified from reference lists. Results: The challenges, opportunities, lessons learnt and priorities for SBCC were consistent across study contexts, showing marked variations over time. The significance of technology, infodemic management, and behavioural data generation emerged more frequently and became increasingly important over time. Identified challenges were uptake hesitancy, limited capacity to undertake infodemic management, inadequate funding and human resources for SBCC, competing priorities, parallel or conflicting interventions due to inadequate coordination, difficulties evaluating SBCC programmes and missed opportunities for integration into routine programmes. Existing supportive structures for SBCC, strong political will and participation, as well as rapid information exchange enabled by technological advancement, represented opportunities for enhancing the effectiveness of SBCC programmes. Key lessons were that a multisectoral approach and coordination, partnership and active collaboration amongst stakeholders; building/strengthening trust, target population segmentation and localization of interventions, are important for enhancing the effectiveness of SBCC programmes. Political will, involvement and participation represent the core of social behavioural change (communication) interventions during a public health emergency. Conclusion: SBCC programming for future response to public health emergencies and disease outbreaks should consider the diverse assortment of benefits, threats/challenges and opportunities brought about by technology, infodemics and behavioural data generation to be more effective.

The Effects of Behaviorally Informed Messages on COVID-19 Vaccination Intentions and Behavior: Evidence from Randomized Survey Experiments in South Africa

With COVID-19 vaccination rates remaining below optimal levels, scalable interventions to shift vaccination intentions are needed. We embedded two randomized experiments in South Africa’s COVID-19 Vaccine Survey (CVACS) to investigate the potential to change vaccine intentions and behavior. In Experiment 1, 3510 unvaccinated South African adults were randomly assigned to a no-message control group, a social norm message, or a message highlighting that vaccines were free, available and easy to obtain. The free and easy message significantly increased vaccine intentions but did not increase other outcome measures. The social proof message was associated with an increase in self-reported vaccination status at follow-up (not significant at traditional statistical thresholds). In Experiment 2, 3608 unvaccinated South African adults were randomly assigned to a no-message control group, a message highlighting gaining greater freedoms, or a message highlighting being part of the solution to the pandemic. Neither value proposition message increased vaccination intentions. Light-touch and scalable messages informed by behavioral science and social marketing principles may increase vaccination intentions and uptake, However, more attention should be paid to understanding the behavioral barriers experienced by different population segments, and to tailoring and targeting messaging to those barriers and segments.

Local perceptions of marine conservation aquaculture for the restoration of native Atlantic salmon (Salmo salar) in Downeast, Maine

The entities responsible for the management of the endangered Gulf of Maine Distinct Population Segment of Atlantic salmon (Salmo salar) have partnered with a commercial aquaculture company to apply a novel conservation aquaculture program. This effort marks a major shift in management and has garnered mixed public reactions. Recent expansion of aquaculture in Maine has been a point of controversy as people and systems grapple with the social, environmental, and legal aspects of this burgeoning industry. Still, the use of aquaculture for conservation has shown some promise. In 2021, a questionnaire was administered to 850 households (response rate 27 %) in Maine via the Drop-off and Pick-up method. We examined differences and similarities in attitudes, beliefs, and knowledge about Atlantic salmon, hatcheries, and aquaculture between property owners in the town where the proposed net pens would be located (Cutler; n=73), and those in neighboring towns (n=152). The Potential for Conflict Index (PCI2) was used to examine differences between the groups. Both groups held similar positive attitudes toward Atlantic salmon, endangered species conservation, freshwater hatcheries, and both commercial and conservation aquaculture. Both groups believe that “Atlantic salmon should be protected,” and that freshwater hatcheries and marine conservation aquaculture “should be used for conservation.” However, Cutler residents had less consensus and supported the use of freshwater hatcheries and marine conservation aquaculture less than other respondents. Community concerns have stalled efforts to move the project forward. Our research indicates there are several social concepts which may help to explain localized opposition to the project.

Blockchain for building trust in genomic initiatives

AbstractThis commentary aims to share the current patient engagement context in genome initiatives within universal healthcare systems worldwide, focusing on the inclusivity of diverse population segments rather than just numerical metrics. It explores the relevance and potential replicability of these initiatives globally, questioning their efficacy in ensuring widespread citizen participation. Empirical evidence shows that hesitancy to opt into genome initiatives goes beyond demographic factors, with a significant portion of the population abstaining due to prevailing mistrust. Given the global aspiration for delivering precision healthcare and promoting a healthy lifestyle for all citizens, this paper investigates the multifaceted reasons behind this distrust. It underscores the need for policymakers to understand these reasons comprehensively and proposes a Blockchain‐based framework centered on trust‐building as a potential solution to enhance citizen engagement. The analysis of distrust factors and their impact on participation leads to the conclusion that decisive measures are necessary to improve the participatory landscape of genomic initiatives. The paper advocates for actions to enhance trust, thereby improving the current operational milieu of precision healthcare. The broader conclusion emphasizes the importance of trust‐building strategies in achieving the goal of fostering a healthy lifestyle for all citizens and provides a foundation for further development in this pioneering healthcare domain.

‘Where is the diversity in this facility?’ Experiences of emergency care among visible minority individuals in Kingston, Ontario

ABSTRACT Introduction Visible minorities, a growing segment of Canada's population, have voiced concerns about experiencing racism while receiving care in the emergency department (ED). Understanding the ED care experiences of visible minorities is crucial to improving care and reducing health disparities. Methods From June to August 2021, we collected data from participants in Kingston, Ontario using a sensemaking approach. Individuals who had accessed emergency care or accompanied someone else to the ED in the prior 24 months were eligible to participate. After sharing a brief narrative about their care experience, participants interpreted the experience by plotting their perspectives on a variety of pre-determined questions. Here, we conducted a thematic analysis of narratives involving patients who identified as visible minorities and complemented it with quantitative analysis of the participants’ interpretative responses. This mixed-methods approach highlighted the distinct experiences of visible minority participants in relation to a comparison group. Results Of the 1973 unique participants, 117 identified as a visible minority and 949 participants did not identify with an equity-deserving group (comparison group). Visible minority participants were more likely to report that too little attention was paid to their identity and more likely to express a desire for a balance between receiving the best medical care and being treated with kindness and respect. Visible minorities’ ED experiences were also more likely to be impacted by how emergency staff behaved. Qualitative analysis revealed negative experiences of feeling uninformed and disempowered, facing judgement and discrimination, and experiencing language barriers. Positive experiences of receiving compassionate care from staff also emerged. Conclusion Visible minority perceptions of ED care were often negative and mainly focused on staff treatment. Cultural competency and language translation services are key areas for improvement to make ED care more accessible and equitable.

Age-Related Changes in Insulin Resistance and Muscle Mass: Clinical Implications in Obese Older Adults.

The older segment of the global population is increasing at a rapid pace. Advancements in public health and modern medicine lengthened life expectancy and reduced the burden of disease in communities worldwide. Concurrent with this demographic change is the rise in overweight people and obesity, which is evident in all age groups. There is also an aging-related reduction in muscle mass and function, or sarcopenia, that is exacerbated by sedentary lifestyle and poor nutrition. The coexistence of muscle loss and elevated body mass index, termed "sarcopenic obesity", has particularly deleterious consequences in older individuals. Worsening insulin resistance and a proinflammatory state operate at the pathophysiologic level and lead to adverse health outcomes such as a proclivity to cardiovascular disease, type 2 diabetes, and even cognitive dysfunction. Although the concept of sarcopenic obesity as a disease construct is being increasingly recognized, a clearer understanding is warranted in order to define its components and health impact. Research is needed at the molecular-cellular level to tie together derangements in insulin action, cytokines, myokines, and endothelial dysfunction with clinical outcomes. Lifestyle modifications as well as targeted nonpharmacologic approaches, such as supplements and antioxidants, appear to have a promising role in reducing the chronic burden of this emerging disorder. Breakthroughs in drug therapies that retard or even reverse the underlying dynamics of sarcopenia and obesity in older persons are being actively explored.

Identifying Veterans with a Higher Risk of Social Needs Using Cluster Analysis.

Many social need screening to advance population health and reduce health disparities, but barriers to screening remain. Improved knowledge of patient populations at risk for social needs based on administrative data could facilitate more targeted practices, and by extension, feasible social need screening and referral efforts. To illustrate the use of cluster analysis to identify patient population segments at risk for social needs. We used clustering analysis to identify population segments among Veterans (N=2010) who participated in a survey assessing nine social needs (food, housing, utility, financial, employment, social disconnection, legal, transportation, and neighborhood safety). Clusters were based on eight variables (age, race, gender, comorbidity, region, no-show rate, rurality, and VA priority group). We used weighted logistic regression to assess association of clusters with the risk of experiencing social needs. National random sample of Veterans with and at risk for cardiovascular disease who responded to a mail survey (N=2010). Self-reported social needs defined as the risk of endorsing (1) each individual social need, (2) one or more needs, and (3) a higher total count of needs. From the clustering analysis process with sensitivity analysis, we identified a consistent population segment of Veterans. From regression modeling, we found that this cluster, with lower average age and higher proportions of women and racial minorities, was at higher risk of experiencing ≥ 1 unmet need (OR 1.74, CI 1.17-2.56). This cluster was also at a higher risk for several individual needs, especially utility needs (OR 3.78, CI 2.11-6.78). The identification of characteristics associated with increased unmet social needs may provide opportunities for targeted screenings. As this cluster was also younger and had fewer comorbidities, they may be less likely to be identified as experiencing need through interactions with healthcare providers.

Incorporating multiracial and multiethnic experiences into genetic counseling practice and research: A necessary opportunity.

The conflation of race and genetic ancestry can have harmful consequences. Biological conceptualizations of race have long been used to justify inequities and distract from social structures that afford opportunities to some that are unjustly denied to others. Despite recent efforts within the scientific community to distinguish between the sociopolitical constructs of race and ethnicity and the biological constructs of genetic ancestry and genetic similarity, their conflation continues to influence genomic research and its translation into clinical care. One overlooked aspect of this problematic conflation is the extent to which discrete monoracial and monoethnic categorization systems persist and perpetuate unequal benefit-sharing in the clinical translation of genomic technologies. In genetic service delivery, reliance on discrete racial and ethnic categories undermines the clinical translation of genomic technologies for large segments of the global population. For multiracial and multiethnic individuals, who have complex identities that defy discrete categorization systems, the potential benefits of genomic discoveries are especially elusive. Scholars have recently begun to call for the inclusion of multiracial, multiethnic, and admixed individuals in race, ethnicity, and ancestry frameworks in genetics and genomics. However, little work has been done to explore and address the unique challenges and opportunities posed by multiracial/multiethnic individuals in genetic counseling specifically. We discuss how conceptualizing diversity along discrete racial and ethnic lines perpetuates inequitable patient care and limits efforts to increase inclusion and belonging within genetic counseling. Moreover, we argue that ongoing efforts to mitigate racial inequity must actively challenge the paradigm of monoracial and monoethnic categories to accomplish their goal.

Fostering Future Investors: Analysing Determinants of Stock Market Participation Among Malaysian Students using PLS-SEM

Participation in the stock market is crucial for financial engagement and wealth creation. However, specific population segments, such as students from higher learning institutions, may exhibit lower stock market participation levels. Addressing this issue, this study uses the behavioral finance theory to examine how financial literacy, financial well-being, herding behavior, overconfidence bias, risk tolerance, social interaction, and investment intention influence stock market participation. Data was collected through a self-administered questionnaire distributed to 669 university students in Malaysia aged 17-30 years old. The findings reveal that financial literacy, herding behavior, risk tolerance, and social interaction positively influenced investment intention. The study also discovered that investment intention positively influences stock market participation. This study has made significant contributions to both theory and practice. Theoretically, this study contributes to the literature by confirming the positive relationship between financial literacy and investment intention. This study contributes to the development of more effective interventions and policies that not only educate students about an essential aspect of financial literacy but also prepare them for a financially secure future.

Linking resource selection to population performance spatially to identify species' habitat across broad scales: An example of greater sage-grouse in a distinct population segment.

Management decisions often focus on the habitat selection of marked individuals without considering the contribution to demographic performance in selected habitats. Because habitat selection is not always adaptive, understanding the spatial relationship between habitat selection and demographic performance is critical to management decisions. Mapping both habitat selection and demographic performance for species of conservation concern can help guide population-scale conservation efforts. We demonstrate a quantitative approach to differentiate areas supporting selection and survival at large spatial extents. As a case study, we applied this approach to greater sage-grouse (Centrocercus urophasianus; hereafter, sage-grouse), an indicator species for sagebrush ecosystems. We evaluated both habitat selection and survival across multiple reproductive life stages (nesting, brood-rearing) in the Bi-State Distinct Population Segment, a genetically distinct and geographically isolated population of sage-grouse on the southwestern edge of the species' range. Our approach allowed us to identify both mismatches between selection and survival and trade-offs between reproductive life stages. These findings suggest resource demands vary across time, with predation risk being a dominant driver of habitat selection during nesting and early brood-rearing periods when chicks are smaller and flightless, whereas access to forage resources becomes more important during late brood rearing when resources become increasingly limited. Moving beyond identifying and managing habitat solely based on species occupancy or use by incorporating demographic measures allows managersto tailor actions to their specific goals; for example, protections of areas that support high selection and high survival and restoration actions focused on increasing survival in areas of high selection and low survival.

Who is ready to live a car-independent lifestyle? A latent class cluster analysis of attitudes towards car ownership and usage

An excessive use of private cars for transportation has multiple negative effects on our society. It is therefore paramount to identify the underlying factors driving car usage among different segments of travellers. In this study, we aim to identify and characterise traveller segments in terms of their car-related attitudes and how different sociodemographic attributes, travel behaviour characteristics (such as using cars as the primary mode of transportation), and the accessibility of their place of residence vary amongst different population segments. Through Confirmatory Factor Analysis and Latent Profile Analysis we identify five different classes, namely car-detractors, −hesitants, −positives, −friends, and −lovers. More favourable car attitudes are associated with higher car ownership and access but, interestingly, there are no significant differences in terms of travel frequency and trip length distribution. This suggests that attitudinal differences relate mostly to modal preference rather than to the underlying travel demand patterns and the associated activities. We also see that car-less individuals are more likely to be car detractors, suggesting that the experiencing barriers for owning a car may contribute to developing more negative attitudes towards cars. Our results shed light on the different influencing factors and characteristics of individuals that consider, or not, a car-centred mobility.

Abstract B144: Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors

Abstract Background: Sub-Saharan African immigrants (SSAI) in the United States (US) constitute one of the fastest-growing segments of the immigrant population. Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that period. We define SSAI as the 2 million individuals living in the US originally from the region of the African continent located south of the Saharan desert. Despite their growing numbers, little is published about the extent to which SSAI adapt to health behaviors more common in the US or remain immersed in the values, beliefs, and practices reflective of their country of origin. Importantly, no study has comprehensively examined the social determinants of health factors among this population and its influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment. Aim: This study seeks to better understand the lived experiences, unmet needs and the impact of migration on the quality of life of SSAI cancer survivors in the US. Methods. We employ a qualitative approach guided by grounded theory. Selective sampling was used to identify potential participants from a database obtained via the Florida and Minesota cancer registries. We proceeded to conduct in-depth interviews with 16 cancer survivors recruited from the two caner registries. Results. We developed a conceptual framework illuminating the full range of social, behavioral, environmental, and structural factors associated with the experiences of SSAI prostate cancer survivors. From the data, the post diagnosis experiences of study participants can be categorized into three domains: 1) health behaviors; 2) treatment decision and antecedents; 3) challenges of being an immigrant. Characteristics of health behaviors include using informal care teams for social support and second opinions before treatment. Selective disclosure of diagnosis, changes to diet, exercise and searching for information about the diseases were other manifestation of behavior. While some participants made decisions about treatment soon after diagnosis, others took a more deliberative approach and relied on faith and family for social support. Some challenges in terms of being an immigrant include knowledge gaps about the US health system, lack of health insurance and transportation to hospital during treatment. Implication for public health practice. Some of the unmet needs of study participants include transportation cost to and from hospital for radiotherapy and other treatment and reducing the high out of pocket cost for co-payment and drugs. The knowledge deficit about navigating the US health system can be addressed through community-based intervention in partnerships with immigrant groups, advocacy organizations and faith-based organizations. The focus of this intervention should be to educate and empower SSAI men on how to navigate the US health system and be more assertive about their health needs and desires for treatment during doctor’s visit. Citation Format: Ernie Kaninjing, Gladys Asiedu, Kaitlin Van Voorhis, Daniel Lee, Rakinya Hinson, Mary Ellen Young. Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B144.

Efforts to Introduce an Indigenous Identifier in a Canadian Provincial Health Authority

Across Canada, Indigenous identity data is not routinely collected in healthcare settings. This paper focuses on [province] and whether the largest and only province-wide healthcare services organization in Canada, [healthcare organization name] should implement an Indigenous identifier in their new electronic medical record system. Due to the current absence of an Indigenous identifier, it is difficult to identify Indigenous peoples in administrative healthcare data to guide healthcare decision-making specifically for Indigenous peoples and to assist with population-specific disease surveillance and prevention programs. Moreover, it is often challenging for Indigenous nations, communities, and organizations to access this data. The data that does exist in [province] frequently excludes large segments of the Indigenous population. Indigenous researchers globally have called for improved health data in alignment with Indigenous research principles, data governance and sovereignty. This paper reports on an exploratory study of potential avenues to enhance availability of Indigenous specific health data in [province]. Of interest are possible supports, concerns, and potential barriers for the introduction of a policy to collect self-disclosed Indigenous identity data in the [org] new electronic medical record system. This research included interviews and focus group sessions with diverse subject matter experts including academics, Indigenous health practitioners and healthcare administrators. The project was embedded in the [removed] which is an [province] based research network for improving primary health with and for Indigenous peoples

Does child abuse predict a population segment with large economic burden?

ObjectivesThe enormous societal and individual consequences of mental health disorders and detrimental health behaviours in the general population are of paramount concern. Many argue that ‘prevention is the best cure’, pushing for the implementation of early (preventive) interventions. Key questions regarding early interventions include which population segment to target for screenings and what information these screenings should focus on. In line with previous efforts, this study aimed to identify which population segment holds the majority (≥ 80 %) of different economically costly outcomes in society, and whether child abuse before the age of 16 years predicts being part of that population segment. Study designEpidemiological cohort study. MethodsThis study used the Netherlands Mental Health Survey and Incidence Study-2, a Dutch epidemiological cohort study including 6646 adults aged 18–64 years at baseline, spanning four timepoints from 2007 to 2018. Cumulative distributions were computed to identify high-cost population segments of economically costly outcomes in adulthood (i.e., mental and physical health [behaviours], unemployment and work absenteeism). Child abuse was examined as a potential predictor of these segments and the risk of multiple high-cost population segment membership was investigated by conducting Poisson regressions. ResultsA 20 % population segment carried between 42 % and 100 % of economically costly outcomes. Being exposed to more child abuse predicted being in a high-cost population segment, albeit with small effect sizes. Being exposed to more child abuse also predicted belonging to multiple high-cost population segments across different economically costly outcomes. ConclusionsThe study findings have implications for policy makers. Emphasis should be placed on prevention aimed at identifying potential members of multiple high-cost population segments.