Social Determinant Factors Research Articles

A Healthy Lifestyle Intervention for Hispanic Families: Moderating Effects of Education, Income, Nativity

ObjectiveTo explore the moderation effect of parental social determinant factors—educational attainment, income, and nativity—on intervention effects of a family-based lifestyle intervention, Familias Unidas for Health and Wellness (FUHW). DesignLongitudinal analysis across 6- and 24-months postbaseline of a randomized controlled trial. ParticipantsTwo-hundred and eighty primary caregivers. AnalysisModeration analysis was used to examine the interactive effects between intervention effects and social determinant factors. Main Outcome MeasuresParental body mass index, added sugar intake, sugar-sweetened beverage intake, and fruits and vegetable intake. ResultsFindings indicated that FUHW effects on added sugar intake were moderated by educational attainment (P = 0.006), income (P = 0.023), and nativity (P = 0.024). In addition, FUHW effects on sugar-sweetened beverage intake were moderated by parent education (P = 0.042). Conclusions and ImplicationsThis study suggests that FUHW may be helpful in reducing added sugar and sugar-sweetened beverage intake for Hispanic parents who face social determinant factors—educational attainment, income, and foreign-born status—that may influence their dietary behaviors. By including demographic information in intervention development, effects may be enhanced by ensuring that considerations related to participants’ socioeconomic and cultural status are incorporated into intervention components and help reduce overweight and obesity.

4-OR: Racial/Ethnic Disparities in Diabetes Self-Care in Young Adults (YA) with Type 1 Diabetes (T1D)

Background: Racial/ethnic disparities in diabetes self-care among YA with T1D may contribute to worse outcomes. We conducted a secondary data analysis of the Young Adult Racial Disparities in Type 1 Diabetes (YARDD) study to determine racial-ethnic differences in self-care and contributory factors. Methods: The YARDD study recruited a diverse cohort of YA with T1D aged 18-28 years from six diabetes centers across the U.S. and collected cross-sectional information on sociodemographics, social determinants of health, clinical factors, psychosocial variables, and diabetes self-care. We performed multivariable linear regression to examine the association of race/ethnicity with a measure of diabetes self-care (Self-Care Inventory Revised (SCI-R)), and related factors. Results: We included 299 YA with T1D: median age 20 years (IQR 19-22); 55% female (n=162); 33% each non-Hispanic White, non-Hispanic Black, and Hispanic. Compared with White YA, Black YA reported slightly lower SCI scores (B= -6.81/100, P=0.006), while Hispanic YA reported similar scores (B=-1.33/100, P=0.58). In multivariate analyses, race/ethnicity accounted for little variability in SCI score (adjusted R-squared=0.02), while age, sex and diabetes distress explained significant variability (adjusted R-squared=0.24). Diabetes distress scores on the Diabetes Distress Scale were slightly higher in Black YA than Hispanic or White YA (B= 0.38/6.0, P=0.01). Discussion: In this large national study of YA with T1D, race/ethnicity was not independently associated with differences in diabetes self-care after accounting for demographic, social determinant, psychosocial, and clinical factors. However, diabetes distress was slightly higher among Black YA with T1D and had a strong association with diabetes self-care, providing a potential race-specific target for intervention. Disclosure R. Sadiq: None. M. Fazzari: None. S. Nahvi: Research Support; Self; Pfizer Inc. C. Cunningham: Employee; Spouse/Partner; GE Healthcare, Stock/Shareholder; Spouse/Partner; GE Healthcare. S. Agarwal: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115869); National Center for Advancing Translational Science (UL1TR002556)

The Role of Social Determinants in Mental Health and Resilience After Disasters: Implications for Public Health Policy and Practice.

In this general literature review, we will explore the impacts and contribution of social determinants to mental health and resiliency following both natural and man-made disasters. Natural disasters, such as wildfires, earthquakes, tsunamis, and hurricanes, as well as man-made disasters, such as civil wars, have been known to inflict significant damage to the mental health of the victims. In this paper, we mainly explore some most studied vulnerability and protective social determinant factors such as gender, age, ethnicity, socials support and socioeconomic status for the mental health and resiliency in survivors of such disasters. Several other possible factors such as previous trauma, childhood abuse, family psychiatric history, and subsequent life stress that were explored by some studies were also discussed. We conducted a literature search in major scientific databases, using keywords such as: mental health, social determinants, disasters, wildfires, earthquakes, terrorist attacks, and resilience. We discuss the implications for public health policy and practice.

'If relevant, yes; if not, no': General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory.

The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about 'sense' making and 'engagement'. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as 'ethnicity' in the limited time available in consultations was also worrying. Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants' views and the EU GDPR.

Exploring access to, use of and benefits from population-oriented digital health services in Australia.

The provision of population-oriented, on-demand digital health services in many countries exemplifies the perceived utility of digital health services in supporting population health. Yet, limited knowledge exists regarding the equity of these services. Using mixed-method research, we recruited users of a health website and general practice patients to surveys (n = 441) and telephone interviews (n = 40). We contribute specific evidence investigating barriers to access, use and benefit from digital health services within an equity framework that incorporates social determinant factors, eHealth Literacy and trust. Our research highlights the foundational role of trust in predicting use, showcases which groups are unlikely to benefit from population-oriented digital health services, and proposes strategies to enhance the equity of these services. The theoretical framework we developed serves as a roadmap for future health promotion research and action by outlining the complex and interrelated pathways that can promote and threaten digital health equity.

Corrigendum to: Descriptive analysis of social determinant factors in urban communities affected by COVID-19.

Corrigendum to: Descriptive analysis of social determinant factors in urban communities affected by COVID-19.

92. PERSPECTIVES ON THE PEDIATRICIAN'S ROLE IN SOCIAL DETERMINANTS OF HEALTH: A NATIONAL SURVEY OF CHIEF RESIDENTS

Background Pediatric resident physicians often care for underserved populations and are expected to address social determinants of health (SDH); however, training varies in the identification of and referral to appropriate local resources. Pediatric physicians have reported insufficient knowledge and confidence as reasons for not addressing SDH, but report higher satisfaction when they do address SDH factors in the care of their patients. We aimed to assess chief resident perspectives of the pediatrician's role in, knowledge of, and referral to community resources which mitigate SDH. Methods We performed a national web-based survey of pediatric chief residents in Fall 2019 on their perspectives of SDH referrals, specifically regarding their knowledge of resources, their responsibility to refer, how often they refer, and confidence level in referring. Social determinant resources included: Development & Early Childhood Services, Education Resources, Dental Services, Mental Health, Housing, Parental Employment & Financial Support, Food Insecurity Support, Recreational/Physical Activity Needs, Legal Aid, Transportation Access, Domestic Violence, Parental Substance Use, and Parental Literacy Support. Results 28% (42/150) of programs responded. Chief residents agreed they must have knowledge of and hold responsibility to refer to many social determinant factors; however, practices and confidence levels in referring to resources were often low. For instance, 90% agreed that general pediatricians must have knowledge of housing resources, yet only 45% reported always or often referring, while 36% felt confident in their ability to refer. Chief residents reported lack of knowledge of resources and time constraints as the top factors influencing referring to social needs resources. Conclusions Understanding the specific resources pediatricians lack knowledge of and confidence in referring to can help develop and tailor residency curriculum in SDH screening, referral, and community resources.

The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes.

This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA1c) in older adults with diabetes. Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA1c from the time period were used and treated as time varying in analyses. SAS PROC GLIMMIX was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting. Before adjustment for demographics, difficulty paying bills (β = 0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA1c over time. Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.

Public Health 2020

Journal of Public Health and Nutrition is an international peer-reviewed, open access journal that prioritizes publication of articles in the field of Public Health Research and Nutritional Science. The journal has special focus upon various research outputs and social determinant factors and encourages publishing multidisciplinary articles. The journal publishes current developments and scientific information as Research articles, Review articles, Case reports, Short communications, Mini Reviews, Commentaries, Image articles, Special issues, Thesis, etc. and provide online access without any restrictions or subscriptions to the researchers worldwide.

The Social Determinant Factors and Policy Recommendations for an Efficient Management of State Educational Funding: A Case of Vocational Education in Thailand(

The Social Determinant Factors and Policy Recommendations for an Efficient Management of State Educational Funding: A Case of Vocational Education in Thailand(

Social Determinant Factors of Elderly as an Input in Enhancing Primary Health Care in Indonesia

Objective: To analyze the differences of social determinant factors among elderly according to gender, in urban and rural areas in Indonesia. Indonesia is one of the most populated countries in the world, faces an increased number of elderly. This situation leads to the increase of degenerative diseases and demands of caregivers as well. The identification of social determinant factors of elderly has an important role in enhancing primary health care. Methods: A comparative study was carried out in 33 provinces in Indonesia using secondary data from Statistics Indonesia 2013. The variables included in this study were percentage of elderly according to education, marital status, occupation, income and living arrangements, divided in gender, urban and rural areas. The normally distributed data were analyzed using unpaired T test and not normally distributed data were analyzed using Mann-Whitney test. Results: This study showed that there were differences in education, occupation and income between urban and rural areas. In urban area, most of the elderly worked in industry and trade and in rural area they worked in agricultural, indicated huge risks of occupational haxards. Most of them were poor, still married, lived with spouses and family of three generations. Conclusions: It can be concluded that there were differences of social determinant factors (education, occupation and income) in elderly who live in urban and rural areas that can contribute to the risks of disease in elderly and these situations must be considered as an input to enhance the primary health care. Keywords: Elderly, gender, rural, social determinants, urban

Post Stroke Depression: the Mechanisms, Prevention and Therapy Through Holistic Treatment Approach

Background/ObjectivesStroke is the third most common cause of disability and second most common cause of death worldwide. At least one‐third of stroke survivors suffer from depression.Depression is a common complication of stroke, leading to increased morbidity and mortality, and is defined as depressed mood on a daily basis for a minimum duration of two weeks.Objective is to investigate the causal associations between post stroke depression and its outcomes. To evaluate the associations between stroke and depression in Nigerians adults living American and in NigeriaMethodInvestigation of post stroke depression in American adults and Nigerian‐American adult living in America and Nigeria.Holistic clinical approach interventions when treating PSD for better outcome than pharmacological only approach. These includes: Adult day care, dietitian, speech therapy, social services, PT, OT, yoga, psycho‐therapy, primary care clinicians, family and friends.Results/discussionStudy participants living with other people did better than those living alone P‐value 0.05.ConclusionStroke has been identified as one of the prioritized non‐communicable diseases the hope is that the promotion and endorsement of new, more‐effective approaches for the prevention of stroke and CVD, in combination with prevention strategies, will change current practice worldwide, thereby saving millions of lives. By complementing cost‐effective individual health‐care interventions with population‐wide prevention strategies, to make a substantial impact on the global non‐communicable diseases. There are many factors that have effects on PSD. The severity of stroke is an important factor in the occurrence of PSD. Mental history is a possible predictor of PSD. Prevention of PSD requires social and family participation, and holistic therapy approach.RECOMMENDATIONSThe recommendations listed below must be considered. For any successful outcome in treating PSD, nursing, social worker, family members, and power of attorney or guardians should team up for better living arrangement, because this study showed that patients living with others have better outcomes than those living alone. Social determinant factors cannot be ignored in this patient population. Considering social determinant factors such as level of poverty, less than high school education, median house income, employment, transportation factors all play a role for successful outcome in managing PSD. Support or Funding InformationEinstein Institute ‐ USATThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

FAKTOR DETERMINAN SOSIAL YANG MEMPENGARUHI KEGAGALAN PEMBERIAN ASI EKSKLUSIF DI SRATUREJO, BAURENO, KOTA BOJONEGORO

The breast milk is the best food for babies right for infancy up to 6 months. Breast milk not only benefits the baby, but also brought benefits the mother. Globally, only 38% of infants aged 0 - 6 months are exclusively breastfed. The latest analysis of non-exclusive breastfeeding contributes to 11.6% of deaths in children under 5 years of age. This is equivalent to around 804,000 child deaths in 2011 (WHO, 2012). This research was conducted to analyze the social determinant factors that affect the failure of Exclusive Breast Feeding in Sraturejo, Baureno , Bojonegoro City. This research was an observational analytic study with a quantitative approach. The research was a cross sectional design. The research was conducted in Sraturejo Village, Baureno, Bojonegoro from 3 July to 9 August 2018. The population were 150 mothers who had children aged 0-24 months. The sample is calculated using the simple random sampling formula which resulted to 110 mothers who have babies 0-24 months of age. The data collection technique used primary data, by filling out the questionnaires of knowledges, attitudes, and behaviors. Then the priority of the problem will be determined using the USG matrix, which the proceeded with finding the cause of the problem with the metaplan technique and a fishbone diagram to identify the root causes of a problem. Then the analysis is conducted with the SWOT method. The results showed no corelation between knowledge and behavior, and there was no corelation between attitude and behavior. Other social determinants discovered are information, methods, economics, environment, individuals, and health. The social determinant factors that most affected the failure of exclusive breastfeeding are economic factors, such as working mothers. The conclusion is that working mothers affected the failure of exclusive breastfeeding.

Predicting student attrition using social determinants: Implications for a diverse nursing workforce.

Attrition of academically qualified nursing students affects the size of the nursing workforce. A better understanding of the multifaceted predictive factors of attrition is needed to inform targeted interventions to promote program progression and maintain an adequate nursing workforce. The purpose of this study was to identify demographic, academic, and social determinant factors associated with attrition at the end of the first semester in an upper-division baccalaureate nursing program. Students' demographic and academic data from an administrative database were combined with social determinants data collected via a web-based survey. Among this cohort (n=164), social determinants were significantly associated with attrition. A significantly greater percentage of students who failed were born outside the United States (U.S.), had one or both parents born outside the U.S., reported English was not the primary language spoken in the home, and were racially/ethnically diverse. Attrition was primarily among students with diverse racial, ethnic, and/or cultural backgrounds, which has implications for achieving a diverse nursing workforce. Proactive strategies to support success should be especially targeted on diverse students.

Gay Identity and HIV Risk for Black and Latino Men Who Have Sex with Men.

Strong gay identity among white men who have sex with men (MSM) has been associated with decreased HIV risk, but data for black and Latino MSM (BLMSM) are inconclusive. We examined gay identity and HIV risk among BLMSM to inform social and structural HIV intervention strategies. BLMSM were administered a computerized survey as part of an HIV research study during 2011-2012 conducted in New York City. We used a brief scale of Gay Identity Questionnaire. After data analysis, Stage I (not fully accepting) and Stage II (fully accepting) gay identity were determined based on participant responses. We used logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between gay identity with HIV risk and social determinant factors. Among 111 self-identified BLMSM (median age = 32 years, 68.4% with some college or higher education), 34.2 reported receptive anal sex without condoms in the previous three months. Gay Identity Questionnaire Scale assessment indicated that 22 (19.8%) were Stage I, and 85 (76.6%) were Stage II in this BLMSM sample. Stage II gay identity was more likely seen among BLMSM with high involvement in the gay community (aOR 3.2; CI 1.00, 10.26) and less likely among BLMSM who exchanged sex for food or shelter (aOR 0.15; CI 0.02, 0.98). Fully accepting gay identity may be protective for BLMSM as it relates to transactional sex; these factors warrant further research and consideration as part of HIV prevention strategies.

Association between untreated carious lesions and asthma in adults at Rabat University Hospital, Morocco: a cross sectional study

BackgroundDepending on risk factors, cumulative risk of developing more dental caries by age has been reported. However, the association between dental caries and asthma is less studied among adults. The aims of this study were to evaluate the severity of untreated carious lesions in a population of asthmatic adults and to evaluate the mediation of socio-economic and oral health behaviour variables.MethodsThe study involved participants with diagnosed asthma (N = 100) and control (N = 100) subjects attending a tertiary hospital. Groups were matched by age and gender. Asthma was the exposure of interest. The outcome measure was the rate of carious lesions. Recorded variables included demographics, socio-economic status, tooth brushing habits and oral health status using WHO criteria. Poisson regression analysis examined the association between asthma and untreated dental caries.ResultsThe adjusted model, after the inclusion of individuals’ behaviours regarding oral health, social determinants and asthma, revealed a significant association between the number of untreated carious lesions and asthma (PR = 1.23; 95% CI 1.23–1.58; p < 0.001).ConclusionPatients with asthma showed a greater number of untreated carious lesions. Looking forward, better understanding of the association between asthma and oral health may require exploiting the interactions of behavioural, social determinant and biological factors.

The Impact of National Health Insurance Program on Household Health Expenditures and Utilization of Health Services in Indonesia

Background: Indonesia has implemented social security program through Government-run health insurances through PT. ASKES for civil servants and pensioners, PT. JAMSOSTEK for private employees, provided Community Health Insurance scheme (JAMKESMAS) and Regional Health Insurance (JAMKESDA) for the poor. Since 2014 central government has implemented JKN (jaminan Kesehatan Nasional or National Health Insurance) scheme which basically merged all various government-run social security for health in a single Social Security Agency namely BPJS(Badan Penyelenggara Jaminan Sosial). This study examines the impact of JKN implementation on households health expenditure and health care utilization by comparing before and after the implementation of JKN in 2014 using IFLS (Indonesian Family Live Survey) 2007 and IFLS 2014 data. Method: This study was an analytical study based on quantitative data using two panel data from IFLS (Indonesian Family Life Survey) or IFLS-4 2007dan IFLS-5 2014, by using univariate, bivariate, multivariate regression method and fixed effects regression analysis. Result: Compared to situation in 2007, the implementation of National Health Insurance (JKN) in 2014 had impacted on improving utilization of health care facilities. On the other hand, social determinant factors such as increasing household income, education level of household heads, having family members aged 65 old and above, having children below five years old, increasing health needs in 2014, resulted in increasing household health expenditure in Indonesia. JKN also has no significant impact on reducing catastrophic health expenditure. Conclusion: Health insurance program in Indonesia had significant impacted on increasing utilization of health facilities, but had no significant impacted in reducing household health expenditure in Indonesia.

An Examination of Gendered Violence and School Push-Out Directed Against Urban Black Girls/Adolescents: Illustrative Data, Cases and a Call to Action

ABSTRACTThis article focuses on Black girls/adolescents, a frequently neglected group, given a dominant focus on Black males and their risk status within the school-to-prison pipeline. This article provides a framework for the analysis of the gendered violence to which Black girls/adolescents are subjected while urging a shift in focus from individual-level behavior to a focus on social contextual, structural, and social determinant factors; this means a shift from focusing on proximal factors to distal or upstream factors operating as underlying mechanisms. Both illustrative data and cases are presented and analyzed to highlight how racial disparities in suspension, expulsion, and discipline—which disproportionately negatively impact Black girls/adolescents compared to White girls/adolescents—necessitate a major call to action to close these disturbing gaps.

What makes stroke rehabilitation patients complex? Clinician perspectives and the role of discharge pressure.

BackgroundApproximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of ‘complex patients’. No single definition of ‘patient complexity’ exists; therefore, applied health researchers seek to understand ‘patient complexity’ as it relates to a specific clinical context.ObjectiveTo understand how ‘patient complexity’ is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity.MethodsA qualitative descriptive approach was utilized. Twenty-three stroke rehabilitation clinicians participated in four focus groups.ResultsFive elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors to identify complexity results in all patients being complex; operationalization of the definition led to the identification of systemic elements. A disconnect between acute, inpatient rehabilitation and community services was identified as a trigger for increased complexity.ConclusionsPatient complexity is not a dichotomous state. If applying existing complexity definitions, all patients are complex. This study extends the understanding by suggesting a structural element of complexity from manageable to less manageable complexity based on ability to discharge.

Epidemiological Pattern of Scabies and Its Social Determinant Factors in West of Iran

Objectives: Scabies has a different epidemiological distribution among different communities worldwide due to different social factors, management approaches and healthcare policies. The present study came to address outbreaks of scabies according to the social factors in west of Iran. Methods: In a cross-sectional study, using the census sampling method, all consecutive patients with the primary diagnosis of scabies based on clinical manifestations referred to healthcare center throughout the two great provinces of Hamadan and Kermanshah at western Iran between March 2006 and February 2010 were enrolled into the study. The baseline characteristics were collected from recorded files at the healthcare centers or by interviewing with the affected patients. Results: Among 3,625,966 subjects covered by the two studied provinces, 177 cases of scabies (170 cases in Kermanshah and 7 cases in Hamadan) were identified by medical staff at the healthcare centers according to clinical manifestations (85.3%) and laboratory microscopic assessments (14.7%). The highest and the lowest prevalence rates were specified to 2009 (58.2%) and 2008 (1.7%). Regarding gender distribution of disease, 53.1% of men and 46.9% of women suffered from scabies with no significant discrepancy. In respect to age distribution of disease, the highest rates of scabies were revealed in the ages ranged 17 to 30 years (31.6%), followed by younger than 17 years (30.5%). The prevalence of scabies was dependently associated with residency in rural areas, family history of scabies, lower educational level, household density, lower monthly income, low personal hygiene, the existence of livestock or rodents at home, seasonal conditions, and movement to contaminated areas. Conclusion: West region of Iran especially Kermanshah province faced with high prevalence and this high disease burden can be determined by some potential factors such as residency in rural areas, family history of scabies, lower educational level, household density, lower monthly income, low personal hygiene, the existence of livestock or rodents at home, seasonal conditions, and movement to contaminated areas.