Social Risk Index Research Articles

Social Markers of Differences in Fruit and/or Vegetable Consumption Among Brazilians: An Intersectional Analysis

Objective The objective of this study was to examine the differences in fruit and/or vegetable consumption (FVC) among Brazilian adults by examining various social markers, such as gender, race, income, and education level. Method A cross-sectional study of 88,531 Brazilian adults aged 18 years or older who participated in the 2019 National Health Survey was conducted. The dependent variable was irregular FVC (<5 d/wk). Individuals at the highest risk for irregular FVC include those who are men and Black and who have lower education levels and lower income. Individuals at lower risk include those who are women and White and who have higher education levels and higher income. The prevalence of irregular FVC was calculated considering the levels of the social risk index for FVC and the intersections among two, three, and four risk categories. Odds ratio (OR) and 95% confidence interval (CI) analyses were performed to compare groups at higher risk with those at lower risk. Results The prevalence of irregular FVC was 57.2% in the general population, 38.1% for individuals in the lowest risk group, 47.5% for individuals in one risk category, 57.9% for individuals in two risk categories, 67.6% for individuals in three risk categories, and 74.4% for individuals in the highest-risk group, and there were significant differences at each level. The highest risk group had a 4.36 (95% CI, 3.86–4.92) times greater chance of irregular FVC. Conclusions The complex path to promote FVC among the Brazilian population underscores the need for intersectoral policies aimed at reducing inequalities.

Moderating effect of social risk on the relationship between biological risk and child development.

Human development is influenced by the interaction between biological and social factors. This study aimed to verify the moderating effect of social risk on the relationship between biological risk and child development. Data were collected on 201 children, aged 6 to 72 months. The independent variable was measured by the biological risk index, and the moderator variable by the social risk index was assessed by the Denver II test. Linear regression, effect size, and analysis of moderation were used to verify the relationship between BRI and the child development (Denver II), and the moderating effect of the SRI. BRI was negatively associated with child development, the interaction between the BRI and SRI increased the explained variance in the Denver II result to 14%. The SRI was also a significant moderator of the Language and Gross Motor domains. This research evidence that social risk moderates the relationship between biological risk and child development, the more social risk factors, the stronger this relationship becomes. On the other hand, it can be said that some social factors favor child development, even in the presence of biological risk factors.

Increasing Social Determinants of Health Screening Rates Among Six Endocrinology Centers Across the United States: Results From the T1D Exchange Quality Improvement Collaborative.

Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months.

1074-P: Multicenter Quality Improvement Project—Increasing Social Determinants of Health (SDOH) Screening across Six Diabetes Centers in the United States

Background: Social Determinants of Health (SDOH) are strongly associated with outcomes for patients with diabetes. Incorporating widespread clinic SDOH screening programs is challenging. We aim to demonstrate the use of Quality Improvement (QI) interventions in expanding SDOH screening practices across 5 pediatric and 1 adult diabetes center in the T1D Exchange Improvement Collaborative (T1DX-QI). Method: The centers applied QI principles to design iterative plan-do-study-act (PDSA) cycles to develop and expand interventions to improve screening rates. The interventions include staff training, creating a social risk index, using EHR patient-facing portal, partnership with community organizations, referral to clinic, and community resources. The centers shared monthly aggregate data with the coordinating center. Statistical Process Control charts were created and analyzed for significant shifts. Result: All centers successfully implemented SDOH screening, and improvement ranged from 41% to 68%. Overall screening increased from baseline by 56% in 24 months. Disclosure O.Odugbesan: None. E.J.Hess: None. N.Rioles: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T.Wright: None. N.Yayah jones: Consultant; Medtronic. M.Gallagher: None. J.Ilkowitz: None. S.A.Dei-tutu: None. E.L.Dewit: None. R.Izquierdo: None. M.Desimone: None.

Sensitivity of market performance to social risk index: Evidence from global listed companies in logistics and transportation industry

Sensitivity of market performance to social risk index: Evidence from global listed companies in logistics and transportation industry

An Indicator to Measure the Regional Social Risk: The Case of the Cajamarca Department in Peru

This research starts with a literature synthesis on risk and its measurement; then, as a second point, presents the methodological process for the construction of an index to measure social risk for Cajamarca’s department in Peru, which has been based on the application of probability theory. The estimation methodology addresses two approaches: i) the probability of occurrence of an event that generates a total or partial paralysis of the private sector activity for a specific month, and ii) the probability of occurrence of at least one day of paralysis for a specific month. The data used has been recorded for the period between January 1992 and December 2022, based on journalistic information. The results are plotted in two-time series which show the evolution of the Cajamarca Social Risk Index in basis points for both methodological approaches. Additionally, I present a comparison of the annualized probability of occurrence of Cajamarca’s private sector total or partial paralysis for five-year periods, regional governors, and political parties.

Social Risk Factors Are Associated With Disability Prevalence - Results From 17 States in the 2017 Behavioral Risk Factor Surveillance System.

Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type. The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillance System data from states whose surveys included items about social risk factors. Respondents from 17 US states. Respondents included 136432 adults. Dichotomized social risk factors included food, housing, and financial insecurity, unsafe neighborhood, and healthcare access hardship. Weighted χ2 and logistic regression analyses adjusted for demographic characteristics, measures of socioeconomic position, and comorbid health conditions were used to examine differences in the prevalence of disability by social risk factor and via a social risk index created by summing the social risk factors. Compared to those reporting 0 social risk factors, respondents reporting ≥4 had more than thrice the odds of reporting a cognition ((adjusted odds ratio [AOR]=3.37; 95%CI [2.75-4.13]), independent living (AOR=3.24 [2.52-4.15]), self-care (AOR=3.33 [2.55-4.34]), or any disability (AOR=3.90 [3.24-4.70]); more than twice the odds of reporting a vision (AOR=2.61 [1.93-3.52]) or mobility (AOR=2.72 [2.16-3.41]) disability; and more than 1.5 times the odds of reporting a hearing disability (AOR=1.59 [1.22-2.07]). Incremental increases in the number of social risk factors were independently associated with higher odds of disability. Intervention efforts should address the social context of US adults with disabilities to improve health outcomes.

Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States.

IntroductionSocial risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objective was to determine the association between individual and multiple social risks and the prevalence and burden of arthritis by using a representative sample of adults in 17 US states.MethodsData are from the 2017 Behavioral Risk Factor Surveillance System. Respondents were 136,432 adults. Social risk factors were food insecurity, housing insecurity, financial insecurity, unsafe neighborhoods, and health care access hardship. Weighted χ2 and logistic regression analyses, controlling for demographic characteristics, measures of socioeconomic position, and other health conditions examined differences in arthritis prevalence and burden by social risk factor and by a social risk index created by summing the social risk factors.ResultsWe observed a gradient in the prevalence and burden of arthritis. Compared with those reporting 0 social risk factors, respondents reporting 4 or more social risk factors were more likely to have arthritis (adjusted odds ratio [AOR], 1.92; 95% CI, 1.57–2.36) and report limited usual activities (AOR, 2.97; 95% CI, 2.20–4.02), limited work (AOR, 2.72; 95% CI, 2.06–3.60), limited social activities (AOR, 3.10; 95% CI, 2.26–4.26), and severe joint pain (AOR, 1.86; 95% CI, 1.44–2.41).ConclusionIncremental increases in the number of social risk factors were independently associated with higher odds of arthritis and its burden. Intervention efforts should address the social context of US adults to improve health outcomes.

Mining Industry of the Republic of Sakha (Yakutia) and Problems of Environmental and Social Security of Indigenous Peoples

The Republic of Sakha (Yakutia; RS(Y)) is located in the northeast of Siberia (Russia) in the basins of the Lena, Yana, and Indigirka rivers, in the lower reaches of the Kolyma River. Yakutia is an industrial–agrarian republic with a developed mining, fuel, and energy industry. Indigenous peoples live mainly in the Arctic regions, where the large-scale development of mineral resources is planned, and South Yakutia, where the mining industry is well developed. The aim of this study is the development of methodological approaches to assessing the impact of the mining industry on the natural environment and the social sphere in the places of residence and traditional economic activities of the indigenous peoples of the North. We used the results of research work (R&amp;D), materials of expeditionary work, and regulatory documents of the Republic of Sakha (Yakutia) and the Russian Federation (RF). The state of the environment (ES) was assessed on the basis of the analysis of indicators for three areas: (a) anthropogenic load, (b) environmental and social consequences, and (c) resistance of natural complexes to technogenic impacts. In total, 22 indicators were used for the 3 areas, for example, population density, person/km2; the volume of extraction of rock mass, million m3; and emissions, t/year. To bring dissimilar indicators into comparable ones, we used a methodological approach with the use of the social risk index (SRI). In Arctic regions (mainly agricultural), the ES is in a favorable and relatively favorable state: SRI 0.61–0.70; in the central regions (mainly agricultural), it is satisfactory and relatively satisfactory: SRI 0.71–1.0; in the southern and western regions with a developed mining industry, it is relatively tense and tense: SRI 1.01–3.0. An extremely tense state of environmental conditions has developed in the city of Yakutsk: SRI ≥ 3. Generally, the deterioration of the environmental situation and vital activity of the indigenous peoples in investigated Arctic region correlated with the impact of the mining industry.

Influence mechanism of congestion degree of layout on domino effect in petrochemical plants

The study focused on the establishment of the congestion degree in describing the layout of process plants, and discovering the influence mechanism of congestion degree on the risk of domino effect, in view of the fact that the congestion degree has not been used to represent the characteristics of petrochemical plant layout. A characterization model was built for the congestion degree of process plant layouts applying the theory of fuzzy model that it took safety distance, the amount of materials involved and the hazard of these substances into consideration, and came out with a membership function through logical calculus, which made congestion degree a comparable data. Secondly, a systematic domino effect risk analysis method was generalized on account of domino effect quantitative risk analysis method which include the equipment damage probability, the domino effect occurrence probability, risk analysis based on the consequences, individual risk index and social risk index, the process plant natural risk index and real risk index, and then these indices were compared to select the most suitable ones to illustrate the risk of domino effect and to research about part of the storage tank field of a petrochemical plant. Finally, the influence mechanism of layout congestion degree on domino effect of regional accident was obtained through this quantitative analysis. Simultaneously, a range of the congestion degree was acquired according to the individual risk index which can be used as a reference in the design stage of the process plant. The result proved that high congestion degree in process plant greatly increased the risk of domino effect in most of the quantitative risk analysis index, such as the probability of resulting in secondary accidents, the harm on both human and the equipments caused by the initial accident, and the individual risk and social risk, etc. The characterization models for the congestion degree and the domino risk analysis method established and summarized in the study have been applied in the design stage of process plant layout to optimize the layout, and thus reduce the risk of domino effect caused by accidents.

Maternal and family factors differentiate profiles of psychiatric impairments in very preterm children at age 5-years.

Very preterm (VPT; <30weeks gestation) children are a heterogeneous group, yet the co-occurrence of psychiatric and neurodevelopmental impairments remains unclear. Moreover, the clinical and socio-environmental factors that promote resilient developmental outcomes among VPT children are poorly understood. One hundred and twenty five children (85 VPT and 40 full-term) underwent neurodevelopmental evaluation at age 5-years. Parents and teachers completed measures of internalizing, externalizing, attention-deficit/hyperactivity (ADHD), and autism symptoms. Psychiatric and neurodevelopmental measures were analyzed using Latent Profile Analysis. Multinomial regression examined the extent that infant, sociodemographic, and family factors, collected prospectively from birth to follow-up, independently differentiated resilient and impaired children. Four latent profiles were identified, including a Typically Developing Group which represented 27.1% of the VPT group and 65.0% of the full-term group, an At-Risk Group with mild psychiatric and neurodevelopmental problems (VPT 44.7%, full-term 22.5%), a Psychiatric Group with moderate-to-severe psychiatric ratings (VPT 12.9%, full-term 10.0%), and a school-based Inattentive/Hyperactive Group (VPT 15.3%, full-term 2.5%). Clinical diagnoses were highest among the Psychiatric Group (80%). Factors that differentiated resilient and impaired subgroups of VPT children included prolonged exposure to maternal psychosocial distress (p≤.04), current family dysfunction (p≤.05), and maternal ADHD symptoms (p≤.02), whereas social risk index scores differentiated resilient and impaired full-term children (p<.03). Lower levels of maternal distress, family dysfunction, and maternal ADHD symptoms were associated with resilience among VPT children. Maternal distress and family dysfunction are modifiable factors to be targeted as part of psychiatric interventions embedded in the long-term care of VPT children.

Social Adversity and Cognitive, Language, and Motor Development of Very Preterm Children from 2 to 5 Years of Age

To assess the extent to which social and family factors explain variability in cognitive, language, and motor development among very preterm (<30 weeks of gestation) children from 2 to 5 years of age. As part of a longitudinal study, very preterm children recruited as neonates were assessed at 2 (n = 87) and 5 (n = 83) years of age using standardized tests of cognitive, language, and motor ability alongside demographically matched full term (FT) children (n = 63). For very preterm children, developmental change scores were calculated for each domain to assess within-individual variability to 5 years of age. Multivariate regression and mixed-effect models examined social risk index, parenting stress, family functioning, and maternal intellectual ability as predictors of developmental variation among very preterm children. Very preterm children demonstrated poorer cognitive, language, and motor abilities than FT children at 2 (P ≤ .001) and 5 (P < .002) years of age. Social adversity was associated with cognitive (P < .001) and language (P < .001) outcomes at both ages, with parenting stress also related to cognitive outcomes (P = .03). Infant medical risk was associated with motor outcome at 5 years (P=.01). Very preterm children showed considerable within-individual variation between assessments. Among very preterm children, neonatal white matter abnormalities predicted worsening cognitive (P=.04) and motor development (P = .01). Social risk index predicted worsening language development (P = .04), but this association was subsequently explained by dysfunctional maternal affective involvement (P = .01) and lower maternal intellectual ability (P = .05). Both clinical and socioenvironmental factors are associated with cognitive, language, and motor developmental variation among very preterm children from infancy to early school age.

Term-equivalent functional brain maturational measures predict neurodevelopmental outcomes in premature infants

BackgroundTerm equivalent age (TEA) brain MRI identifies preterm infants at risk for adverse neurodevelopmental outcomes. But some infants may experience neurodevelopmental impairments even in the absence of neuroimaging abnormalities. ObjectiveEvaluate the association of TEA amplitude-integrated EEG (aEEG) measures with neurodevelopmental outcomes at 24–36 months corrected age. MethodsWe performed aEEG recordings and brain MRI at TEA (mean post-menstrual age of 39 (±2) weeks in a cohort of 60 preterm infants born at a mean gestational age of 26 (±2) weeks. Forty-four infants underwent Bayley Scales of Infant Development, 3rd Edition (BSID-III) testing at 24–36 months corrected age. Developmental delay was defined by a score greater than one standard deviation below the mean (<85) in any domain. An ROC curve was constructed and a value of SEF90 < 9.2, yielded the highest sensitivity and specificity for moderate/severe brain injury on MRI. The association between aEEG measures and neurodevelopmental outcomes was assessed using odds ratio, then adjusted for confounding variables using logistic regression. ResultsInfants with developmental delay in any domain had significantly lower values of SEF90. Absent cyclicity was more prevalent in infants with cognitive and motor delay. Both left and right SEF90 < 9.2 were associated with motor delay (OR left: 4.7(1.2–18.3), p = 0.02, OR right: 7.9 (1.8–34.5), p < 0.01). Left SEF90 and right SEF90 were associated with cognitive delay and language delay respectively. Absent cyclicity was associated with motor and cognitive delay (OR for motor delay: 5.8 (1.3–25.1), p = 0.01; OR for cognitive delay: 16.8 (3.1–91.8), p < 0.01). These associations remained significant after correcting for social risk index score and confounding variables. ConclusionsaEEG may be used at TEA as a new tool for risk stratification of infants at higher risk of poor neurodevelopmental outcomes. Therefore, a larger study is needed to validate these results in premature infants at low and high risk of brain injury.

Implementing road safety measures in conditions limited by budget

Abstract Adopted in 2018 was the Strategy of Traffic Safety for 2018 – 2024 years which stipulates the social risk index making not more than 4 fatalities per 100.000 people, as well as the craving for zero fatality in road vehicle accidents by 2030, as a benchmark in 2024. A level of the tasks at hand requires significant increase in efficiency of traffic safety management which is possible by application of the expert system for traffic safety assurance. Given in the present article is an evaluation method of activities implementation investment attractiveness which allows determining the importance of some or other activity depending on the selected production rules in a limited budget. The fuzzy-set theory (Kofman, 1982), the expert evaluation method, the expert system functioning principles form the basis of this method. In order to illustrate this method the activities on enhancement of pedestrian traffic safety are selected. Considered as an example are two variants of production rules which make it possible to evaluate the selective potentials of the method. The proposed method can be used not only as an instrument of the expert system for traffic safety, but also independently. The use of this method allows most effectively spend budget funds allocated for enhancement of traffic safety.

Cumulative social risk and type 2 diabetes in US adults: The National Health and Nutrition Examination Survey (NHANES) 1999-2006.

The cumulative effects of adverse social factors on the diabetes risk remains to be clarified. Cross-sectional analysis of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006. We included 10,276 adults aged ≥20 years. Diabetes mellitus was defined by physician diagnosis or fasting plasma glucose (≥126 mg/dl) or glycated hemoglobin (≥6.5%). Social risk factors (low family income, low education level, minority racial/ethnic group status, and single-living status) and health-related behaviors (physical activity and dietary intake) were self-reported. Social risk factors were combined in a cumulative social risk index (range 0 to ≥3) and logistic regression used to assess the association of cumulative social risk and diabetes, taking into account complex survey design and sampling weights. Of 10,276 participants, 1515 (weighted proportion - 10%) had diabetes, 3295 (32.3%) and 1830 (9.0%) were exposed to ≥1 adverse social risk factor and ≥3 social risk factors, respectively. Diabetes was associated with increasing cumulative social risk in a graded manner (p for trend <0.001). Compared with a cumulative social risk score of 0, the age- and sex-adjusted diabetes odds for a cumulative social risk score of ≥3 was 2.84 (95% confidence interval: 2.23-3.62), and 2.72 (95% confidence interval: 2.05-3.60) after further adjustment for family history of diabetes, body mass index, smoking, dietary intake and leisure time physical activity. Health behaviors and adiposity only partially influenced the cumulative social risk and diabetes relationship. Simultaneous exposure to several adverse social risk factors significantly influences the odds of diabetes. Better prevention and control of diabetes needs accounting for all aspects of social disadvantage.

Effect of methylphenidate preexposure on methylphenidate-induced conditioned taste avoidance

s / Drug and Alcohol Dependence 146 (2015) e34–e117 e47 Support, traumatization, and employment differences in drug court outcomes Diane Morse1, Catherine Cerulli 1, Sanjukta Bandyopadhyay2, Joseph J. Guido2, Hongmei Yang2, John L. Wilson1, F. Taxman3 1 Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States 2 Biostatistics, University of Rochester School of Medicine, Rochester, NY, United States 3 Criminology, Law & Society, George Mason University, Fairfax, VA, United States Aims: Adult drug treatment court (ADTC) outcomes in relation to social support, trauma, and employment are poorly understood. We examined these outcomes and related factors. Methods: Bivariate analysis using chi square and t-test assessed the following outcomes: substance abuse, arrests, health problems, emotional problems, social risk problems, and recovery environment risk using Global Appraisal of Individual Need data collected as part of a multi-site study examining drug use, recidivism, service utilization and treatment. ADTC clients from twelve sites were included (N=666 male, 915 female). Independent variables included: gender, race, age, years of education, income, partner status, employment, social support, traumatization, and traumagenic factors. Results: Social support was associated with a decreased likelihood of arrest (p< .033), substance abuse (p< .001), recovery environment risk (p< .001) and social risk index (p< .001). Victimization within the past year was associated with increased substance use (p< .001), social risk problems (p< .008), and recovery environment risk (p< .001). Employment within the past year was associated with decreased recovery environmental risk (p< .024) and substance use (p< .001). Female gender was associated with an increased likelihood of reduction in substance abuse (p< .038). Conclusions:Desirable ADTCoutcomes derive from: Social support related to 4 of 6 outcomes. Victimization history related to 3 of 6 outcomes. Employment related to 2 of 4 outcomes. Client victimization related to ADTC outcomes. Addressing victimization and employment appear important to improve outcomes, as supported by these findings. Future analyses will examine whether these findings are robust in a multivariate analysis, controlling for trauma-informed treatment as well as a rasch based outcome model to determine factors that affect multiple outcomes. Financial support: NIDA 1K23DA031612-01A1, SAMHSA/Center for Substance Abuse Treatment 270201200001c. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.498 Effect of methylphenidate preexposure on methylphenidate-induced conditioned taste avoidance Mirabella Muller, Bradley B. Wetzell, Shaun M. Flax, Heather E. King, Anthony L. Riley Psychopharmacology Laboratory, Department of Psychology, American University, Washington, DC,

Support, traumatization, and employment differences in drug court outcomes

s / Drug and Alcohol Dependence 146 (2015) e34–e117 e47 Support, traumatization, and employment differences in drug court outcomes Diane Morse1, Catherine Cerulli 1, Sanjukta Bandyopadhyay2, Joseph J. Guido2, Hongmei Yang2, John L. Wilson1, F. Taxman3 1 Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States 2 Biostatistics, University of Rochester School of Medicine, Rochester, NY, United States 3 Criminology, Law & Society, George Mason University, Fairfax, VA, United States Aims: Adult drug treatment court (ADTC) outcomes in relation to social support, trauma, and employment are poorly understood. We examined these outcomes and related factors. Methods: Bivariate analysis using chi square and t-test assessed the following outcomes: substance abuse, arrests, health problems, emotional problems, social risk problems, and recovery environment risk using Global Appraisal of Individual Need data collected as part of a multi-site study examining drug use, recidivism, service utilization and treatment. ADTC clients from twelve sites were included (N=666 male, 915 female). Independent variables included: gender, race, age, years of education, income, partner status, employment, social support, traumatization, and traumagenic factors. Results: Social support was associated with a decreased likelihood of arrest (p< .033), substance abuse (p< .001), recovery environment risk (p< .001) and social risk index (p< .001). Victimization within the past year was associated with increased substance use (p< .001), social risk problems (p< .008), and recovery environment risk (p< .001). Employment within the past year was associated with decreased recovery environmental risk (p< .024) and substance use (p< .001). Female gender was associated with an increased likelihood of reduction in substance abuse (p< .038). Conclusions:Desirable ADTCoutcomes derive from: Social support related to 4 of 6 outcomes. Victimization history related to 3 of 6 outcomes. Employment related to 2 of 4 outcomes. Client victimization related to ADTC outcomes. Addressing victimization and employment appear important to improve outcomes, as supported by these findings. Future analyses will examine whether these findings are robust in a multivariate analysis, controlling for trauma-informed treatment as well as a rasch based outcome model to determine factors that affect multiple outcomes. Financial support: NIDA 1K23DA031612-01A1, SAMHSA/Center for Substance Abuse Treatment 270201200001c. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.498 Effect of methylphenidate preexposure on methylphenidate-induced conditioned taste avoidance Mirabella Muller, Bradley B. Wetzell, Shaun M. Flax, Heather E. King, Anthony L. Riley Psychopharmacology Laboratory, Department of Psychology, American University, Washington, DC,

Cumulative Social Risk Exposure, Infant Birth Weight, and Cognitive Delay in Infancy

ObjectiveTo determine the effect of exposure to multiple social risks on cognitive delay at 9 months of age; and whether obstetric factors mediate the relationship between cumulative social risk and cognitive delay. MethodsData were from 8950 mother–child dyads participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort. Cognitive delay was defined as falling in the lowest 10% of mental scale scores from the Bayley Short Form–Research Edition. Five social risk factors were combined and categorized into a social risk index. Staged multivariable logistic regressions were used to investigate whether obstetric factors mediated the impact of social risk on the odds of cognitive delay. ResultsInfants with cognitive delay were more likely to live with social risks than infants without cognitive delay. The percentage of infants with cognitive delay increased with the number of social risks. In adjusted analyses, exposure to multiple social risk factors was associated with higher odds of cognitive delay at 9 months of age (adjusted odds ratio 2.11; 95% confidence interval 1.18–3.78 for 4 or more risks vs no risks). Accounting for birth weight attenuated this relationship (P < .001). ConclusionsThis population-based study investigated the independent and cumulative effects of social risk factors on cognitive delay in infancy. Findings revealed a significant cumulative relationship between exposure to social risk and cognitive delay, which was partly mediated by birth weight. Programs that address the social context of US infants are needed to improve their developmental trajectories.

Geomedicine: Area-Based Socioeconomic Measures for Assessing Risk of Hospital Reutilization Among Children Admitted for Asthma

We assessed whether geographic information available at the time of asthma admission predicts time to reutilization (readmission or emergency department revisit). For a prospective cohort of children hospitalized with asthma in 2008 and 2009 in Cincinnati, Ohio, we constructed a geographic social risk index from geocoded home addresses linked to census tract extreme poverty and high school graduation rates and median home values. We examined geographic risk associations with reutilization and caregiver report of hardship. Thirty-nine percent of patients reutilized within 12 months. Compared with those in the lowest geographic risk stratum, those at medium and high risk had 1.3 (95% confidence interval [CI] = 0.9, 1.9) and 1.8 (95% CI = 1.4, 2.4) the risk of reutilization, respectively. Caregivers of children at highest geographic risk were 5 times as likely to report more than 2 financial hardships (P < .001) and 3 times as likely to report psychological distress (P = .001). A geographic social risk index may help identify asthmatic children likely to return to the hospital. Targeting social risk assessments and interventions through geographic information may help to improve outcomes and reduce disparities.

Influence of Multiple Social Risks on Children's Health

Social risk factors such as growing up in poverty, racial/ethnic minority status, and maternal depression have been associated with poorer health outcomes for children. This study examined the strength of association of 8 social risk factors, both individually and as part of a cumulative social risk index, on parent-reported child health status. We performed an analysis of cross-sectional data from the 2003 National Survey of Children's Health, a telephone survey of 102,353 parents of children aged 0 to 17 years. In bivariate and multivariate logistic regression models, 8 social risk factors were tested as independent predictors of 4 parent-reported child health outcomes: global health status, dental health, socioemotional health, and overweight. These risk factors were combined into a categorical "social risk index" ranging from low risk (0 risk factors) to very high risk (> or = 6 risk factors), and risk gradients were examined using linear polynomial testing and multivariate logistic regression. The percentage of children in poorer health increased with the number of social risk factors across all health outcomes. More than half of children had > or = 2 risk factors, and 24% had > or = 4. Low maternal mental health, black or Hispanic race/ethnicity, < 200% of the federal poverty level, low household education, unsafe neighborhoods, and lack of health insurance increased the odds for less than very good child health in adjusted models. Multiple social risk factors have a cumulative effect on parent-reported child health status across physical and socioemotional domains, demonstrating a very strong risk gradient effect. These findings emphasize the importance of addressing multiple levels of social risk to achieve improvements in child health.