Social Risk Research Articles

Social Inequalities and Geographical Distribution in Caries Treatment Needs among Schoolchildren Living in Buenos Aires City: A Cross-Sectional Study.

Caries experience in Argentine children is quite high and no national data are present. This cross-sectional observational survey aimed to assess the oral health status of schoolchildren in Buenos Aires (CABA) using CTNI and to evaluate the ecological association between health inequalities and caries prevalence. Data were collected, via a clustered procedure, during the 2016-2018 school years. Children were examined at school to determine dental status according to the CTNI performed under standardized conditions, using light, dental mirrors, WHO probes and magnification (2.5×). Secondary sources were used to acquire socio-demographic and epidemiological data. A hierarchical cluster analysis was carried out with the municipalities of the CABA as the dependent variable and the socio-demographic factors. The study population consisted of 62,904 schoolchildren, 43,571 of whom were enrolled into the study. Total caries prevalence was 67.78% while severe caries prevalence was 28.29%, which was statistically associated with the year of the survey (p < 0.01). Four territorial conglomerates from a socio-epidemiological standpoint outline homogeneous areas of social risk; cluster 1 had the highest social risk. The prevalence of severe caries (CTNI 7-14) was highest in cluster 1 (44.7-53.2% of the population). The social inequalities between municipalities of the CABA were statistically associated with high inequalities in oral health needs.

Renewable energy technology innovation and ESG greenwashing: Evidence from supervised machine learning methods using patent text

As global environmental pollution worsens, environmental governance has become a critical aspect of corporate development. In environmental, social, and governance (ESG) risk management, how firms address the threat of greenwashing has emerged as a central focus in achieving sustainable green development. This study explores an under-researched factor contributing to ESG greenwashing: renewable energy technology innovation (RETI). Using supervised machine learning and text analysis methods, the study constructs a proxy variable for RETI and applies it to a sample of Chinese listed companies. The findings reveal that RETI reduces corporate ESG greenwashing, and this effect remains consistent after a series of endogeneity and robustness tests. The inhibitory impact of RETI on ESG greenwashing is more significant when board experiential diversity and media attention are higher. This study contributes to the theoretical basis and demonstration for the research on RETI, greenwashing, managerial experience, and corporate governance.

Modeling and scenario building for climate change adaptation planning: The case of large mining in Chile

The mining sector in Chile is a strategic industrial sector for the country. Existing evidence shows that it faces several serious climate change threats; precipitation and flooding, droughts, heatwaves, among others. This scene put pressure on the government and the industry to develop efficient adaptation plans. To date, adaptation plans are designed under the rather linear paradigm of predict-then-act or the impact-lea approach as they are characterized in the IPCC Assessment Report 5 (AR5). Literature and the IPCC reports have identified the limits of those planning paradigms showing the relevance of adaptation barriers or enabling conditions, which should be considered as intrinsic part of the planning problem.In methodological terms, planning for climate change risks implies an enriched adaptation plan problem, previously characterized only by an operative climate risk management, that must be described at the beginning of the decision-making process. In this study, our objective is to contribute to the climate change adaptation planning of large-scale mining in Chile. The study is based on a climate change adaptation planning approach that overcomes the limitations of the current paradigm. In doing so, we start from the understanding that what emerges as an object of analysis from adding to the climate risks their enabling managing conditions is a social system. The social system whose function is that social climate risk management takes place. Therefore, we call it the Social Management System for Adaptation to Climate Change (SMSACC). As such the SMSACC should be the adaptation planning key object.In the first place we modeled that system applying a qualitative system methodology and then we developed it into a mathematical model based on graph theory, in particular the signed digraphs. This allows us to simulate two types of intervention on the enlarged object of analysis of the large mining adaptation plan. On the one hand, we carried out a future scenario analysis based on prospective tools which enables us to understand the system's answer to different future behavior of its environment, including climate change. On the other hand, we simulate different strategic interventions options on the system, which facilitates understanding the system's reaction under different public policy approaches.The modeling and simulation results provided an insightful understanding of the dilemma of social adaptation management of large mining in Chile, and as such they are useful input for the planning process.

Factors Affecting Intention to Make Purchasing Through E-Commerce in Indonesia

Electronic commerce, or "e-commerce," is the term used to describe all sales and purchases made using electronic media, mostly websites and applications. With the growth of digital interactions, it is more important than ever to understand the subtleties of e-commerce purchasings. With an emphasis on Indonesia, where online purchase is becoming more and more popular, this study attempts to pinpoint the critical factors that affect customers' decision to interact with e-commerce platforms. This study looks at the variables impacting customer behaviour in the platforms using a quantitative research methodology. The results, which cover social risk, financial risk, product risk, and social impact, are important components. When it comes to purchasing, trust is an important consideration, especially in a market where worries about online fraud are prevalent. Furthermore, studies show that an easy-to-use interface increases the probability that customers will make a purchase since it promotes trust and contentment. The variety of products offered and the allure of pricing packages impact customer decisions as well, highlighting the necessity for e-commerce suppliers to adopt a holistic strategy. The research provides an overview of Indonesia's e-commerce scene and makes suggestions for merchants looking to improve consumer happiness and build a strong online presence

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018.

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

GEOTECHNICAL DESIGN FOR THE STABILIZATION WORKS OF THE LETTOMANOPPELLO LANDSLIDE (ABRUZZO, ITALY)

In order to stabilize the landslide of Lettomanoppello, the stabilization works are finalized to reduce/control the causes and to mitigate the economic, social, and environmental risks. A careful geotechnical design, of the stabilization works can allow an economic recovery of the cost by means of a virtuous and profitable process to produce electric energy. The landslide of Lettomanoppello, located in Central Italy (south-west of the city of Pescara) is a large, very complex active landslide. Slope instability phenomena, often triggered by intense rainfall and seismic events are recurrent in this region of Apennines and frequently result in serious damage to the historical-environmental heritage and in dreadful economic losses. The stability of slope is mainly affects by the hydrogeological conditions of the area characterized by a complex drainage system. Various stabilization works were executed along the slope during the years. The paper presents the studies (geological and geotechnical characterizations) and a general plan of the works required to stabilize the entire slope. The general stabilization project includes different types of works: (i) structural works (retaining walls), effective in short term; (ii) drainage works (tunnel for deep water drainage), effective to medium-long term, aimed at reducing/controlling the major causes of the landslide; (iii) protection from erosion at the toe of slope and surface drainage works. The tunnel crosses a horseshoe shape underneath the historical centre of Lettomanoppello and the elevations of its mouths are at 296 m a.s.l. The drainage waters will be conveyed to pipe towards a hydraulic turbine located at 206 m a.s.l. in the lower part of the slope. Furthermore, the geometry of the cut-off retaining walls at the toe slope are conceived as foundations of aeolian turbines.

Risk of tuberculosis after achieving HIV virological suppression on antiretroviral therapy: a Danish nationwide prospective cohort study.

In countries with low tuberculosis (TB) burden, the risk of TB in people with HIV (PWH) once HIV virological suppression is achieved is not fully understood. In a nationwide cohort, we included all adult PWH from the Danish HIV Cohort initiating antiretroviral therapy (ART) (1995-2017) without prior TB disease. We used Kaplan-Meier estimation and Poisson regression to calculate TB incidence rate (IR) after six months of ART, along with associated risk factors and mortality rates (MR). Among 6,849 PWH initiating ART (median follow-up 7.4 years), 84 developed TB (IR 1.4/1000 person-year [PY]), 54 of them beyond six months of ART initiation, IR 0.97/1000 PY (95%CI:1.17-1.79): 1.95 (95%CI:1.34-2.76) in non-Danish born, 0.36 (95%CI:0.21-0.62) in Danish-born without injection drug use (IDU), and 2.95 (95%CI:1.53-5.66) in Danish-born with IDU. Danish-born with suppressed viremia, and no IDU or known TB exposures had the lowest risk (IR 0.05/1000 PY).In the adjusted analysis, being non-Danish born (aIRR 4.27[95%CI:2.36-7.72]), IDU (aIRR 4.95[95%CI:2.55-9.62]), and previous AIDS-defining events (aIRR 2.05[95%CI:1.06-3.94]) raised TB risk, while suppressed HIV-RNA (aIRR 0.58[95%CI:0.34-0.99]) reduced it. The overall MR for HIV/TB co-infected post- ART was high, at 48.9/1000 PY (95%CI:30.4-78.7). The TB risk remains elevated in PWH beyond six months of ART initiation, especially among migrants, IDU, those without suppressed HIV-RNA, and individuals exposed to high TB endemic areas or with social risk determinants of health. Conversely, PWH without these risk factors have a TB risk similar to the general population and would not require targeted TB screening strategies.

An investigation of perceived risk dimensions in acceptability of shared autonomous vehicles, a mediation-moderation analysis

The integration of shared and autonomous mobility has led to the emergence of shared autonomous vehicles with ride-sharing services (SAVWRS), which have the potential to significantly reduce private car usage and promote sustainable transportation. Despite numerous studies on this topic, there is still no research examining the impact of all dimensions of perceived risk theory on usage intention. Therefore, we aim to investigate these relationships and gain deeper insights by examining the mediating effect of trust and the moderating effect of generation (Millennials vs. Baby Boomers) to address potential disparities across generations. To gather insights, we design an online survey that was completed by a random sample of 723 individuals in 2021. The estimation results of the structural equation model reveal that all perceived risk dimensions (social, performance, time, physical, security, and financial risks, in descending order) are negatively related to consumers’ intention. Additionally, trust fully mediates the relationships between performance, physical, financial, and security risks and usage intention, whereas it partially mediates the relationships between social and time risks and the intention to use. Furthermore, moderation analysis revealed that Millennials are less concerned about most dimensions of perceived risk theory, except for social and time risks. In conclusion, our study contributes to a deeper understanding of the complex relationships between perceived risk dimensions, trust, and usage intention in SAVWRS. Our findings suggest that policymakers and industry stakeholders should consider strategies to address these concerns to promote widespread acceptance of SAVWRS.

Health risks associated with urinary incontinence among older Korean Americans living in subsidized senior housing.

We examined the association of urinary incontinence (UI) with physical, mental, and social health among older Korean Americans living in subsidized senior housing. Data were obtained from surveys conducted in 2023 with older Korean Americans residing in subsidized senior housing in the Los Angeles area (n = 313). UI was measured using a question about the frequency of involuntary urine loss. Physical, mental, and social health risks were assessed with a single item for self-rated health (fair/poor rating), the Patient Health Questionnaire-9 (probable depression), and the Lubben Social Network Scale-6 (isolation from family and friends). Over half of the sample reported UI, with 46.3% experiencing it infrequently (i.e. seldom) and 10.3% frequently (i.e. sometimes or often). UI was significantly associated with physical and mental health indicators; the odds of reporting fair or poor health and having probable depression were 1.94-7.32 times higher among those with either infrequent or frequent UI compared to those without UI. While family isolation was not associated with UI, the odds of being isolated from friends were 2.85 times greater among those with frequent UI compared to those without UI. Our findings confirm the adverse impact of UI on physical and mental health and highlight its unique role in social health. UI-associated social isolation was significant only in relationships with friends, providing new insights into the distinction between isolation from family and friends. These findings enhance our understanding of the health risks associated with UI and inform strategies for health management and promotion within the senior housing context.

Assessing the Risk of Tuberculosis Relapse Development during the Period of Stabilization of the COVID-19 Epidemic

The objective: to evaluate risk factors for tuberculosis relapse development during stabilization of the COVID-19 situation.Subjects and Methods. 165 patients over 18 years of age were enrolled in the observational comparative study, those patients were followed up due to respiratory tuberculosis relapses in 2021-2023. Risk factors for early and late relapses that occurred during the pandemic (2021-2022) and post-pandemic (2023) periods were analyzed. They included age, gender, accommodation, social status, imprisonment, smoking, alcohol and substances abuse, comorbidities, clinical forms of tuberculosis, presence of cavities, bacterial excretion, and drug resistance of Mycobacterium tuberculosis.Results. The data obtained confirmed the assumption that the COVID-19 pandemic had led to changes in social and medical-biological risk factors for tuberculosis relapse.

Combined Diabetes Education/Skills Training and Social Needs Resolution Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (DM Social Needs): Study Protocol for a Randomized Controlled Trial.

Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population.

A Novel Framework to Evaluate the Effect of Strategic Systems Thinking on Sustainable Supply Chain Risks, LARG Capabilities and Performance

Supply chain (SC) disruptions created due to sustainable, social, economic, environmental and technical risks are mitigated by lean, agile, resilient and green (LARG) capabilities across the SC node. This study aims at the assessment and alignment of SC risks and capabilities for a strategic fit of appropriate practices resulting in performance, efficiency and continuity of operations. The novelty of this research work is the investigation of the direct and mediating effects of strategic system thinking (SST) between SC risks, capabilities and performance. A survey comprising of 78 items was administered to 255 managers of Pakistan automotive SC industries. The exploratory factor analysis and confirmatory factor analysis were executed to identify the valid constructs along with their reliability and validity. The structural equation modeling (SEM) was used to test the conceptual model by establishing the second order constructs. SEM results indicated only technical risks having negative significant effect with performance. In terms of capabilities, the general, efficiency, integration as well as the redundant resources were found to have significant association with SC performance. The SST approach was found to be significantly associated with technical risks and capabilities such as general, recovery and redundancy. The hypothesis of SST as a mediating variable across all factors was not observed to be valid in this research. This study can help in the policy and decision-making as well as strategic assessment, planning, development, positioning and alignment of resources across the sustainable SC. The operations can be influenced positively through system integration and conservation of resources for a sustainable performance. The green, environmental and social risks had higher SC impact and need to be focused upon in Pakistan automotive SC for higher performance and sustainability.

A fair individualized polysocial risk score for identifying increased social risk in type 2 diabetes.

Racial and ethnic minorities bear a disproportionate burden of type 2 diabetes (T2D) and its complications, with social determinants of health (SDoH) recognized as key drivers of these disparities. Implementing efficient and effective social needs management strategies is crucial. We propose a machine learning analytic pipeline to calculate the individualized polysocial risk score (iPsRS), which can identify T2D patients at high social risk for hospitalization, incorporating explainable AI techniques and algorithmic fairness optimization. We use electronic health records (EHR) data from T2D patients in the University of Florida Health Integrated Data Repository, incorporating both contextual SDoH (e.g., neighborhood deprivation) and person-level SDoH (e.g., housing instability). After fairness optimization across racial and ethnic groups, the iPsRS achieved a C statistic of 0.71 in predicting 1-year hospitalization. Our iPsRS can fairly and accurately screen patients with T2D who are at increased social risk for hospitalization.

New Turkey, social policy, and a daytime talk show as a remedy: Müge Anlı as a modern Çalıkuşu

ABSTRACT ‘Müge Anlı ile Tatlı Sert’, which investigates unresolved criminal cases with interactive audience support, is one the most popular daytime television shows in contemporary Turkey. The neoliberal restructuring of the welfare system in New Turkey posits that providing protection and security against social risks is the sole responsibility of individuals and families. In line with this approach, the show individualizes social problems ready to be resolved by ‘Müge Abla’ (Sister Müge) and her audience. Müge Anlı's image, which conforms to the ideal modern and modest Republican woman, allows her to gain authority, trust, respect, and popularity. The show’s discourses, structure, and communicative strategies are the product of the New Turkey where ‘the sacred family’ is the central political unit and the nation is an extended, happy family reproduced through this show.

The Social Contagion of Risk Perceptions of Emerging Technologies through Evolutionary Game in Networks

Emerging technologies are leading the fourth industrial revolution, bringing profound changes to modern life. However, the contagion of public risk perceptions pertaining to these technologies may result in new social stability risks according to the social amplification of risk framework (SARF). As such, understanding the formation and contagion mechanisms behind public risk perceptions of emerging technologies is critical to promoting their increased receptivity. Based on an evolutionary game theoretical approach to complex networks, this paper constructs a social contagion model of the risk perception of emerging technologies and uses simulations to analyze the influence of factors such as individual cognition and social environment. Results indicate the following: (1) the rate of risk perception contagion gradually increases with the level of individual risk perception and trust in communicators; (2) the risk perception contagion rate gradually decreases as the level of risk governance participation increases; and (3) comparing different social networks, kinship networks have a greater effect than social media networks on risk perception contagion.

Psychotic experiences and psychological distress in adolescents: an examination of longitudinal bidirectional effects across sex

BackgroundAlthough the co-occurrence of psychotic experiences (PEs) and psychological distress symptoms is growingly recognized in several previous studies, there is still a lack of literature, which clearly outlines how these two psychopathological entities affect each other over time. This study is intended to add to the literature by examining: (a) the longitudinal, bidirectional associations between PEs and psychological distress in a sample of Tunisian adolescents, and (b) whether these associations are moderated by sex.Methods510 adolescent students (mean age of 16.05 ± 1.01 years, 61.2% females) took part in a prospective longitudinal study. PEs and psychological distress were measured at three occasions over a one-year period. The cross-lagged panel modeling approach was adopted.ResultsThe current results showed that the experience of PEs at baseline tended to temporally precede prospective increases in psychological distress (at 6 months), which had in turn led to further exacerbation of psychological distress at 12 months of follow-up. Temporally primary psychological distress symptoms were not a significant predictor for the development of later psychotic symptoms in the whole sample. However, temporal patterns between adolescent distress and psychotic symptoms differed for girls and boys. Endorsing PEs at baseline was followed by greater psychological distress at 6 months, which was in turn associated with a significant increased risk of subsequent exacerbation of PEs at 12 months in boys, whereas psychological distress at 12-month follow-up was significantly predicted by pre-existing PEs in girls.ConclusionThese findings suggest that clinicians and support workers are recommended to take into account different social risk profiles for boys and girls when considering interventions to address PEs and distress in adolescents.

Paternal perinatal depression: underestimation of the disorder, its clinical and classificatory entanglements, and therapeutic alternatives

In the perinatal period, fathers may also suffer from depression, referred to as paternal perinatal depression. Studies have shown that the prevalence of paternal perinatal depression is considerably higher than in the general adult population. For example, a meta-analysis showed that the prevalence of depression among fathers was 9.76% during the prenatal period and 8.75% during the postpartum year.1 Paternal perinatal depression can deteriorate the marital relationship and generate psychosocial and behavioral problems in the offspring (Ramchandani et al., 2021).2 However, paternal perinatal depression has received comparatively little clinical attention. A review of the literature on this subject will list the biological, psychological and social risk factors for this condition, which include a history of depression or anxiety disorders, lack of social support, conflicts in the couple's relationship, economic and labor problems. The clinical characteristics of depression share similarities with depressions in other periods of life, and there are differential clinical features, such as anger, aggressiveness, somatic symptoms and greater comorbidity with substance abuse disorder. Early detection with scales such as the Edinburgh, Gotland and PAPA and the appropriate approach are fundamental to mitigate the effects of paternal perinatal depression. Psychotherapeutic support, psychoeducation of the disorder, and self-care tools can be part of a comprehensive approach to help parents experiencing this condition. In conclusion, the proposal to include this disorder within the parental perinatal affective disorders, as proposed by the author Baldoni,3 given the level of overlap that it usually has with other comorbid conditions (anxiety, alcohol abuse, impulse control disorders) and high frequency of masked symptoms, goes in the direction to give the attention it deserves for early detection and provide adequate support and treatment.

Generic and site-specific social life cycle assessment of municipal wastewater treatment systems in Spain: challenges and limitations of the method when applied to resource recovery systems

Abstract Purpose This work aims to provide insights on the application of social life cycle assessment (S-LCA) in evaluating the social impacts associated with municipal wastewater treatment (WWT). The study assesses the social risks and social performance of two municipal WWT systems in Catalonia, Spain: a conventional wastewater treatment plant (WWTP) (Reference System) and a novel system that recovers water and other valuable resources (Novel System). Methods S-LCA was conducted at Generic and Site-Specific levels using 1 m3 of wastewater treatment as the functional unit (FU). The Generic assessment was conducted via the Product Social Impact Life Cycle Assessment (PSILCA) database, while the Site-Specific assessment employed the Subcategory Assessment Method (SAM) with four-level reference scales to assess the social performance of the WWTP operator and its first-tier suppliers. Furthermore, activity variables were calculated based on organizations’ shares in the total costs per FU, and the Novel System’s multifunctionality was solved through economic allocation. Results were aggregated by (i) assigning equal weights to organizations and (ii) factoring in organizations’ weights and the allocation factor, leading to results per FU. Results and discussion The Generic analysis results indicated that the Novel System entailed fewer social risks than the Reference System. Most social risks in both systems occurred in the subcategories “Access to material resources,” “Fair salary,” “Freedom of association and collective bargaining,” “Contribution to economic development,” and “Corruption.” In the Site-Specific assessment, the Novel System presented better social performance than the Reference System per 1 m3 of wastewater treatment. The latter’s performance per FU did not meet the basic requirement in four out of eleven subcategories, mainly due to the performance and weight of a chemical supplier. Allocation greatly benefitted the Novel System’s results per FU compared to the results obtained when equal weights were applied. Conclusions Activity variables were used to connect organizations’ conduct with particular WWT systems, and multifunctionality was solved. This approach allowed for obtaining results per FU at both assessment levels. However, social performance was also evaluated by calculating the average social performance of each system without considering activity variables and the FU, leading to different results. The social performance of the Novel System per FU was satisfactory across all subcategories but required improvement in four subcategories based on the average results. Given the limitations of using activity variables and allocation in S-LCA, further research is necessary to appropriately evaluate and compare the social effects of novel resource recovery systems.

Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

IntroductionSocial health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals’ social risks such as food, housing, transportation, and financial insecurity, and their interest in receiving assistance from the healthcare system (social needs), can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions. MethodsWe conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation). and by intersectional strata based on a combination of age, income, gender, and race and ethnicity. ResultsOf 10,274 who completed the survey, 52% reported any social risk and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). Our intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher income (>$50,000/year) or older age (>60) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black and Multiracial adults had the highest estimates of social risk and need. ConclusionsHigher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.

Implementation of a patient-centered phone line to address non-medical cancer support needs in an integrated health system.

208 Background: From the moment cancer is suspected, patients and their caregivers may feel overwhelmed and not know where to seek help for non-medical questions. Social risks, including financial instability, housing and food insecurity can lead to poor cancer outcomes, and 39% of Kaiser Permanente (KP) cancer patients screened positive for at least one social risk. KP implemented the Cancer Support Line to provide patients and caregivers with a single point of contact to address non-medical concerns, including financial navigation, social health needs, and general cancer information. Methods: Kaiser Permanente partnered with patients, clinicians, and health plan functions supporting member services, social health, and quality to co-design and implement a phone number for cancer members in the KP Northwest market. The Cancer Support Line (‘Line’) is an inbound phone number staffed by Cancer Support Specialists (‘Specialists’), a dedicated team of health plan member services, trained in cancer support skills. Specialists use four co-designed pathways to navigate callers to resources for financial questions, social needs, and general cancer information and support. If clinically appropriate questions arise, Specialists use existing operational channels to connect patients back to their care teams. Results: During the pilot, there were 1,057 interactions with members, patients, and caregivers from March 12 th to May 17 th . Financial questions about payment assistance and insurance benefits/eligibility emerged as the highest call driver. The top call outcomes by volume are shown in the included table. A high majority of calls (94%, n=992) were addressed by the Cancer Support Specialists themselves. Post-call survey results revealed that 96% of callers (n=26) rated their call experience high when asked “How would you rate your overall call experience today?” Conclusions: Effective collaboration across KP’s project teams was a critical driver of the pilot’s success. Workflows were built with all partner teams and departments, Specialist training was designed internally with consultation from the American Cancer Society, team communications were open and consistent, call reporting was robust and adaptable. Furthermore, the Line addresses a critical gap in the cancer patient experience: navigating non-medical needs that busy care teams are unable to address on their own. Though positive, these pilot results are preliminary and focused on one KP market. To evaluate the pilot for scalability, the team will assess process metrics and outcomes on caller, frontline staff, and Specialist experience on an ongoing basis to capture the Line’s broader operational impact. Call transfer destination. Transfer Destination # of calls % No Transfer 992 93.9% KP Community Support Hub Transfer 45 4.3% Clinical Transfer 17 1.6% KP Community Support Hub + Clinic Transfer 3 0.3%