Socioeconomic Disadvantage Research Articles

Regional access to a centralized extracorporeal membrane oxygenation (ECMO) service in Victoria, Australia

IntroductionVictoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described. ObjectiveDescribe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access. DesignRetrospective observational study with spatial mapping. Participants and settingAdult (≥18 years) ECMO recipients from July 2016–June 2022. Data from administrative Victorian Admissions Episodes Database analysed in conjunction with Australian Urban Research Infrastructure Network population data and choropleth mapping. Presumed ECMO modes were inferred from cardiopulmonary bypass and pre-hospital cardiac arrest codes. Spatial autoregressive models including Moran's test used for spatial lag testing. OutcomesDemographics and outcomes of ECMO recipients; ECMO incidence by patient residence (Statistical-Area Level 2, SA-2) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD); and ECMO utilisation adjusted for patient factors and linear distance from the central ECMO referral site. Results631 adults received ECMO over 6 years, after exclusion of paediatric (n = 242), duplicate (n = 135), and interstate or incomplete (n = 72) records. Mean age was 51.8 years, and 68.8 % were male. Overall ECMO incidence was 3.00 ± 3.95 per 105 population. 135 (21.4 %) were presumed VA-ECMO, 59 (9.3 %) presumed ECPR, and 437 (69.3 %) presumed VV-ECMO. Spatial lag was non-significant after adjusting for patient characteristics. Distance from the central referral site (dy/dx = 0.19, 95% CI −0.41–0.04, p = 0.105) and IRSAD score (dy/dx = 0.17, 95% CI −0.19–0.53, p = 0.359) did not predict ECMO utilisation. ConclusionVictorian ECMO incidence rates were low. We did not find evidence of inequity of access to ECMO irrespective of regional area or socioeconomic status.

Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study.

Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth care and services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There are notable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in patients with breast cancer and oncology services offered through telehealth versus in-person visits. We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among patients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits. Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-person visit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology services comparing telehealth and in-person visits. The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58% (52/1161) identified as Asian, 19.72% (229/1161) as Black, 3.01% (35/1161) as Hispanic, and 72.78% (845/1161) as White. Overall, 35.96% (416/1157) had a telemedicine visit in the past 12 months. Of these patients, 65% (266/409) had a videoconference visit only, 22.7% (93/409) had a telephone visit only, and 12.2% (50/409) had visits by both videoconference and telephone. Higher ADI scores were associated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95% CI 0.82-0.97). Black (AOR 2.38, 95% CI 1.41-4.00) and Hispanic (AOR 2.65, 95% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients. Compared to patients with high school or less education, those with an associate's degree (AOR 2.67, 95% CI 1.33-5.35), a bachelor's degree (AOR 2.75, 95% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95% CI 1.31-5.04) had higher odds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1% vs 55/405, 13.6%; P=.32) or cancer genetic counseling (11/405, 2.7% vs 19/405, 4.7%; P=.14) between telehealth and in-person visits. Of the telemedicine users, 95.8% (390/407) reported being somewhat to extremely satisfied, and 61.8% (254/411) were likely or very likely to continue using telemedicine. In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-level socioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations.

Factors influencing living space utilization among older Afro-Colombian adults

ABSTRACT Objectives: Investigate the factors influencing life space utilization in older Afro-descendant adults residing in Tumaco, Colombia – a marginalized region of the country. Design: This cross-sectional study included 388 Afro-descendant older adults. The study assessed living space using the Life Space Assessment (LSA) scale and collected demographic data. Cognitive levels were measured with the Mini-Mental State Examination (MMSE), and depressive symptoms were assessed using the Yesavage scale. Socio-emotional indicators were determined with the Medical Outcomes Study (MOS). The research employed linear and logistic regression models for data analysis. Results: On average, participants scored 27.0 on the LSA scale. A lack of perceived income resulted in a 10.44-point decrease on the LSA scale. For each unit increase in the MOS-Instrumental Dimension score, the LSA score increased by 0.52 points (95% CI 0.17–0.87). As for cognitive performance (MMSE scale), each one-point increase resulted in a 0.69 decrease in the LSA score (95% CI −1.25 to −0.12). Conclusion: Socioeconomic disadvantages limit living space utilization, particularly in the Afro-descendant population. Yet, social support can enhance living space use despite environmental and economic constraints.

Social patterning of childhood overweight in the French national ELFE cohort

An inverse social gradient in early childhood overweight has been consistently described in high-income countries; however, less is known about the role of migration status. We studied the social patterning of overweight in preschool children according to the mother’s socio-economic and migration background. For 9250 children of the French ELFE birth cohort with body mass index collected at age 3.5 years, we used nested logistic regression to investigate the association of overweight status in children with maternal educational level, occupation, household income and migration status. Overall, 8.3% (95%CI [7.7–9.0]) of children were classified as overweight. The odds of overweight was increased for children from immigrant mothers (OR 2.22 [95% CI 1.75–2.78]) and descendants of immigrant mothers (OR 1.35 [1.04–2.78]) versus non-immigrant mothers. The highest odds of overweight was also observed in children whose mothers had low education, were unemployed or students, or were from households in the lowest income quintile. Our findings confirm that socio-economic disadvantage and migration status are risk factors for childhood overweight. However, the social patterning of overweight did not apply uniformly to all variables. These new and comprehensive insights should inform future public health interventions aimed at tackling social inequalities in childhood overweight.

Intra-generational social mobility and mortality among older men in the Concord Health and Ageing in Men Project: A cohort study

ObjectivesWe examined associations between intra-generational social mobility (reflected in life-course socioeconomic trajectories) and mortality, among older men. MethodsData came from a prospective Australian community-based cohort of older men. Social mobility was defined by socioeconomic indicators from three points in the life-course: educational attainment (late adolescence-early adulthood), occupation (mid-life), and current sources of income (older age). We defined indicators of social mobility trajectory (6 categories; reflecting the direction of social mobility) and social mobility status (2 categories; mobile or non-mobile). We used Cox regression to examine associations with mortality, adjusting for age, country of birth, and living arrangement. ResultsWe followed 1568 men (mean age 76.8, SD 5.4) for a mean duration of 9.1 years, with 797 deaths recorded. Moving upward was the predominant social mobility trajectory (36.0%), followed by mixed trajectories (25.1%), downward (15.1%), stable low (12.2%), stable high (7.6%), and stable middle (4.0%). Men with downward (Hazard ratio 1.58, 95% CI 1.13 to 2.19) and stable low socioeconomic trajectories (1.77, 1.25 to 2.50) had higher mortality risks than men with stable high socioeconomic trajectories, while men with upward trajectories had similar risks to those with stable high trajectories. 76.2% of the participants were classified as having mobile status; no associations were evident between binary social mobility status and mortality. DiscussionsThese findings suggest cumulative and persistent exposure to disadvantaged socioeconomic conditions across the life-course, rather than social mobility, is associated with increased mortality. For each stage of the life-course, addressing socioeconomic disadvantage may reduce inequities in mortality.

Community-level social determinants of health and pregestational and gestational diabetes

Individual adverse social determinants of health are associated with increased risk of diabetes in pregnancy, but the relative influence of neighborhood or community-level social determinants of health is unknown. This study aimed to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. We conducted a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Home addresses in the first trimester were geocoded at the census tract level. The exposures (modeled separately) were the following 3 neighborhood-level measures of adverse social determinants of health: (1) socioeconomic disadvantage, defined by the Area Deprivation Index and measured in tertiles from the lowest tertile (ie, least disadvantage [T1]) to the highest (ie, most disadvantage [T3]); (2) food desert, defined by the United States Department of Agriculture Food Access Research Atlas (yes/no by low income and low access criteria); and (3) less walkability, defined by the Environmental Protection Agency National Walkability Index (most walkable score [15.26-20.0] vs less walkable score [<15.26]). Multinomial logistic regression was used to model the odds of gestational diabetes or pregestational diabetes relative to no diabetes as the reference, adjusted for age at delivery, chronic hypertension, Medicaid insurance status, and low household income (<130% of the US poverty level). Among the 9155 assessed individuals, the mean Area Deprivation Index score was 39.0 (interquartile range, 19.0-71.0), 37.0% lived in a food desert, and 41.0% lived in a less walkable neighborhood. The frequency of pregestational and gestational diabetes diagnosis was 1.5% and 4.2%, respectively. Individuals living in a community in the highest tertile of socioeconomic disadvantage had increased odds of entering pregnancy with pregestational diabetes compared with those in the lowest tertile (T3 vs T1: 2.6% vs 0.8%; adjusted odds ratio, 2.52; 95% confidence interval, 1.41-4.48). Individuals living in a food desert (4.8% vs 4.0%; adjusted odds ratio, 1.37; 95% confidence interval, 1.06-1.77) and in a less walkable neighborhood (4.4% vs 3.8%; adjusted odds ratio, 1.33; 95% confidence interval, 1.04-1.71) had increased odds of gestational diabetes. There was no significant association between living in a food desert or a less walkable neighborhood and pregestational diabetes, or between socioeconomic disadvantage and gestational diabetes. Nulliparous individuals living in a neighborhood with higher socioeconomic disadvantage were at increased odds of entering pregnancy with pregestational diabetes, and those living in a food desert or a less walkable neighborhood were at increased odds of developing gestational diabetes, after controlling for known covariates.

Responding to challenging behaviour in post-primary schools: Exploring a new authority

This pilot study aimed to evaluate the effectiveness of a staff intervention for post-primary schools using the New Authority approach to behaviour management, an approach informed by the principles of Non Violent Resistance (NVR). A review of the literature highlighted gaps in current approaches to behaviour management, particularly when responding to young people from backgrounds of trauma, chronic stress and socio-economic disadvantage, neurodivergent students and those with neurodevelopmental delays – those to whom behaviour management strategies are most often applied. The intervention aimed to reduce the frequency of unproductive behaviours in the classroom and increase participant self-efficacy, measured both quantitatively and qualitatively through an experimental and outcome evaluation design. Results, though preliminary, showed a reduction in the frequency of a range of aggressive and anti-social behaviours, and a smaller reduction for low-level disruptive behaviours. Results also indicated that participants displayed an increased sense of self-efficacy in management of student behaviour after the intervention. Feedback indicated moderate to high satisfaction with the intervention. Thematic analysis showed that participants valued the increased support from colleagues inherent within the intervention. The New Authority is proposed as a relationship-based response to challenging behaviour in schools that is sensitive to the brain's response to stress, the impact of trauma and disadvantage, and the impact of neurodivergence and neurodevelopmental delays.

Unpacking and unpicking the challenge of 600 hours of preschool attendance

The Australian Government’s (2022) Preschool Reform Funding Agreement and initiatives by state governments aim to lift enrolment and maximise the benefits of early childhood education (ECE) in the year before school. The Agreement is particularly relevant for children and families from vulnerable and disadvantaged backgrounds, many of whom do not utilise the annual attendance target of 600 hours available to every child. Children’s enrolment and daily attendance records are key to understanding participation in ECE, but few studies or government reports have examined this information in detail. Drawing on administrative records provided by 19 long day care and preschool centres/schools in areas of socio-economic disadvantage, we analysed weekly attendance for 971 preschool-aged children over four 10-week terms. Results for the ‘percentage of enrolled days’ attended (M = 88%) and ‘total hours’ attended (M = 576 h) approached the target but differed for children enrolled in preschool versus long day care.

Neighborhood selection by parent personality, depression, and coparent support: A two-study replication.

This study addresses the degree to which three selection factors (parent personality, depression, and coparent support) drive movement into neighborhoods and predict changes in youth externalizing behavior. Two studies followed children from birth to age 15 (N = 1,364 for Study 1; N = 4,898 for Study 2). Neighborhood socioeconomic disadvantage, family income, and youth externalizing behavior were consistently and significantly correlated cross sectionally and longitudinally. Selection factors predicted changes in youth externalizing behavior. Higher family income, mother agreeableness, and perceived support from a coparent predicted movement over time into less disadvantaged neighborhoods. Lower levels of mother impulsivity, neuroticism, and depression also predicted movement over time into less disadvantaged neighborhoods. Neighborhood disadvantage did not predict change in youth externalizing behavior when any of the above selection factors were included in the model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region.

Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15years old, ≥5years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.

Automated procedure for demographic adjustments on cognitive test scores

Performances of normal people on cognitive tests are known to vary by demographic characteristics, such as age, education, and sex. Thus, cognitive test scores should be corrected for demographic influences when they are used to detect below-expected results due to disease or injury involving the central nervous system (CNS). Normative corrections, if estimated from a large, diverse, and well-characterized cohort of controls, help to remove expected differences in cognitive performance associated with normal demographic characteristics and associated socio-economic disadvantages. In this paper, we (1) describe in detail the process of generating regression-based normative standards, and its advantages and limitations, (2) provide recommendations for applying these normative standards to data from individuals and populations at risk for CNS dysfunction, and (3) introduce an R package, test2norm, that contains functions for producing and applying normative formulas to generate demographically corrected scores for measuring deviations from expected, normal cognitive performances.

Impact of the Exercise Right for Active Ageing program on physical function in older adults: a quasi-experimental pre-post study

BackgroundThe Exercise Right for Active Ageing (ERAA) program was established to improve access to exercise classes for community-dwelling older Australians. The aims of this study were to determine whether older adults, who participated in ERAA exercise classes experienced a change in physical function, and identify factors associated with this change.MethodsParticipants included community-dwelling older adults, aged ≥ 65 years, from every state and territory of Australia. The ERAA program included 12 subsidised, weekly, low- to moderate-intensity exercise classes, delivered by accredited exercise scientists or physiologists (AESs/AEPs). Primary outcomes included the 30 s Sit-to-Stand (STS) and the 3-metre Timed Up and Go (TUG) tests. Secondary outcomes included grip strength, the Chair Sit and Reach test, and waist circumference. Linear mixed-effects regression models were used to evaluate the change in outcomes following program completion, and to determine factors associated with changes in the primary outcomes.Results3,582 older adults (77% female) with a median (IQR) age of 72 (69–77) years completed follow-up testing. For all primary and secondary outcomes, there was a statistically significant improvement after program completion (p < 0.001). The STS increased by 2.2 repetitions (95% CI: 2.1, 2.3), the TUG decreased by 0.9 s (95% CI: -1.0, -0.8), right and left grip strength increased by 1.3 kg (95% CI: 1.2, 1.5) and 1.5 kg (95% CI: 1.3, 1.6), respectively, right and left reach increased by 1.7 cm (95% CI: 1.4, 2.0), and waist circumference decreased by 1.2 cm (95% CI: -1.4, -1.1). Greater improvements in STS were observed for participants aged 65–69 years, females, and those with greater socio-economic disadvantage. For the TUG, greater improvements were observed in participants reporting 2 + comorbidities, and residing in outer regional areas and areas with greater socio-economic disadvantage.ConclusionsParticipation of older Australians in the ERAA program, led to statistically significant improvements in physical function. The program reached a large number of older Australians from every state and territory, including those from regional and remote parts of Australia, aged over 85 years, and with high levels of comorbidity, which supports the feasibility and acceptability of AES- and AEP-led exercise classes amongst community-dwelling older Australians.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000483651). Registered 12 May 2023 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12623000483651.aspx.

Observations of Positive Parenting from Online Parent–Child Interactions at Age 1

SYNOPSIS Objective. Brief, reliable, and cost-effective methods to assess parenting are critical for advancing parenting research. Design. We adapted the Three Bags task and Parent Child Interaction Rating System (PCIRS) for rating online visits with 219 parent–child dyads (White, n = 104 [47.5%], Black, n = 115 [52.5%]) and combined the video data with survey data collected during pregnancy and when children were aged 1. Results. The PCIRS codes of positive regard, stimulation of child cognitive development, and sensitivity showed high reliability across the three parent–child interaction tasks. A latent positive parenting factor combining ratings across codes and tasks showed good model fit, which was similar regardless of parent self-identified race or ethnicity, age, socioeconomic disadvantage, marital/partnered status, and parity, as well as methodological factors relevant to the online video assessment method (e.g., phone vs. laptop/tablet). In support of construct validity, observed positive parenting was related to parent-reported positive parenting and child socioemotional development. Finally, parent reports of supportive relationships in pregnancy but not neighborhood safety or pandemic worries, were prospectively related to higher positive parenting observed at age 1. With the exception of older parental age and married/partnered status, no other parent, child, sociodemographic, or methodological variables were related to higher overall video exclusions across tasks. Conclusions. PCIRS may provide a reliable approach to rate positive parenting at age 1, providing future avenues for developing more ecologically valid assessments and implementing interventions through online encounters that may be more acceptable, accessible, or preferred among parents of young children.

Associations of Neighborhood Disadvantage, Cardiometabolic Risk, and Cognition in a Community‐Dwelling Cohort

AbstractBackgroundSocial determinants of health (SDoH) are important environmental factors in cardiometabolic risk and cognitive aging. Area Deprivation Index (ADI) is a measure of neighborhood‐level socioeconomic disadvantage and has been studied in normal cognition (NC), but relatively less is known about impact in those with mild cognitive impairment (MCI).MethodThis study explores, in participants with NC and MCI enrolled in the Wake Forest ADRC Clinical Core, baseline measures of metabolic risk (Oral Glucose Tolerance Testing of blood glucose 120‐minute post‐challenge; OGTT‐120), cognition (Preclinical Alzheimer’s Cognitive Composite; PACC), demographics (age, education, diagnosis, race, sex), and participant national ADI rank (using baseline home address). Consensus diagnosis of NC and MCI was adjudicated by a panel of experts.ResultDemographics of community‐dwelling adults enrolled as a convenience sample in the Wake Forest ADRC with metabolic and cognitive measures by cognitive status is listed in Table 1. MCI participants, compared with CN, were older, more likely male and white, with lower education and PACC, and higher ADI (higher = more disadvantaged). Significant differences in ADI were observed when participants were stratified by race (Figure 1); post‐hoc tests indicate significantly higher ADI in Black compared to white participants, and to some degree, by higher ADI among Black participants compared with Asian participants. OGTT‐120 in participants with NC (n = 265) and MCI (n = 156) was not significantly associated with ADI national rank (Figure 2A); when controlling for age, sex, education, and diagnosis, there was still no association between OGTT‐120 and ADI. Higher ADI was significantly associated with lower PACC scores in individuals with NC (p = 0.044), but not MCI (Figure 2B); this association remained significant (p = 0.004) independent of age, sex, education, and diagnosis (all covariates p&lt;0.001).ConclusionAmong community‐dwelling older adults, ADI national rank differs by participant race. OGTT‐120 does not correlate with ADI in participants with NC or MCI. PACC scores correlate negatively with ADI national rank in participants with NC, but not MCI; this relationship remained when controlling for covariates. Further analyses are necessary to examine the association between cardiometabolic risk and ADI.

Non‐economic aspects of social deprivation and cognitive health in old age

AbstractBackgroundIt is well established that socioeconomic disadvantages such as low income are associated with a higher risk for poor cognitive health in old age. Under the concept of social deprivation, researchers have recently started exploring a broader concept of social embedding including, for instance, unemployment and asset ownership. However, little known of other characteristics of social deprivation and to what extent they are associated with cognitive health.MethodParticipants of the multicenter DZNE Cognitive Impairment and Dementia Study (DELCODE) were asked to complete a questionnaire on four characteristics of social deprivation, (1) Conditions of the living environment, (2) Regional accessibility, (3) Neighborhood support, (4) Family social support. A total of N = 296, 48.3% male, M = 70.8 (SD = 5.8) years old, n = 97 cognitive healthy, n = 161 subjective cognitive decline (SCD), n = 38 mild cognitive impairment (MCI)) returned the questionnaire. Using confirmatory factor analysis, we excluded questions with non‐significant loadings and with coefficients &lt;0.5. The latent scores were saved and a sum score was calculated. The scores were categorized into tertiles (high, medium, low).ResultResults from logistic regression (adjusted for age, gender, education, family status, depression, diabetes, hypertension, hypercholesterol, cerebrovascular diseases, heart disease, and body mass index) indicated that those with low (compared to high) social deprivation had a significantly reduced risk for SCD (OR = 0.38, p = 0.006) and MCI (OR = 0.25, p = 0.018). Of the individual factor scores, only Neighborhood support was significantly associated with SCD (OR = 0.48, p = 0.030) and MCI (OR = 0.32, p = 0.049).ConclusionOur findings suggest that social deprivation and, in particularly, neighborhood support such as visits, helping out, and receiving/giving advice can play an important role in cognitive health in old age. Accordingly, individuals with a high risk for age‐related cognitive impairment might benefit from being embedded in a supportive neighborhood.

The influence of Area Deprivation Index on cognition in cognitively‐normal adults as measured by Principal Component Analysis of Neuropsychological Data

AbstractBackgroundPrevious research has demonstrated that neighborhood disadvantage is associated with worse health outcomes including increased risk for dementia. The Area Deprivation Index (ADI) measure represents the theoretical domains of income, education, employment, and housing quality, which allows for the ranking of neighborhoods based on socioeconomic disadvantage. In the present study, we hypothesized that greater neighborhood disadvantage (i.e., higher ADI scores) would be associated with lower cognitive function after controlling for age, education, and sex.MethodPrincipal component analysis (PCA) was used to examine the component structure of a neuropsychological test battery administered to 852 adult participants enrolled in the Southern Illinois University Longitudinal Cognitive Aging Study (SIU LCAS). The vast majority of the cohort was White/Not Hispanic (&gt;98.0%) and female (72.4%). Mean age and education were 67.5 years and 14.8 years, respectively. Linear regression analysis was used to examine the relationship between ADI and PCA cognitive component scores after controlling for age, education, and sex.ResultPCA identified four cognitive components, which were labeled speed/flexibility, visuospatial skills, word list learning/memory, and story memory (immediate and delayed recall). Regression analysis revealed that all three demographic variables were significantly associated with each cognitive component score (p&lt;0.001). After controlling for age, gender, and education, higher ADI scores were associated with lower cognitive component scores for only the speed/flexibility component (p = 0.03). Age, education, and sex accounted for 23% of the variance in the speed/flexibility component. ADI accounted for only an additional 0.4% of the variance in the speed/flexibility component. There was no significant relationship between ADI scores and the visuospatial skills, word list learning/memory, and story memory components.ConclusionOur results suggest that the relationship between greater neighborhood disadvantage and poorer cognitive function are very subtle and may only be present for some, but not all, cognitive domains. One major limitation in the present study was that collection of cognitive data and ADI calculations were not synchronous. More studies are needed to better understand the relationship between neighborhood disadvantage and cognitive functioning.

Sex Selection – Cultural and Ethical Issues

This lecture on “Sex Selection – Cultural and Ethical Issues” delves into the complex and controversial topic of sex selection, exploring its technological, cultural, and ethical implications. While there is an argument of parent autonomy and their rights to choose and have the option to control and design their family structure, the topic of designing one’s own family is still considered highly contentious as well as controversial. At first glance, such a practice seems quite justifiable as the technology enables parents to avoid having disabled children and serious genetic disorders and maintain balance in the family structure. Yet, on the slippery slope and fine line drawn between what is justifiable and acceptable and what is a definite strong NO, people have become increasingly misguided and ill steered into a rather dark and mischievous side of the practice of sex selection. The lecture begins by discussing the cultural aspects of sex selection, examining how different societies view gender preferences and how these preferences impact reproductive choices. It explores historical perspectives and cultural norms that influence the desire for a specific sex, highlighting variations across regions and communities. The existing patriarchal traditions in most of the Asian countries, masculine hegemony, female seclusion, social and cultural norms with regards to gender roles all contribute to a male biased sex selection. As the Chinese say, “With one son you have a descendant, with ten daughters you have nothing”, and Amartya Sen has rightly stated the concept of ‘missing girls’, the social norms of preference for a son has led to a situation of ‘floating men’ or ‘bare branches’ or ‘surplus males’. These skewed sex ratios are a threat to the society in ways that may not be realised at the moment. Women-trafficking, expansion of prostitution, young surplus males failing to find partners will be prone to pursue satisfaction through vice and violence, which may intensify socially disruptive behaviour, low self-esteem, rape, anti-social behaviour, threatening regional and international security. While at the national level, all south Asian countries have taken a paternalistic approach by making strict regulations regarding the abortion and female feticide (sex selective abortion SSA), what remains to be addressed is the society’s mind-set towards ending discrimination at the womb. Couples in such societies are under constant coercive forces in their family and outside, for sex selection, and may perhaps be stigmatized by their society for not having a male child. So, is it even up-to the parents at all to decide their family structure? The evidence shows that banning SSA is not enough to control SSA; banning SSA resembles treating a disease but not the cause of the disease. Women’s devaluation in many Asian societies is embedded in religious beliefs and traditional cultural practices, and uprooting this culture may not be easy and immediate. A good stewardship approach is what is the need of the hour, wherein, the countries develop and implement policies, legislations, and programs within a holistic context, addressing women’s education deficit, rights, socioeconomic disadvantage, health, and nutrition, living conditions, so that they are not perceived as ‘Paraya Dhan’, meaning someone else’s property, but seen as independent, empowered members of the society.

Abstract B130: Social determinants associated with HPV disparities among people with HIV infection in Puerto Rico

Abstract Background: People with HIV (PWH) have a higher risk of acquiring oral HPV infection when compared to people without HIV, which can lead to the high prevalence of oropharyngeal cancers in PWH. Puerto Rico (PR), a US jurisdiction, is on the top 10 in terms of HIV prevalence and cumulative AIDS cases among the US and have a significant burden and disparity of HPV-related malignancies. Additionally, PR has socio-economic disadvantages, which is a social determinant of oral health disparities, and can potentially affect oral HPV. The relationship of these social determinants with HPV have not been investigated in PWH in PR. Hence, in this study, we evaluated the relationship between socio-economic, behavioral, and oral health factors with oral HPV among PWH. Methods: We evaluated 117 sexually active PWH (102 males and 15 females) from a community clinic in San Juan, PR. Oral rinse samples were collected and analyzed for HPV infection and genotype using the DNA ELISA kit HPV SPF10 and RHA kit HPV SPF10-LiPA25. We collected sociodemographic characteristics (age, marital status, employment, income) as well as lifestyle variables (smoking habits, alcohol consumption, sexual practices) through an administered questionnaire. Participants also underwent a clinical full-mouth periodontal assessment following the CDC/AAP guidelines. Statistical analyses in relation to HPV were performed in R statistical software. Findings: There was a prevalence of oral HPV infection of 29.9% in PWH in PR, which 70% were high-risk genotypes, with HPV-18 being the most abundant genotype (27.5%). There were 33.3% of males who had oral HPV while only 20% of females had oral HPV. Also, oral HPV infection was significantly associated with periodontitis (p&amp;lt;0.05). In men, oral HPV positivity trended to be frequent with no HPV vaccination (p=0.08). No HPV vaccination was associated with lower income (p&amp;lt;0.05). There was no association between HPV status and sociodemographic and lifestyle variables. Interpretation: The prevalence in high-risk HPV genotypes among PWH was higher than what has previously been observed in PR. We also found a higher prevalence of HPV-18, which may explain clinical disparities concerning oropharyngeal cancer in PR’s population. Additionally, our findings highlight the importance of access to medical care in low-resource settings. Low income can be a surrogate of lack of access of care, which can impact early diagnosis, risk, and prevention of oral HPV. Therefore, targeting social determinants, may help lower the risk of infection and oral cancer in underserved populations. While our findings contribute to understanding the impact of social determinants in oral cancer, more studies are still needed that investigate the relationship between other sociodemographic factors that affect oral health in PWH. Citation Format: Carlos A. Solá-Morlá, Yabdiel Ramos-Valerio, Coral Martes-Villalobos, María M. Sánchez-Vázquez, Ramón F. Gonzalez-García, Ana P. Ortiz, Magaly Martinez-Ferrer, Josué Pérez-Santiago. Social determinants associated with HPV disparities among people with HIV infection in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B130.

Disadvantage', Resilience and Opportunity of 'Socioeconomic and Cultural Status Disadvantage' Junior High Gifted Students

Disadvantage', Resilience and Opportunity of 'Socioeconomic and Cultural Status Disadvantage' Junior High Gifted Students

Rural‐urban disparities in the consumption of fruits and vegetables and cognitive performance in Brazil

AbstractBackgroundAdherence to a healthy diet has been associated with lower risk of dementia and cognitive decline. Furthermore, low consumption of fruits and vegetables has been associated with lower cognitive performance. Rural Brazilians have several factors related to poor diet quality, such as low education and income.Additionally, rural residents of Latin America face a higher burden of dementia compared to urban residents. However, differences in the association of fruit and vegetable consumption with cognitive performance in urban and rural areas have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults.MethodThe sample included 9,412 adults 50 years or older from the 2015 wave of the Brazilian Longitudinal Study of Aging. Consumption of fruits and vegetables was measured using a food frequency questionnaire. Cognitive performance was evaluated using the immediate recall, late recall, semantic verbal fluency, prospective memory, semantic memory, and temporal orientation. A global composite z‐score was derived from these tests. Association of consumption of fruits and vegetables with cognitive performance was evaluated using linear regression, adjusted for sociodemographic, lifestyle, and clinical variables.ResultIn 6,743 participants (mean age 61.3±8.9 y, 53% women, 43% White, and 15% from rural areas), the mean intake of fruits and vegetables was 2.0±1.3 portions a day (Table 1). Higher consumption of fruits and vegetables was associated with better episodic (β = 0.021, 95% CI = 0.004;0.037, p = 0.013) and semantic memory (β = 0.037, 95% CI = 0.019;0.055, p&lt;0.001), verbal fluency (β = 0.035, 95% CI = 0.018;0.053, p&lt;0.001), and global cognition (β = 0.032, 95% CI = 0.016;0.048, p&lt;0.001) performances (Table 2). There was a modifying effect of urban/rural area of residency (p for interaction &lt;0.001). Stratified analysis showed that consumption of fruits and vegetables was associated with better episodic and semantic memory, verbal fluency, and global cognition performances in participants who resided in urban, but not rural areas (Table 3).ConclusionConsumption of fruits and vegetables was associated with cognitive performance in urban, but not in rural areas in Brazil, possibly due to socioeconomic disadvantages and lower access to healthcare.