Household Socioeconomic Status Research Articles

Adolescent Obesity Modeling: A Framework of Socio-Economic Analysis on Public Health.

Bayesian Structural Equation Modeling (SEM-Bayesian) was applied across different research areas to model the correlation between manifest and latent variables. The primary purpose of this study is to introduce a new framework of complexity to adolescent obesity modeling based on adolescent lifestyle through the application of SEM-Bayesian. The introduced model was designed based on the relationships among several factors: household socioeconomic status, healthy food intake, unhealthy food intake, lifestyle, body mass index (BMI) and body fat. One of the main contributions of this study is from considering both BMI and body fat as dependent variables. To demonstrate the reliability of the model, especially in terms of its fitting and accuracy, real-time data were extracted and analyzed across 881 adolescents from secondary schools in Tehran, Iran. The output of this study may be helpful for researchers who are interested in adolescent obesity modeling based on the lifestyle and household socioeconomic status of adolescents.

Incidence of Plasmodium falciparum malaria infection in 6-month to 45-year-olds on selected areas of Bioko Island, Equatorial Guinea

BackgroundExtensive malaria control measures have been implemented on Bioko Island, Equatorial Guinea over the past 16 years, reducing parasite prevalence and malaria-related morbidity and mortality, but without achieving elimination. Malaria vaccines offer hope for reducing the burden to zero. Three phase 1/2 studies have been conducted successfully on Bioko Island to evaluate the safety and efficacy of whole Plasmodium falciparum (Pf) sporozoite (SPZ) malaria vaccines. A large, pivotal trial of the safety and efficacy of the radiation-attenuated Sanaria® PfSPZ Vaccine against P. falciparum is planned for 2022. This study assessed the incidence of malaria at the phase 3 study site and characterized the influence of socio-demographic factors on the burden of malaria to guide trial design.MethodsA cohort of 240 randomly selected individuals aged 6 months to 45 years from selected areas of North Bioko Province, Bioko Island, was followed for 24 weeks after clearance of parasitaemia. Assessment of clinical presentation consistent with malaria and thick blood smears were performed every 2 weeks. Incidence of first and multiple malaria infections per person-time of follow-up was estimated, compared between age groups, and examined for associated socio-demographic risk factors.ResultsThere were 58 malaria infection episodes observed during the follow up period, including 47 first and 11 repeat infections. The incidence of malaria was 0.25 [95% CI (0.19, 0.32)] and of first malaria was 0.23 [95% CI (0.17, 0.30)] per person per 24 weeks (0.22 in 6–59-month-olds, 0.26 in 5–17-year-olds, 0.20 in 18–45-year-olds). Incidence of first malaria with symptoms was 0.13 [95% CI (0.09, 0.19)] per person per 24 weeks (0.16 in 6–59-month-olds, 0.10 in 5–17-year-olds, 0.11 in 18–45-year-olds). Multivariate assessment showed that study area, gender, malaria positivity at screening, and household socioeconomic status independently predicted the observed incidence of malaria.ConclusionDespite intensive malaria control efforts on Bioko Island, local transmission remains and is spread evenly throughout age groups. These incidence rates indicate moderate malaria transmission which may be sufficient to support future larger trials of PfSPZ Vaccine. The long-term goal is to conduct mass vaccination programmes to halt transmission and eliminate P. falciparum malaria.

Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.

Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda. The survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out. Overall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured. The findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.

Higher socioeconomic status does not predict decreased prosocial behavior in a field experiment

Does higher socioeconomic status predict decreased prosocial behavior? Methodological issues such as the reliance of survey studies on self-reported measures of prosociality, the insufficient control of relative incentives in experiments, and the use of non-random samples, have prevented researchers from ruling out that there is a negative association between socioeconomic status (SES) and prosociality. Here, we present results from a field experiment on the willingness of unaware individuals of different SES to undertake an effortful prosocial task—returning a misdelivered letter. Specifically, using the rental or sale value of homes as indicators of SES, we randomly selected households of high and low SES and misdelivered envelopes to them. Despite controlling for numerous covariates and performing a series of ancillary tests, we fail to find any evidence that higher SES predicts decreased prosocial behavior. Instead, we find that misdelivered letters are substantially more likely to be returned from high rather than low SES households.

Contribution of Remittance on Economic status of Dharan - 6, Panbari

The study aims to explore the Contribution of remittance on economic progress of Dharan -6, Panmari. For this purpose, Twenty-five households having immigrant family members were selected in Dharan -6, Panmari. The information was collected through interview by using structured interview by using structured interviewed schedule. Descriptive statistics is carried out to analyze the Contribution of remittance on economic status of the sampled household in the past-migration period is better than that in the pre-migration period. In the study area, remittance is a main source of income. So, it has brought a qualitative change in economic status of migrant household. An improvement in the economic status of migrant household, the involvement of the household in community development activities and participation in social organization have brought a positive change in the overall socio economic status of the migrant household.

Children of Smoking and Non-Smoking Households' Perceptions of Physical Activity, Cardiorespiratory Fitness, and Exercise.

Previous research has shown secondhand tobacco smoke to be detrimental to children’s health. This qualitative study aimed to explore children from low socioeconomic status (SES) families and their reasons for being physically active, attitudes towards physical activity (PA), fitness and exercise, perceived barriers and facilitators to PA, self-perceptions of fitness and physical ability, and how these differ for children from smoking and non-smoking households. A total of 38 children (9–11 years; 50% female; 42% smoking households) from the deprived areas of North West England participated in focus groups (n = 8), which were analysed by utilizing thematic analysis. The findings support hypothesised mediators of PA in children including self-efficacy, enjoyment, perceived benefit, and social support. Fewer than a quarter of all children were aware of the PA guidelines with varying explanations, while the majority of children perceived their own fitness to be high. Variances also emerged between important barriers (e.g., sedentary behaviour and environmental factors) and facilitators (e.g., psychological factors and PA opportunity) for children from smoking and non-smoking households. This unique study provided a voice to children from low SES and smoking households and these child perspectives could be used to create relevant and effective strategies for interventions to improve PA, fitness, and health.

Body dissatisfaction and disordered eating are prevalent problems among U.S. young people from diverse socioeconomic backgrounds: Findings from the EAT 2010–2018 study

PurposeBody dissatisfaction and disordered eating are linked to adverse health consequences. Research describing socioeconomic patterns in the prevalence of these problems is important for informing the design of health services and efforts to improve health equity. MethodsPopulation-based cohort study (EAT 2010–2018: Eating and Activity over Time) of socioeconomically and ethnically/racially diverse U.S. young people who completed surveys as adolescents in 2009–2010 (mean age = 14.5 years) and as emerging adults in 2018 (mean age = 22.0 years). Participants were recruited from 20 schools in Minneapolis-St. Paul, Minnesota. Household socioeconomic status was determined using adolescent report of parental education, employment, and public assistance benefits. Analyses were conducted using data from 1531 participants and regression models that accounted for repeated measures within individuals. ResultsAmong females, high body dissatisfaction and unhealthy weight control behaviors (e.g., skipping meals) were more prevalent and regular use of lifestyle weight management behaviors (e.g., exercise) was less prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Among males, thinness-oriented dieting, unhealthy weight control behaviors, and extreme weight control behaviors (e.g., taking diet pills) were all more prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Few differences were observed across SES groups in models that adjusted for ethnic/racial identity and body mass index. ConclusionsThere is a need for greater attention to the reach and relevance of efforts to prevent disordered eating and improve body satisfaction to ensure efforts benefit young people across SES groups.

The role of tax-filing status in uncovering socioeconomic and physical activity differences in college-aged students

Objective: This study examined relationships among multifaceted measures of socioeconomic status (SES) and physical activity (PA) in undergraduates. Participants were classified into dependent and independent tax filers to encapsulate the atypical divide in financial responsibility. Participants: 366 diverse American undergraduates. Methods: Participants completed an online survey including three SES metrics and the International Physical Activity Questionnaire. Results: Participants engaged in the same amount of total PA, albeit different proportions depending on SES measure and PA type. Independent tax filers engaged in more occupational PA than dependent tax filers, regardless of SES. Students with low SES engaged in less leisure-time PA than students with high SES. Conclusion: Household Material Hardship and SES proxy measures should be considered in the context of tax filing status among undergraduates. Greater precision with multifactorial SES measures will assist in providing the nuanced context when optimizing interventions and reducing barriers to increase PA in young adults.

Perceived Changes in Mood and Anxiety Among Male Youth During the COVID-19 Pandemic: Findings From a Mixed-Methods Study

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has changed almost every aspect of our lives. Young adults are vulnerable to pandemic-related adverse mental health outcomes, but little is known about the impact on adolescents. We examined factors associated with perceived changes in mood and anxiety among male youth in urban and Appalachian Ohio. MethodsIn June 2020, participants in an ongoing male youth cohort study were invited to participate in an online survey that included questions about changes in mood, anxiety, closeness to friends and family, and the major impacts of the pandemic. Weighted log-binomial regression models were used to assess the risk of worsened mood and increased anxiety. Chi-square tests were used to examine the association between perceived changes in mood and anxiety and perceived changes in closeness to friends and family and open-ended responses to a question about COVID-19's impact on participants. ResultsPerceived worsened mood and increased anxiety during the pandemic were associated with higher household socioeconomic status, older age, feeling less close to friends and family, and reporting that COVID-19 negatively affected mental health. A perceived increase in anxiety was also associated with a history of symptoms of depression or anxiety. ConclusionsSpecific subgroups of male youth may be at heightened risk of worsening mental health during the COVID-19 pandemic. Interventions should target vulnerable adolescents and seek to increase closeness to social contacts. Such efforts could involve novel programs that allow youth to stay connected to friends, which might mitigate the negative impact on mental health.

Early Impact of COVID-19 on Food Security and Livelihood in Vietnam

ObjectivesOn April 1, 2020, Vietnam initiated a three-week lockdown to curb the spread of COVID-19. Lockdowns like this have had severe economic and social repercussions that are not experienced uniformly. This study evaluates whether households reporting to be severely impacted differ from those reporting to be less affected in terms of household food availability, affordability, and market access.MethodsCross-sectional data were collected as part of a World Vision Rapid Response Assessment in Vietnam (n = 3431) in May 2020. Data on household demographics, employment, food availability, affordability, and market access were collected. Households reporting a perceived severe (full or severe) impact of the COVID-19 pandemic were compared to those reporting less (moderate, slight, or no) impact using multivariable logistic regressions.Results19.2% of respondents indicated that the pandemic had severely impacted their livelihood. There was a higher percentage of females (56.4% vs. 45.6%; P < 0.001) and urban residents (25.3% vs. 8.6%; P < 0.001) in the severely impacted group. The groups differed significantly by type of employment prior to the pandemic, and a greater proportion of those who were severely impacted reported decreased income (85.4% vs. 39.9%). Both groups reported similar availabilities of staple food groups at the household-level, but the availability of green vegetables was lower in the severely affected group (OR = 0.62, 95% CI: 0.38, 1.00) than in the less affected group. However, the adjusted odds ratios for local market access to hygiene items (OR = 1.64, 95% CI: 1.13, 2.39) and essential medicines (OR = 1.80, 95% CI: 1.29, 2.50) indicate higher odds of accessibility for those more impacted relative to the less impacted group.ConclusionsThere were relatively few differences identified between the groups. While the self-reported livelihood impact status generally aligned with a loss of income, the connection between this designation and the indicators of household food availability, affordability, and market access were not as strong. The self-determination of a severe economic impact may represent a relative change in the household's socioeconomic status from before the pandemic that is not indicative of current vulnerability.Funding SourcesNone

Both Quantity and Quality of Antenatal Care Matter for Child Birthweight: An Analysis of Nationally Representative Data From Bangladesh, India, Nepal, and Pakistan

ObjectivesAntenatal care (ANC) is an important platform to deliver health and nutrition interventions during pregnancy but there is limited evidence on how both the number and content of ANC visits relate to birth outcomes. We examined the independent and additive contributions of ANC quantity and quality on child birthweight in four South Asian countries. MethodsWe used Demographic and Health Surveys for mothers of children with birthweight data from Bangladesh (2018; n = 2,279), India (2016; n = 147,762), Nepal (2016; n = 2,618) and Pakistan (2017; n = 1,621). We assessed number of ANC visits and ANC quality using a set of 11 health and nutrition intervention indicators (e.g., weight and blood pressure measurement, urine sample collection, ultrasound, nutrition education). Each country had different indicators available, so we generated country-specific dummies for high ANC quality (woman received more than half of interventions). We categorized mothers into 4 groups: 1) low quantity (<4 ANC visits) and low quality, 2) high quantity (≥4 ANC visits) and low quality, 3) low quantity and high quality, 4) high quantity and high quality. For each country, we ran a logistic regression with low birthweight (LBW; <2500 grams) as the outcome and the 4-group quantity/quality indicator as the main predictor of interest. To test for bias in the subsample with birthweight data, we reran models using the outcome of perceived birth size on the full sample. All models adjusted for child age and sex, woman’s age, education, and household socioeconomic status. ResultsBoth high quantity and high-quality ANC were reported most often by women in Nepal (42.9%), followed by Pakistan (32.0%), Bangladesh (26.6%) and India (21.8%). Compared to women reporting both low quantity and low quality, women who reported high quantity and high quality had lower odds of giving birth to a LBW child in India (OR = 0.83, 95% CI = 0.78–0.88), Nepal (0.58, 0.39–0.86) and Pakistan (0.43, 0.22–0.81). In 3 of 4 countries, only high quantity or only high quality were not protective against child LBW. We found similar results with the outcome of perceived birth size. ConclusionsANC quantity and quality are both important for optimal pregnancy and birth outcomes. Frequent low-quality ANC visits or infrequent high-quality ANC visits do not protect children from risk of LBW. Funding SourcesBill and Melinda Gates Foundation.

Changes in Sugar Sweetened Beverage Intake Related to Changes in Body Composition in Mexican Adolescents

ObjectivesTo examine the relationship between changes in sugar sweetened beverage (SSB) intake and changes in adiposity over a two-year period during adolescence in a Mexico City cohort. MethodsThe analytic sample comprised 511 Mexican adolescents enrolled in a birth cohort study with complete information on sugar sweetened beverage intake and body composition for two time points. In 2015 and 2017, a food frequency questionnaire (FFQ) from the 2006 Mexican National Health and Nutrition Survey was administered to participants ages 9 to 20. Seven variables from the FFQ were summed to use as daily servings of SSBs as a predictor: regular soda, coffee with sugar, tea with sugar, sweetened fruit water, chocolate milk, corn atole, and Yakult (sweetened probiotic milk beverage). Adiposity measurements included body mass index (BMI), body fat % estimated by bioelectrical impedance, and waist circumference, measured by trained research assistants using standard techniques. We used linear regression models with changes in adiposity measures as the continuous outcome and quartiles of change in sugar sweetened beverage intake as the predictor adjusting for age, sex, household socioeconomic status, screen time, and physical activity. ResultsAt baseline (2015), mean age was 14.5 ± 2.1 years with 48% male. The median intake of SSBs was 341 mL/day (IQR = 463 mL) for males and 257 mL/day (IQR = 391 mL) for females. The median SSB intake change over the 2-year period was a 51 mL decrease (IQR = 441 mL) for males and no change (IQR = 360 mL) for females. In adjusted analyses, adolescents with the highest change in SSB intake (Quartile 4,274.3 mL median (IQR = 297.1) increase in SSB intake) had a 0.30 increase kg/m2 in BMI (95% CI –0.15, 0.75), a 1.14% increase in body fat (95% CI –0.02, 2.31), and a 1.64 cm increase in waist circumference (95% CI 0.27, 3.00), compared to those with decreases or no change in SSB intake. ConclusionsIncreased intake of sugar sweetened beverages was associated with higher changes in body fat percentage, waist circumference, and BMI over a two-year period among Mexican adolescents. Funding SourcesThis project was supported by a P01 research grant through the NIH/NIEHS.

Neural oscillations reveal differences in the process of word learning among school-aged children from lower socioeconomic status backgrounds.

Building a robust vocabulary in grade school is essential for academic success. Children from lower socioeconomic status (SES) households on average perform below their higher SES peers on word learning tasks, negatively impacting their vocabulary; however, significant variability exists within this group. Many children from low SES homes perform as well as, or better than, their higher SES peers on measures of word learning. The current study addresses what processes underlie this variability, by comparing the neural oscillations of 44 better versus worse word learners (ages 8-15 years) from lower SES households as they infer the meaning of unknown words. Better word learners demonstrated increases in theta and beta power as a word was learned, whereas worse word learners exhibited decreases in alpha power. These group differences in neural oscillatory engagement during word learning indicate there may be different strategies employed based on differences in children's skills. Notably, children with greater vocabulary knowledge are more likely to exhibit larger beta increases; a strategy which is associated with better word learning. This sheds new light on the mechanisms that support word learning in children from low SES households.

Diet diversity of urban households in India during the COVID-19 lockdown.

Background: The nature of the COVID-19 pandemic forced several nations to impose country-wide lockdowns. The lockdown impacted several aspects of life including the economy. Food security became a growing concern for many households. Aim: The aim of the study was to explore the diet diversity of urban households in India during the nationwide COVID-19 lockdown. Methods: Information regarding socioeconomic status (SES), family size and information regarding availability and access to food were gathered from 450 households. Diet diversity was assessed using a 69-item food frequency questionnaire. Food variety scores (FVS) were computed for individual food groups and overall. Results: The majority of the households (86.4%) belonged to the upper-middle or upper SES. Households did not experience any constraints in accessibility and availability of food except the meat group. Overall, 84% of the households had low FVS for most of the food groups except for sugar and milk and milk products. The household SES score was positively associated with the milk FVS (B = 0.039, p = 0.020) and negatively with the fat FVS (B = -0.062, p < 0.001). The number of adults (B = 6.773, p < 0.001) in the household positively predicted the FVS of cereal, vegetable, fruit, fat and total FVS. Conclusions: The higher SES households in urban India did not experience food insecurity. Despite this, their poor diet diversity is a serious cause for concern, especially in the wake of the evolving pandemic. This highlights the need to promote consumption of a diverse variety of foods.

Abstract P197: Household And Neighborhood Context As Contributors To Racial Disparities In Sleep Among Adolescents

Background: Short sleep duration (e.g., &lt;9 hours (hrs) for 6-12 years and &lt;8 hrs for 13-18 years) is highly prevalent and associated with cardiometabolic risk among adolescents. Significant racial disparities in sleep duration among adolescents have been found. Investigating mechanisms driving sleep disparities is important for informing interventions to reduce disparities. Neighborhood and household stressors may contribute to racial disparities in sleep among adolescents as prior literature have found them to be patterned by race/ethnicity and associated with sleep duration. This study examined neighborhood and household context as mediators in the association between race/ethnicity (a proxy for sociocultural factors such as racism) and sleep duration among adolescents. Methods: Participants (n=13,019) were from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative multi-ethnic sample of adolescents and their health in adulthood. Sleep duration was self-reported in whole hours per day and categorized based on age-specific cut-offs for short sleep (6-12 years: &lt;9 hrs, 13-18 years: &lt;8 hrs, 19-25 years: &lt;7 hrs) vs. recommended (6-13 years: 9-11 hrs, 14-17 years: 8-10 hrs, 18-25 years: 7-9 hrs). Neighborhood factors included neighborhood socioeconomic status (SES) (e.g. census tract measures: proportions of female-headed households, individuals below the poverty threshold, individuals receiving public assistance, adults with &lt; high school education, and adults unemployed), perceived safety and social cohesion. Household factors included living in a single parent household and household SES (e.g. highest parental education, income, and occupation). Structural equation modeling (SEM) was used to simultaneously assess mediation of neighborhood and household context in the association between race/ethnicity and short sleep duration adjusting for age and sex. Results: The sample was 4% Asian, 15% African American (AA), 2% American Indian (AI), 12% Hispanic, and 66% non-Hispanic White (NHW) and mean age 15 years (SD=.1). In SEM, AAs (β=.055, p&lt;.001) and Asians (β=.047, p=.047) were more likely to have short sleep duration than NHW. Higher household SES was associated with a greater probability for short sleep duration (β=.061, p=.004) in the total sample. Only household SES was a significant mediator, explaining 11.6%, 9.9%, and 42.4% of AA-NHW, AI-NHW, and Hispanic-NHW differences, respectively. Conclusion: Although household SES partially explained racial disparities, improving household SES conditions for racial/ethnic minority adolescents may not reduce disparities, given that higher household SES was positively associated with short sleep duration. Future studies should explore buffers for racial/ethnic minority adolescents in the context of SES to inform interventions and reduce disparities in sleep.

Minimum acceptable diet among children aged 6\u201323\u2009months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study

BackgroundSuboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old.MethodsCommunity-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis.ResultsOverall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet.ConclusionActions targeting these factors are expected to improve infant feeding practices in South Kivu.

Socioeconomic Effects on Household Access to Primary Healthcare Facilities in Selected Riverine Communities, Rivers State, Nigeria

Access to healthcare is complex and varies across countries, regions, communities and individuals. The study aimed to assess the socioeconomic effects on household access to Primary Healthcare (PHC) facilities in selected riverine communities in Rivers State, Nigeria. Objectives of the study are to characterise the socioeconomic condition of households in the study area; determine the spatial distribution of PHC facilities in the study area, identify the effects of the socioeconomic conditions of households to access to PHC facilities in the selected riverine communities in the study area, and suggest appropriate policy measures to improve households access to PHC facilities and services in the study area. The study employed Mixed Methods Research (MMR) approach and sequential explanatory research design for data collection and analyses. The study employed simple random and purposive sampling techniques. A total of 400 respondents (households) were interviewed including key informants (government agencies and professionals) and Geographic Information System (GIS) was used for map analysis to show spatial distribution of PHC facilities in the study area. However, 328 questionnaires were considered valid for analysis of data. The study revealed, most of the households’ occupations are fishing, artisan and petty trading characterising low socioeconomic status. The study found PHC facilities are not evenly spatially distributed in the study area which has made households to use various available transport modes to access the facilities since the area is separated by creeks, rivers and sea. This has made travel time, distance and cost economically unfavourable to households in term of accessibility since they are relatively poor economically. The study has suggested the following recommendations including improvement of the socioeconomic status of households through education and vocational training programmes that will provide better employment opportunities, government should provide Mobile Healthcare programmes and services through water vessels and ambulances to reach remoted communities, proper study should be carried out to ascertain the population and their characteristics before locating PHC facilities for optimum utilisation, Smart Healthcare Services (SHCS) should be provided through Tele-Healthcare facilities to overcome distance and time, and government should collaborate with non-governmental organisations (NGOs) and multinational to provide Mobile Healthcare services in riverine communities to reduce challenges of accessibility and cost on households.

Association of household socioeconomic status, neighborhood support system and adherence to dietary recommendation among persons with T2DM, a facility-based cross-sectional study in Ghana

BackgroundDietary recommendation help persons with diabetes adopt to healthy eating habits to achieve optimal glycemic control. Socioeconomic-status and neighborhood support system can influence adherence to dietary recommendation. The purpose of our study is to assess the association of household-socioeconomic status and neighborhood-support system with adherence to dietary recommendation among persons with type 2 diabetes mellitus (T2DM).MethodsFacility-based cross-sectional-survey was conducted in Brong Ahafo region, Ghana. Six hospitals were randomly selected and 530 individuals with T2DM consecutively recruited from the selected hospitals for the study. Structured-questionnaires were used to collect socio-demographic variables. Adherence to dietary-recommendation was the outcome-variable, and was assessed using perceived dietary-adherence questionnaire.ResultsAge (years) (P-value = 0.005), Physical-Activity level (P-value = 0.024) Receive-moderate Social-Support (P-value = 0.004) and High-Socioeconomic status (P-value = 0.046) were significantly correlated with adherence to dietary-recommendation. Age (years) regression coefficient (β) -0.089, 95%CI (− 0.12, − 0.001), Being married β0.103, 95%CI (0.002, 0.02), moderate and low-social support system β 0.309, 95%CI (0.17, 0.38) and β-0.192, 95%CI (− 0.26, − 0.06) respectively, and high-socioeconomic status β 0.197, 95%CI (0.06, 0.25) were significantly associated with adherence to dietary-recommendation.ConclusionSocial-support system and socioeconomic-status could be associated with adherence to dietary-recommendation. Therefore, health workers should consider patients’ social support system and socioeconomic status as modifiable factors for optimum adherence.

Investigating air pollution as a contributor to health disparities during the coronavirus disease 2019 pandemic

The high rates of morbidity and mortality from coronavirus disease 2019 (COVID-19) among Black patients have been a ubiquitous component of media coverage of the pandemic.1 Although the association between race and COVID-19 is likely multifactorial owing to household crowding, socioeconomic status, and percentage of essential workers,2 the association between air pollution and the disproportionate exposure of COVID-19 for minority communities has not been adequately explored. Emerging evidence has shown that there is a relationship between exposure to increased levels of air pollution and adverse COVID-19 outcomes and displayed that race is a significant predictor of living in a polluted area within the United States.

Ex ante Inequality of Opportunity in Health among the Elderly in China: A Distributional Decomposition Analysis of Biomarkers

Using pooled data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS) linked with the 2014 CHARLS Life History Survey, we analyse ex ante inequality of opportunity (IOp) in blood‐based biomarkers among Chinese adults aged 60+. We apply a re‐centered influence function approach and a Shapley‐Shorrocks decomposition to partition the contributions of different sets of measured circumstances and find that these account for between 2.01 percent and 23.95 percent of total health inequality across the range of biomarkers. The decompositions show that spatial circumstances such as urban/rural and province of residence at birth are the dominant factors for most of the biomarkers. Distributional decompositions further reveal that the relative contributions of household socioeconomic status and health and nutrition in childhood increase in the right tails of the distribution, where the clinical risk is focused, for most of the biomarkers.