Neighborhood Status Research Articles

Abstract PR001: A comparison of modeling approaches to assess the interplay of social, behavioral, and environmental factors on lung cancer racial disparities

Abstract Purpose: While risk factors for lung cancer incidence are well established, our understanding of factors driving an increased risk of lung cancer among Black/African American populations remains incomplete. Methods: We assembled data from five U.S. lung cancer case-control studies matched on race, gender and age: the Southern Community Cohort Study, the Inflammation, Health, Ancestry and Lung Epidemiology study, the Northern California Lung Cancer Study, three Detroit area lung studies, and the NCI-Maryland Lung Cancer Study. Incident lung cancers were ascertained from state and regional cancer registries or National Death Index mortality records. Social, behavioral, and environmental factors were ascertained by in-person interviews or mailed-in questionnaires. Participant's residential addresses were geocoded and area-level area deprivation and environmental justice variables were linked at the census block. We evaluated interactions between known lung cancer risk factors and race using multilevel logistic regression analyses and novel tree-based approaches to identify potential factors contributing to racial disparities. Tree-based approaches included a conditional matched classification tree analysis designed to detect complex interactions, as well as a specialized partially recursively induced structured moderation (PRISM) analysis to study variation in disparity in lung cancer risk across levels of educational status. Results: Among 5,829 lung cancer cases and 10,671 controls (64% self-identified Black/African American and 36% White), the average age was 60 years, 50% were female, and 24% had less than a high school education. Conditional logistic regression models fit after imputation of missing data identified increased risk of lung cancer associated with personal history of cancer, family history of lung cancer, current smoking status, smoking duration, smoking pack-years, and higher neighborhood deprivation; whereas, reduced lung cancer risk was associated with higher education and increased BMI. Similar patterns were observed among Black/African Americans only, with the addition of secondhand smoke exposure. Assessment for interactions with race identified significant interactions between race and body mass index (BMI) (p-value < 0.0001), PM2.5 (p= 0.010) and gender (p=0.001) and lung cancer risk. A conditional matched classification tree analysis identified both increased and decreased risk subgroups defined by multi-way interactions of similar variables that were identified as significant main effects in the conditional logistic regression analysis. Smoking pack-years and BMI were identified as the most important determinants of heterogeneity of disparity in lung cancer risk across educational levels in our study population. Conclusions: The use of both traditional and novel tree-based based approaches provide approaches for identifying factors contributing to racial disparities. Future studies should assess the interplay of lung cancer risk factors to inform development of targeted interventions. Citation Format: Melinda C. Aldrich, Chen Zhao, Christine M Lusk, Lucie McCoy, James Jaworski, Michael Mumma, Catherine Pichardo, Michael Betti, John K Wiencke, Brid Ryan, Ann G Schwartz, Sunil Rao. A comparison of modeling approaches to assess the interplay of social, behavioral, and environmental factors on lung cancer racial disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR001.

Congenital Anomalies among Offspring of Women Living in Low Socioeconomic Status Neighborhoods or Hispanic/Latino Enclaves, Texas, 1999-2018

Objectives and ApproachNeighborhood influences pregnancy outcomes through effects on maternal health. We evaluated prevalence of >140 congenital anomalies monitored by the population-based Texas Birth Defects Registry among residents of Hispanic/Latino enclaves (census tracts with high proportions of Hispanic/Latino residents, immigrants, and Spanish-speaking households) and tracts with low socioeconomic status (low nSES). We included all cases regardless of pregnancy outcome (1999-2018) and a reference population of all livebirths, identified by linkage to Texas vital records. We calculated Yost socioeconomic index and Hispanic/Latino enclave index scores using linked U.S. Census Bureau data. We used Poisson regression to estimate the prevalence ratio (PR) and 95% confidence interval of anomalies among residents of: low nSES/enclave (34.5%); low nSES/non-enclave (25.6%); high nSES/enclave (4.6%); and high nSES/non-enclave (referent; 35.3%) tracts. We adjusted for maternal age, education, race/ethnicity, parity, and pre-pregnancy body mass index. ResultsLow nSES was associated with microcephaly, pulmonary artery anomalies, atrial septal defect, and Down syndrome (PRs 1.1-1.6), and inversely associated with hypospadias and other male genital anomalies (PRs 0.8-0.9). Offspring of women in low nSES enclaves were at increased risk of several congenital heart defects relative to those in other neighborhoods. Conversely, prevalence of hypospadias was lowest among offspring of women in low nSES enclaves. ConclusionsLinkage between a population-based registry, vital records, and Census Bureau data revealed novel associations between neighborhood characteristics and congenital anomalies. ImplicationsFurther research is warranted to understand mechanisms linking neighborhood factors to congenital anomalies.

Maternal immigrant status and survival among children with congenital heart disease

ObjectiveTo examine associations between maternal immigrant status and survival of children with congenital heart disease (CHD). ApproachA retrospective population-based cohort study of hospital live births between April 2002 to September 2020 in Ontario, Canada was conducted at ICES. We identified children aged 0-17 years with a diagnosis of CHD from inpatient and health services datasets. The exposure was maternal immigrant status obtained from the IRCC permanent resident database. The outcome was time-to-death from after birth to <18 years olds. Multilevel Cox hazard regression models generated hazard ratios (HR) for associations between maternal immigrant status and children’s deaths while accounting for hospitals as a cluster factor and adjusting for maternal age at birth, neighbourhood income and education quantiles, comorbidities, a composite of severe maternal morbidity, gestational age at birth, birth weight, and infant sex. ResultsRelative to children born to non-immigrant mothers, the adjusted HR for death was 1.17 (95% CI:1.06-1.30) in children whose mothers were immigrants, and 1.33 (95% CI:1.07-1.65) in those from refugees. Moreover, compared to children residing in neighbourhoods with the highest income and educational levels, the adjusted HR of death for children who lived in neighbourhoods with the lowest income and educational level was 1.52 (95% CI: 1.24-1.88) and 1.47 (95% CI: 1.18-1.83) respectively. ConclusionChildren with CHD born to immigrant and refugee mothers, and those living in low socioeconomic status neighbourhoods had worse mortality. Health policy decision makers should target children with CHD from immigrant/refugee families and disadvantaged neighbourhoods to improve their survival.

Willingness of West African Consumers to Buy Food Produced Using Black Soldier Fly Larvae and Frass.

The use of black soldier fly (BSF) larvae and frass in agriculture can make an important contribution to food and nutrition security. However, it is important to understand whether consumers are willing to consume food products resulting from the use of BSF larvae as animal feed or BSF frass as fertilizer. This study employed the stated preference approach as food products produced using BSF larvae and frass are not currently available on the market. Questionnaires were administered to a total of 4412 consumers in Ghana (1360), Mali (1603), and Niger (1449). The results show that the vast majority of respondents are willing to consume vegetables (88%) produced using BSF frass and meat (87%) produced using animal feed made of BSF larvae. A smaller percentage of respondents are even willing to pay USD 1.32 and USD 1.7 more if the base price of BSF-based products were USD 5 per kg. Age, gender, education, and country positively influenced the respondents' willingness to consume food produced using BSF products. In contrast, neighborhood status, income, and household size are inversely related to the respondents' willingness to pay for and consume these products. Our findings are, therefore, important to scaling up BSF technologies in the region.

The Social Failure Model: Do Classroom Norms Play a Role in the Development of Antisocial Behavior and Depressive Symptoms?

This study examined the moderating role of descriptive and status norms in the stability of youth's antisocial behavior, and the link between initial antisocial behavior and the development of depressive symptoms over the course of one academic year, while controlling for initial depression levels. A total of 1081 students (51.06% girls; grades 4 through 6) in schools in low to average socio-economic status neighborhoods completed self-reports and a peer nomination inventory in the fall (T1) and spring (T2) of one year. Descriptive norms were operationalized as the classroom- and sex-specific mean level of antisocial behavior. Status norms were operationalized as the classroom- and sex-specific correlation between antisocial behavior and social preference. Descriptive norms moderated the link between T1 and T2 antisocial behavior, such that youth exhibiting high levels of antisocial behavior showed a greater increase in antisocial behavior in classrooms where descriptive norms strongly favored such behavior (i.e., + 1 SD) than in classrooms with neutral or weak descriptive norms (i.e., - 1 SD). Status norms moderated the association between T1 antisocial behavior and T2 depressive symptoms, such that youth with high levels of antisocial behavior had higher depressive symptoms in classrooms where status norms disfavored antisocial behavior than in classrooms with neutral or favorable norms. No moderating effects of sex or grade were observed. These results suggest that both descriptive norms and status norms play important, albeit distinct, roles in exacerbating youth's depressive symptoms and antisocial behavior, but they may also mitigate these same outcomes in favorable contexts.

Neighbourhood Environments and Lifestyle Behaviours in Adolescents With Type 1 Diabetes

ObjectivesEarly prevention strategies are needed to mitigate the high risk of cardiovascular disease in adolescents with type 1 diabetes (T1D). Residential neighbourhood features can promote healthy lifestyle behaviours and reduce cardiovascular risk, but less is known about their role in lifestyle behaviours in adolescents with T1D, and no studies used comparisons to healthy controls. MethodsWe examined associations between residential neighbourhood features and lifestyle behaviours in adolescents with T1D and healthy controls. Data were analyzed from the CARdiovascular Disease risk factors in pEdiatric type 1 diAbetes (CARDEA) study, a cross-sectional investigation of 100 adolescents with T1D (14 to 18 years) from a pediatric diabetes clinic in Montréal, Canada, and 97 healthy controls. Outcomes included physical activity and sedentary behaviour (accelerometry), screen time and sleep duration (questionnaires), and dietary habits (24-hour recalls). Cluster analysis of selected neighbourhood indicators computed for participants’ postal codes resulted in 2 neighbourhood types: central urban and peri-urban. Central urban neighbourhoods were characterized by very high population density, high active living index, numerous points of interest, higher social deprivation, higher residential mobility, and lower median household income compared with peri-urban neighbourhoods. Associations of neighbourhood type with lifestyle behaviours were estimated with multiple linear regressions and interactions by T1D status were tested. ResultsLiving in central urban neighbourhoods was associated with greater daily minutes of moderate-to-vigourous physical activity (beta = 8.61, 95% confidence interval 1.79 to 15.44) compared with living in peri-urban neighbourhoods. No associations were observed for other lifestyle behaviours, and no statistically significant interactions were found between neighbourhood type and T1D status. ConclusionFeatures that characterize central urban built environments appear to promote physical activity in adolescents, regardless of T1D status.

Depleted Housing Elicits Cardiopulmonary Dysfunction After a Single Flaming Eucalyptus Wildfire Smoke Exposure in a Sex-Specific Manner in ApoE Knockout Mice

Although it is well established that wildfire smoke exposure can increase cardiovascular morbidity and mortality, the combined effects of non-chemical stressors and wildfire smoke remains understudied. Housing is a non-chemical stressor that is a major determinant of cardiovascular health, however, disparities in neighborhood and social status have exacerbated the cardiovascular health gaps within the United States. Further, pre-existing cardiovascular morbidities, such as atherosclerosis, can worsen the response to wildfire smoke exposures. This represents a potentially hazardous interaction between inadequate housing and stress, cardiovascular morbidities, and worsened responses to wildfire smoke exposures. The purpose of this study was to examine the effects of enriched (EH) versus depleted (DH) housing on pulmonary and cardiovascular responses to a single flaming eucalyptus wildfire smoke (WS) exposure in male and female apolipoprotein E (ApoE) knockout mice, which develop an atherosclerosis-like phenotype. The results of this study show that cardiopulmonary responses to WS exposure occur in a sex-specific manner. EH blunts adverse WS-induced ventilatory responses, specifically an increase in tidal volume (TV), expiratory time (Te), and relaxation time (RT) after a WS exposure, but only in females. EH also blunted an increase in isovolumic relaxation time (IVRT) and the myocardial performance index (MPI) 1-week after exposures, also only in females. Our results suggest that housing alters the cardiovascular response to a single WS exposure, and that DH might cause increased susceptibility to environmental exposures that manifest in altered ventilation patterns and diastolic dysfunction in a sex-specific manner.

Representativeness of Patients With Lung Cancer in an Integrated Health Care Delivery System.

Observational research is important for understanding the real-world benefits of advancements in lung cancer care. Integrated health care systems, such as Kaiser Permanente Northern California, have extensive electronic health records suitable for such research, but the generalizability of their populations is often questioned. Leveraging data from the California Cancer Registry, the authors compared distributions of demographic and clinical characteristics, in addition to neighborhood and environmental conditions, between patients diagnosed with lung cancer from 2015 through 2019 at Kaiser Permanente Northern California, National Cancer Institute-designated cancer centers (NCICCs), and all other non-NCICC hospitals within the same catchment area. Of 20,178 included patients, 30% were from Kaiser Permanente Northern California, 8% from NCICCs, and 62% from other non-NCICC hospitals. Compared to NCICC patients, Kaiser Permanente Northern California patients were more similar to other non-NCICC patients on most characteristics. Compared to other non-NCICC patients, Kaiser Permanente Northern California patients were slightly older, more likely to be female, and less likely to be Hispanic or Asian/Pacific Islander and to reside in lower socioeconomic status (SES) neighborhoods. In contrast, NCICC patients were younger, less likely to be female or from non-Asian/Pacific Islander minoritized racial groups, and more likely to present with early-stage disease and adenocarcinoma and to reside in neighborhoods with higher SES and lower air pollution than Kaiser Permanente Northern California or other non-NCICC patients. Patients from Kaiser Permanente Northern California, compared to NCICCs, are more broadly representative of the underlying patient population with lung cancer. Research using electronic health record data from integrated health care systems can contribute generalizable real-world evidence to benchmark and improve lung cancer care.

Trends in the Prevalence of Autism Spectrum Disorder in California: Disparities by Sociodemographic Factors and Region Between 1990-2018.

Autism Spectrum Disorders (ASD) prevalence has risen globally, with regional variation and sociodemographic disparities affecting diagnosis and intervention. This study examines ASD trends from 1990 to 2018 in California (CA), focusing on sociodemographic factors that may inform policy/interventions. Using CA Department of Public Health birth records (1990-2018) and Developmental Services ASD cases (1994-2022), we analyzed diagnosis incidence by age 4 or 8, stratified by sociodemographic and regional factors. From 1990 to 2018, for each birth year the cumulative incidence of ASD by 4 and 8 years of age in CA increased while the diagnosis age decreased. Distinct patterns emerged over these three decades. Children born to White and Asian and Pacific Islander (API) mothers, or to mothers with higher education or living in high socioeconomic status (SES) neighborhoods exhibited higher ASD cumulative incidences throughout the 1990s and early 2000s. However, in the mid-2000s, ASD incidence in children born to Black or Hispanic mothers, with low education, or living in low SES neighborhoods surpassed that of White/API children or those living in high SES neighborhoods. Black or Hispanic children now have the highest ASD cumulative incidence, even though age at first diagnosis remains lowest in high SES regions, for the highly educated, and for White/API children. ASD cumulative incidence in CA from 1990 to 2018 exhibited demographic reversals with higher rates in children born to Black or Hispanic mothers or lower SES neighborhoods. Black and Hispanic children still have delayed age at diagnosis compared to White/API children.

COVID-19 Hospitalization in Hawai'i and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination.

The people of Hawai'i have both high rates of health insurance and high levels of racial and ethnic diversity, but the degree to which insurance status and race and ethnicity contribute to health outcomes in COVID-19 remains unknown. To evaluate the associations of insurance coverage, race and ethnicity (using disaggregated race and ethnicity data), and vaccination with outcomes for COVID-19 hospitalization. This retrospective cohort study included hospitalized patients at a tertiary care medical center between March 2020 and March 2022. All patients hospitalized for acute COVID-19, identified based on diagnosis code or positive results on polymerase chain reaction-based assay for SARS-CoV-2, were included in analysis. Data were analyzed from May 2022 to May 2023. COVID-19 requiring hospitalization. Electronic medical record data were collected for all patients. Associations among race and ethnicity, insurance coverage, receipt of at least 1 COVID-19 vaccine, intensive care unit (ICU) transfer, in-hospital mortality, and COVID-19 variant wave (pre-Delta vs Delta and Omicron) were assessed using adjusted multivariable logistic regression. A total of 1176 patients (median [IQR] age of 58 [41-71] years; 630 [54%] male) were hospitalized with COVID-19, with a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 (25-36) and Sequential Organ Failure Assessment score of 1 (0-2). The sample included 16 American Indian or Alaska Native patients, 439 Asian (not otherwise specified) patients, 15 Black patients, 66 Chinese patients, 246 Filipino patients, 76 Hispanic patients, 107 Japanese patients, 10 Korean patients, 299 Native Hawaiian patients, 523 Pacific Islander (not otherwise specified) patients, 156 Samoan patients, 5 Vietnamese patients, and 311 White patients (patients were able to identify as >1 race or ethnicity). When adjusting for age, BMI, sex, medical comorbidities, and socioeconomic neighborhood status, there were no differences in either ICU transfer (eg, Medicare vs commercial insurance: odds ratio [OR], 0.84; 95% CI, 0.43-1.64) or in-hospital mortality (eg, Medicare vs commercial insurance: OR, 0.85; 95% CI, 0.36-2.03) as a function of insurance type. Disaggregation of race and ethnicity revealed that Filipino patients were more likely to die in the hospital (OR, 1.79; 95% CI, 1.04-3.03; P = .03). When considering variant waves, mortality among Filipino patients was highest during the pre-Delta time period (OR, 2.72; 95% CI, 1.02-7.14; P = .04), when mortality among Japanese patients was lowest (OR, 0.19; 95% CI, 0.03-0.78; P = .04); mortality among Native Hawaiian patients was lowest during the Delta and Omicron period (OR, 0.35; 95% CI, 0.13-0.79; P = .02). Patients with Medicare, compared with those with commercial insurance, were more likely to have received at least 1 COVID-19 vaccine (OR, 1.85; 95% CI, 1.07-3.21; P = .03), but all patients, regardless of insurance type, who received at least 1 COVID-19 vaccine had reduced ICU admission (OR, 0.40; 95% CI, 0.21-0.70; P = .002) and in-hospital mortality (OR, 0.42; 95% CI, 0.21-0.79; P = .01). In this cohort study of hospitalized patients with COVID-19, those with government-funded insurance coverage (Medicare or Medicaid) had similar outcomes compared with patients with commercial insurance, regardless of race or ethnicity. Disaggregation of race and ethnicity analysis revealed substantial outcome disparities and suggests opportunities for further study of the drivers underlying such disparities. Additionally, these findings illustrate that vaccination remains a critical tool to protect patients from COVID-19 mortality.

Processing difficulty while reading words with neighbors is not due to increased foveal load: Evidence from eye movements.

Words with high orthographic relatedness are termed "word neighbors" (angle/angel; birch/birth). Activation-based models of word recognition assume that lateral inhibition occurs between words and their activated neighbors. However, studies of eye movements during reading have not found inhibitory effects in early measures assumed to reflect lexical access (e.g., gaze duration). Instead, inhibition in eye-movement studies has been found in later measures of processing (e.g., total time, regressions in). We conducted an eye-movement boundary change study (Rayner, Cognitive Psychology, 7(1), 65-81, 1975) that manipulated the parafoveal preview of the word following the neighbor word (word N+1). In this way, we explored whether the late inhibitory effects seen with transposed letter words and words with higher-frequency neighbors result from reduced parafoveal preview due to increased foveal load and/or interference during late stages of lexical processing (the L2 stage within the E-Z Reader framework). For word N+1, while there were clear preview effects, there was not an effect of the neighborhood status of word N, nor a significant interaction. This suggests that the late inhibitory effects of earlier eye-movement studies are driven by misidentification of neighbor words rather than being due to increased foveal load.

Racial disparities in initiation of chemotherapy among breast cancer patients with discretionary treatment indication in the state of Georgia

PurposeThe majority of breast cancer patients are diagnosed with early-stage estrogen receptor (ER) positive disease. Despite effective treatments for these cancers, Black women have higher mortality than White women. We investigated demographic and clinical factors associated with receipt of chemotherapy among those with a discretionary indication who are at risk for overtreatment.MethodsUsing Georgia Cancer Registry data, we identified females diagnosed with ER positive breast cancer who had a discretionary indication for chemotherapy (2010–2017). We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associating patient demographic and clinical characteristics with chemotherapy initiation overall, and comparing non-Hispanic Black (NHB) with non-Hispanic White (NHW) women within strata of patient factors.ResultsWe identified 11,993 ER positive breast cancer patients with a discretionary indication for chemotherapy. NHB patients were more likely to initiate chemotherapy compared with NHW women (OR = 1.41, 95% CI: 1.28, 1.56). Race differences in chemotherapy initiation were pronounced among those who did not receive Oncotype DX testing (OR = 1.47, 95% CI: 1.31, 1.65) and among those residing in high socioeconomic status neighborhoods (OR = 2.48, 95% CI: 1.70, 3.61). However, we observed equitable chemotherapy receipt among patients who received Oncotype DX testing (OR = 0.90, 95% CI: 0.71, 1.14), were diagnosed with grade 1 disease (OR = 1.00, 95% CI: 0.74, 1.37), and those resided in rural areas (OR = 1.01, 95% CI: 0.76, 1.36).ConclusionWe observed racial disparities in the initiation of chemotherapy overall and by sociodemographic and clinical factors, and more equitable outcomes when clinical guidelines were followed.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016–2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40–70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

Living in a low socioeconomic status neighbourhood is associated with lower cumulative ongoing pregnancy rate after IVF treatment

Research questionDoes an association exist between neighbourhood socioeconomic status (SES) and the cumulative rate of ongoing pregnancies after 2.5 years of IVF treatment? DesignA retrospective observational study involving 2669 couples who underwent IVF or IVF and intracytoplasmic sperm injection treatment between 2006 and 2020. Neighbourhood SES for each couple was determined based on their residential postal code. Subsequently, SES was categorized into low (<p20), medium (p20–p80), and high (>p80). Multivariable binary logistic regression analyses were conducted, with the cumulative ongoing pregnancy within 2.5 years as the outcome variable. The SES category (reference category: high), female age (reference category: 32–36 years), body mass index (reference category: 23–25 kg/m2), smoking status (yes/no), number of oocytes after the first ovarian stimulation, embryos usable for transfer or cryopreservation after the first cycle, duration of subfertility before treatment and insemination type were used as covariates. ResultsA variation in ongoing pregnancy rates was observed among SES groups after the first fresh embryo transfer. No difference was found in the median number of IVF treatment cycles carried out. The cumulative ongoing pregnancy rates differed significantly between SES groups (low: 44%; medium: 51%; high: 56%; P < 0.001). Low neighbourhood SES was associated with significantly lower odds for achieving an ongoing pregnancy within 2.5 years (OR 0.66, 95% CI 0.52 to 0.84, P < 0.001). ConclusionLow neighbourhood SES compared with high neighbourhood SES is associated with reducing odds of achieving an ongoing pregnancy within 2.5 years of IVF treatment.

Associação entre exposição a telas na infância e obesidade pediátrica: uma revisão de literatura

Introduction: Most children are exposed to screens and digital media early and for a longer period than recommended by scientific societies. This phenomenon has several harmful consequences for the health and development of children. Pediatric obesity has been highlighted as one of these effects, which may be related to exposure to screens as a sedentary behavior. Objectives: To search for and describe the evidence in the literature on the relationship between pediatric obesity and exposure to screens in childhood. Methodology: A non-systematic literature review was performed including articles published between 2018 and 2022 in the following databases: Cochrane, PubMed, Scielo and Lilacs. The terms “screen time” and “pediatric obesity” were used as descriptors. Results: Associations were found between screen exposure time and increased waist circumference, body mass index (BMI) and childhood obesity stage. In addition, the use of screens mediated the positive relationship between obesity and the social status of the childrens neighborhood, as well as the relationship between obesity and asthma. Conclusion: Most of the evaluated studies demonstrated a positive association between the use of screens by children and the occurrence of obesity in pediatrics.

Social Determinants of Health for Positive Mental Health of Iranian Adults

Objectives Considering the importance of positive mental health promotion for preventing psychosocial disorders and increasing physical health and productivity, it is necessary to identify the social determinants of health (SDH) to implement the necessary interventions to improve community health. The present study aims to identify the SDH of positive mental health in Iranian adults. Methods This is a quantitative and correlational study that was conducted on adults aged 30-60 years living in Tehran, Iran. The sample size was estimated to be 547 people using G*Power software. The samples were selected using a multi-stage random sampling method. After reviewing the literature and meeting with a panel of experts, the SDH list was extracted, and the conceptual model was plotted. The criteria for entering the model was a significance level (P≥0.2). At the end, the structural equation modeling method was applied. The tools used included the mental health continuum–short form, the socioeconomic status questionnaire, multidimensional scale of perceived social support, perceived stress scale-10 items, international physical activity questionnaire-short form, Neissi’s job security questionnaire, Ten Horn’s job security questionnaire, the visual analogue scale for occupational stress assessment, the neighborhood status checklist, Internet use checklist, and social security insurance checklist. The data was analyzed in SPSS software, version 21 and LISREL version 8.8. Results The data of 607 questionnaires were analyzed. The mean age of participants was 44.04±9.4 years. The mean score of positive mental health was 45.96±8.65. Among structural determinants, the social class (B=0.181), socio-economic status (B=0.114), job position (B=0.08), building volume per capita (B=0.092) had positive effect on positive mental health, while education (B=-0.071) had negative effect. Among intermediary determinants, job satisfaction (B=0.16), social support (B=0.23) and insurance (B=0.14) had positive effect on positive mental health, while perceived stress (B=-0.62) had negative effect. Conclusion Improving socioeconomic status by increasing social support and job satisfaction can increase Iranian adults' positive mental health. On the other hand, the reduction of perceived stress can determine the positive mental health of Iranian adults both directly and indirectly.

Utilization of Autologous Hematopoietic Cell Transplantation Over Time in Multiple Myeloma: A Population-Based Study

PurposeAutologous hematopoietic cell transplantation (autoHCT) is associated with survival benefits in multiple myeloma (MM), but utilization remains low and differs by sociodemographic factors. Prior population-based studies have not fully captured autoHCT utilization or examined relationships between sociodemographic factors and autoHCT trends over time. Patients and MethodsWe used a novel data linkage between the California Cancer Registry, Center for International Blood and Marrow Transplant Research, and hospitalizations to capture autoHCT in a population-based MM cohort (n = 29, 109; 1991-2016). Due to interactions by treatment era, stratified multivariable Cox proportional hazards regression models determined factors associated with autoHCT. ResultsThe frequency of MM patients who received autoHCT increased from 5.7% (1991-1995) to 27.4% (2011-2016). In models by treatment era, patients with public/no (vs. private) health insurance were less likely to receive autoHCT (2011-2016 Medicare hazard ratio (HR) 0.70, 95% confidence interval (CI): 0.63-0.78; Medicaid HR 0.81, CI: 0.72-0.91; no insurance HR 0.56, CI: 0.32-0.99). In each treatment era, Black/African American (vs. non-Hispanic White) patients were less likely to receive autoHCT (2011-2016 HR 0.83, CI: 0.72-0.95). Hispanic patients were less likely to undergo autoHCT, most prominently in the earliest treatment era (1991-1995 HR 0.58, 95% CI: 0.37-0.90; 2011-2016 HR 1.07, CI: 0.96-1.19). Patients in lower socioeconomic status neighborhoods were less likely to utilize autoHCT, but differences decreased over time. ConclusionsDespite increases in autoHCT utilization, sociodemographic disparities remain. Identifying and mitigating barriers to autoHCT is essential to ensuring more equitable access to this highly effective therapy.

Enhancing resilience and well-being among low-SES populations: The mediating effect of community resources.

Residents of low-socioeconomic status (SES) neighborhoods suffer from social, economic, and health problems and high exposure to crime and neglect. Based on the social cure approach, the study aimed to examine whether community resources are associated with resilience and well-being, and whether they mediate the associations between personal resources and these outcomes. The moderating effect of participating in community activity was also investigated. A total of 400 residents of low-SES communities, 200 of whom were community activists, completed questionnaires measuring personal resources, community resources, and the outcomes (resilience, well-being). Structural equation modeling revealed the mediating role of community resources. Moderation analysis indicated that different paths led to the outcomes among activists and nonactivists. The results indicate that personal resources alone do not substantially enhance welfare in low-SES communities, but should be channeled through community belonging and commitment. Moreover, professionals working with these communities should take into account the distinctions between activists and nonactivists.

FC36: Social determinants of modifiable dementia risk in Maori and Non-Maori: Results of the New Zealand Health, Work and Retirement study

Background:Dementia risk varies along the social gradient, which needs to be considered in risk reduction and prevention strategies. Revealing links of social determinants of health (SDOH) and modifiable health and lifestyle factors for dementia holds clues towards maximizing dementia risk reduction opportunities, especially for vulnerable populations. Therefore, the aim was to investigate associations of SDOH and a dementia risk score in Indigenous Māori and Non-Māori (mainly European descent) in midlife and early late-life.Method:A subsample of the New Zealand Health, Work and Retirement study completed standardized face-to-face cognitive assessments (adapted ‘Kiwi’ Addenbrooke’s Cognitive Examination/ACE-R) in 2010. We computed the Lifestyle for Brain Health (LIBRA) dementia risk score, comprising 8 risk factors (low/moderate alcohol consumption, heart disease, physical inactivity, chronic kidney disease, diabetes, smoking, hypertension, depression). Higher scores indicate higher dementia risk/poorer lifestyle (range= -1;+9.2). First, we assessed associations of LIBRA and cognition. Second, we performed adjusted regression analysis for area-based (socioeconomic deprivation, health care access, neighbourhood safety) and individual SDOH (education, employment status, net income, social loneliness) with LIBRA stratified for Māori and Non-Māori.Results:In 918 participants (age: M= 62.9 years, SD= 6.7, range= 48-75; females= 52.8%; Māori= 26.2%), a higher LIBRA score (M= 1.8, SD= 1.6, observed range= -1; +7.4) was associated with lower cognitive functioning (b= -0.30, 95%CI= [-0.48;-0.11], p= .002) and cognitive impairment (OR= 1.41, 95%CI= [1.10;1.81], p= .007), adjusted for age, sex, education, ethnicity and area-based socio- economic deprivation. Higher area-based socio-economic deprivation was associated with higher LIBRA in Māori (b= .10, 95%CI= [0.02;0.18], p= .020), but not in Non-Māori (b= 0.01, 95%CI= [- .03;0.05], p= .677). Employment status and lower neighbourhood safety were associated with higher LIBRA in Non-Māori only. Health care access difficulties and social loneliness were associated with higher LIBRA in both populations, while education and net income were not.Conclusion:SODH are differentially associated with dementia risk in midlife and early late-life New Zealanders. Area-based socioeconomic deprivation was linked to dementia risk in Indigenous Māori, but not in Non-Māori. This points to systematic inequities in dementia risk, which require equity- focused policy-based public health approaches to risk reduction.

Social determinants of modifiable dementia risk in Māori and Non‐Māori: Results of the New Zealand Health, Work and Retirement study

AbstractBackgroundDementia risk varies along the social gradient, which needs to be considered in risk reduction and prevention strategies. Revealing links of social determinants of health (SDOH) and modifiable health and lifestyle factors for dementia holds clues towards maximizing dementia risk reduction opportunities, especially for vulnerable populations. Therefore, the aim was to investigate associations of SDOH and a dementia risk score in Indigenous Māori and Non‐Māori (mainly European descent) in midlife and early late‐life.MethodA subsample of the New Zealand Health, Work and Retirement study completed standardized face‐to‐face cognitive assessments (adapted ‘Kiwi’ Addenbrooke’s Cognitive Examination/ACE‐R) in 2010. We computed the Lifestyle for Brain Health (LIBRA) dementia risk score, comprising 8 risk factors (low/moderate alcohol consumption, heart disease, physical inactivity, chronic kidney disease, diabetes, smoking, hypertension, depression). Higher scores indicate higher dementia risk/poorer lifestyle (range = ‐1;+9.2). First, we assessed associations of LIBRA and cognition. Second, we performed adjusted regression analysis for area‐based (socioeconomic deprivation, health care access, neighborhood safety) and individual SDOH (education, employment status, net income, social loneliness) with LIBRA stratified for Māori and Non‐Māori.ResultsIn 918 participants (age: M = 62.9 years, SD = 6.7, range = 48‐75; females = 52.8%; Māori = 26.2%), a higher LIBRA score (M = 1.8, SD = 1.6, observed range = ‐1; +7.4) was associated with lower cognitive functioning (b = ‐0.30, 95%CI = [‐0.48;‐0.11], p = .002) and cognitive impairment (OR = 1.41, 95%CI = [1.10;1.81], p = .007), adjusted for age, sex, education, ethnicity and area‐based socio‐economic deprivation. Higher area‐based socio‐economic deprivation was associated with higher LIBRA in Māori (b = .10, 95%CI = [0.02;0.18], p = .020), but not in Non‐Māori (b = 0.01, 95%CI = [‐.03;0.05], p = .677). Employment status and lower neighborhood safety were associated with higher LIBRA in Non‐Māori only. Health care access difficulties and social loneliness were associated with higher LIBRA in both populations, while education and net income were not.ConclusionSODH are differentially associated with dementia risk in midlife and early late‐life New Zealanders. Area‐based socioeconomic deprivation was linked to dementia risk in Indigenous Māori, but not in Non‐Māori. This points to systematic inequities in dementia risk, which require equity‐focused policy‐based public health approaches to risk reduction.