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Background: Parasitic neglected tropical diseases (NTDs) or 'infectious diseases of poverty' continue to affect the poorest communities in the world, including in the Philippines. Socio-economic conditions contribute to persisting endemicity of these infectious diseases. As such, examining these underlying factors may help identify gaps in implementation of control programs. This study aimed to determine the prevalence of schistosomiasis and soil-transmitted helminthiasis (STH) and investigate the role of socio-economic and risk factors in the persistence of these diseases in endemic communities in the Philippines., Methods: This cross-sectional study involving a total of 1,152 individuals from 386 randomly-selected households was conducted in eight municipalities in Mindanao, the Philippines. Participants were asked to submit fecal samples which were processed using the Kato-Katz technique to check for intestinal helminthiases. Moreover, each household head participated in a questionnaire survey investigating household conditions and knowledge, attitude, and practices related to intestinal helminthiases. Associations between questionnaire responses and intestinal helminth infection were assessed., Results: Results demonstrated an overall schistosomiasis prevalence of 5.7% and soil-transmitted helminthiasis prevalence of 18.8% in the study population. Further, the household questionnaire revealed high awareness of intestinal helminthiases, but lower understanding of routes of transmission. Potentially risky behaviors such as walking outside barefoot and bathing in rivers were common. There was a strong association between municipality and prevalence of helminth infection. Educational attainment and higher "practice" scores (relating to practices which are effective in controlling intestinal helminths) were inversely associated with soil-transmitted helminth infection., Conclusion: Results of the study showed remaining high endemicity of intestinal helminthiases in the area despite ongoing control programs. Poor socio-economic conditions and low awareness about how intestinal helminthiases are transmitted may be among the factors hindering success of intestinal helminth control programs in the provinces of Agusan del Sur and Surigao del Norte. Addressing these sustainability gaps could contribute to the success of alleviating the burden of intestinal helminthiases in endemic areas., (© 2024. The Author(s).)

Background: Given increased interest and investment in guaranteed income initiatives across North America, it is critical to understand the impact of guaranteed income on health, an understudied outcome. As part of Baltimore, Maryland's guaranteed income pilot, we conducted formative research to understand the influence of increased income on health and develop concrete recommendations for implementation and evaluation of the pilot., Methods: We conducted semi-structured in-depth interviews with Baltimore community residents (n = 8) and community collaborators (n = 8), probing on familiarity with guaranteed income; effect of guaranteed income on overall health and specific health outcomes (e.g., mental health, nutrition); and recommendations for program structure (e.g., eligibility, target population). Data were analyzed thematically using a framework analysis approach., Results: Respondents agreed that guaranteed income could have beneficial effects on health though some were unsure of specific mechanisms. Respondents emphasized pathways through which guaranteed income could improve health: (1) reduced financial-related stress; (2) improved nutrition through purchase of healthier foods; (3) improved family well-being including child health and parent-child relationships; (4) increased utilization of health services; (5) improved community health through increased community cohesion and decreased violence. Respondents described decreased feelings of time scarcity as a social determinant of health. Most respondents reported that Baltimore's guaranteed income program should prioritize young, low-income families with $1,000/month or more for at least one year., Conclusions: This formative research on the potential health impacts of guaranteed income in Baltimore highlights important health outcomes and pathways, such as social cohesion and decreased feelings of time scarcity, to prioritize for evaluation., (© 2024. The Author(s).)

Cash transfer policies have been widely discussed as mechanisms to curb intergenerational transmission of socioeconomic disadvantage. In this paper, we take advantage of a large casino-funded family transfer program introduced in a Southeastern American Indian Tribe to generate difference-in-difference estimates of the link between children's cash transfer exposure and third grade math and reading test scores of their offspring. Here we show greater math (0.25 standard deviation [SD], p =.0148, 95% Confidence Interval [CI]: 0.05, 0.45) and reading (0.28 SD, p = .0066, 95% CI: 0.08, 0.49) scores among American Indian students whose mother was exposed ten years longer than other American Indian students to the cash transfer during her childhood (or relative to the non-American Indian student referent group). Exploratory analyses find that a mother's decision to pursue higher education and delay fertility appears to explain some, but not all, of the relation between cash transfers and children's test scores. In this rural population, large cash transfers have the potential to reduce intergenerational cycles of poverty-related educational outcomes., (© 2024. The Author(s).)

Background: Previous studies have found that exposure to childhood environmental stress is associated with cardiometabolic risk. However, it is not known whether individual health behaviors disrupt this relationship. This study prospectively evaluated the relationship between cumulative environmental stress in a low-income sample and cardiometabolic risk in middle childhood and examined whether child health behaviors attenuated this relationship., Methods and Results: In a cohort of children (n=338; 57% Hispanic children; 25% Black children), environmental stressors (family and neighborhood factors representing disadvantage/deprivation) and child health behaviors (accelerometry measured physical activity; parent-reported screen time and diet recalls) were measured over 5 time points beginning when children were aged 2 to 4 years and ending when they were aged 7 to 11 years. Children's cardiometabolic risk factors (body mass index, blood pressure, triglyceride/high-density lipoprotein ratio, glucose, hemoglobin A 1c , C-reactive protein) were measured at 7 to 11 years. Emerging cardiometabolic risk was defined as having ≥1 elevations that exceeded clinical thresholds. In adjusted path analyses, greater cumulative environmental stress was associated with higher likelihood of emerging cardiometabolic risk in middle childhood ( P <0.001). Higher levels of moderate to vigorous physical activity and fewer sedentary minutes attenuated the positive relationship between stress and cardiometabolic risk ( P <0.05). Children with > 2 hours of average daily screen time had a higher likelihood of elevated cardiometabolic risk ( P <0.01), but screen time did not moderate the stress-cardiometabolic risk relationship. Dietary intake was not related to cardiometabolic risk., Conclusions: Interventions that promote moderate to vigorous physical activity and limit sedentary behavior may have particular importance for the cardiometabolic health of children exposed to high levels of cumulative environmental stress.

This article aims to provide an illustrated account of layered stigmatisation processes and consequences for those who experience chronic pain and accompanying suicidality. Using constructivist grounded theory, I draw from 20 in-depth interviews conducted from 2022 to 2023 to explore how chronic pain and suicidality operate within people's social worlds. Findings demonstrate how layered stigmatising processes, occurring based on chronic pain and suicidality, operate consistently across multiple social arenas to create interactional troubles, which result in enduring negative social, emotional, and financial impacts. Three themes were constructed, including (1) self-stigma and the multiple roles of the family, (2) missed connections, and (3) anticipated stigma and workplace discrimination. Taken together, themes support the overarching category, 'interactional troubles'. Findings suggest a need for attunement to stigmatising processes' omnipresence and the depth of their consequences. Clinical interventions may benefit from emphasizing participants' social worlds and incorporating the complexity of navigating social arenas given layered stigmatisation. Moreover, policies that support those with chronic pain and mental illness could offset the long-term negative economic consequences of discrimination.

Background: Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity., Methods: A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant., Results: Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals)., Conclusions: A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Objective　Poverty is a significant health determinant. As public assistance recipients experience difficulties in health management, a healthcare management support program to provide health checks has been implemented by welfare offices in Japan since 2021. However, effective approaches to maximize health check rates are limited. This study aimed to identify the impact of telephone navigation on recipients' health check-receiving behaviors, using data from welfare offices in Toyonaka City.Methods　This study included recipients aged 40-60 years who received telephone navigation for health check programs in 2021 and 2022. In 2021, telephone navigation was provided to eligible recipients. In 2022, the recipients were divided into two groups based on their household identification numbers (even/odd). We examined the difference in the health check rate in 2021 depending on whether the navigation system was connected. Additionally, we examined the differences across groups and navigation periods in 2022.Results　In 2021, 32 (7.9%) recipients received health checks. Twenty-six (10.2%) of the 255 recipients and six (4.1%) of the 148 recipients in the navigated and non-navigated groups, respectively, underwent health checks. In the navigated group, health check rates were higher among recipients in their 50s (13.3% vs. 3.1%; P = 0.006), unemployed recipients (13.9% vs. 3.6%; P = 0.014), those who did not receive previous health checks (9.1% vs. 1.5%; P = 0.003), and those who did not receive regular medical consultations (8.3% vs. 0%; P = 0.012). In 2022, 247 and 225 patients were assigned to the odd- and even-numbered groups, respectively, with no differences in their characteristics. During the intervention period, four (1.6%) of the 247 recipients and 10 (4.6%) of the 219 recipients in the odd- and even-numbered groups, respectively, underwent health checks. During the non-intervention period, five (2.1%) and six (2.7%) recipients of the odd- and even-numbered groups, respectively, underwent health checks. Health check rates were higher toward the deadlines. The estimated conditional odds ratio for receiving the health checks by the navigation was 1.35 (95% confidence interval; 0.59-2.93, P = 0.503).Conclusion　Telephone navigation may be effective in some recipients. Meanwhile, targeting recipients with attributes, such as "in their 50s," "unemployed," "received no previous health checks," and "received no regular medical consultations" may increase the response rate. Therefore, policymakers should consider using reliable telephone navigation methods and navigating near deadlines.

Agricultural mechanization is a crucial indicator of modernization in agriculture. It improves productivity and underpins the evolution of a modern state. This study scrutinizes the enduring effects of government subsidies on farm machinery acquisition, income growth, and capital accumulation in rural households. It is based on policies about targeted poverty alleviation and rural revitalization. Research findings indicate that government subsidies have significantly increased the per capita net income of rural households. However, in the post-poverty alleviation era, for households that already possess agricultural machinery, the benefits brought by government subsidies in the early stages of the policy cycle tend to diminish over time. From 2016 to 2020, government subsidies continued to enhance the value of agricultural machinery in rural households. Their impact on ownership rates first slightly declined and then increased again. The promotional effect in 2020 was not significantly better than in 2016. When China is fighting against poverty, it is essential to encourage rural households to use their income and government subsidies to accumulate production capital. A long-term mechanism has been established to protect the achievements of poverty alleviation, promote agricultural mechanization and rural modernization, and support rural revitalization., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhao Liu. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes., Methods: Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope., Results: We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns., Conclusions: High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood., (© 2024. The Author(s).)

The Third Annual Workshop of the American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative occurred on July 23 and 24, 2024. Content from the workshop is provided to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting are reviewed, including the inaugural Corporate Roundtable and Advocacy Day, new partnerships with non-profit organizations, and updates on projects from the Awareness, Poverty and Race and Ethnicity Inequity Committees. In addition, the Junior Faculty and Trainee Immersion Program-sponsored efforts in workforce diversity and physician advocacy are also presented. Lastly, continued education was provided on patient and caregiver participation as well as community engagement. As it enters its third year, the ASTCT-NMDP ACCESS Initiative will transition from foundation-building as a grass roots collaborative to intentional impact in reducing barriers and improving outcome disparities for all patients in need of HCT/CT. Enthusiasm for and participation in the ACCESS Initiative remain high and both are needed to sustain progress in achieving its goal in enabling all patients in need to receive HCT/CT., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Safety concerns continue to be challenging amid racially segregated communities of urban concentrated disadvantage. Although contributing factors to crime in such neighborhoods have been described, there is a lack of knowledge regarding how social isolation and perceptions of safety impact community health. This qualitative study explored how minoritized residents ( N  = 23) from an urban community of economic disadvantage perceived the influence of environmental and residential conditions on their health. Use of the grounded theory method produced conceptual insights into the process of how safety concerns led to fear, which created stress and prevented residents from using outdoor public spaces. Additionally, results indicated how the cyclical nature of such physical withdrawal reinforced social isolation and stigma by those outside the community, ultimately affecting residents' ability to maintain healthy living. Implications include implementing a multi-pronged public health policy that addresses safety perceptions, crime exposure, and social inclusion to improve health conditions in low-income communities.

Aims: This study aims to compare the trends in the quality of hospital care for WHO's three disease groups pre-, during, and post-COVID-19 pandemic peak in Thailand., Methods: The study utilized existing hospital admission data from the Thai Health Information Portal (THIP) database, covering the period from 2017 to 2022. We categorized WHO's three disease groups: poverty-related, noncommunicable, and injury groups using the International Classification of Diseases (ICD)-10 of initial admission of patients, and we analyzed three major outcomes: prolonged (≥ 90th percentile) length of stay (LOS), hospital mortality, and readmission pre-, during, and post-COVID-19 pandemic peak. Relative weight (RW) of hospital reimbursements was used as a surrogate measure of the severity of the diseases., Results: The average prolonged LOS of patients with poverty disease pre-, during, and post-COVID-19 pandemic peak were 7.1%, 10.8%, 9.05%, respectively. Respective hospital mortality rates were 5.02%, 6.22%, 6.05% and readmission were 6.98/1,000, 6.16/1,000, 5.43/1,000, respectively. For non-communicable diseases, the respective proportions in the prolonged LOS were 9.0%, 9.12%, and 7.58%, with respective hospital mortality being 10.65%, 8.86%, 6.62%, and readmissions were 17.79/1,000, 13.94/1,000, 13.19/1,000, respectively. The respective prolonged LOS for injuries were 8.75%, 8.55%, 8.25%. Meanwhile, respective hospital mortality were 4.95%, 4.05%, 3.20%, and readmissions were 1.99/1,000, 1.60/1,000, 1.48/1,000, respectively. The RW analysis reveals diverse impacts on resource utilization and costs. Most poverty-related and noncommunicable diseases indicate increased resource requirements and associated costs, except for HIV/AIDS and diabetes mellitus, showing mixed trends. In injuries, road traffic accidents consistently decrease resource needs and costs, but suicide cases show mixed trends., Conclusions: COVID-19 had a more serious impact, especially prolonged LOS and hospital mortality for poverty-related diseases more than noncommunicable diseases and injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Palupi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia., Methods: Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition., Results: The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table., Conclusions: The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available., (© 2024. The Author(s).)

Background: Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM., Materials and Methods: This was a cross-sectional analysis examining the largest 51 US major metropolitan statistical areas (MSAs) using data from 2018. Demographic data, markers of social inequities, and firearm homicide data were obtained from the US Census Bureau, US Department of Education, and the Frey and Brookings Institute. Food insecurity prevalence was obtained from Feeding America. Spearman ρ and linear regression were performed., Results: Using Spearman rho analysis, higher FI (r = 0.55, P < 0.001) was associated with FHM. Other variables associated with FHM included percent Black/African American (AA) (r = 0.77, P < 0.001), poverty rate (r = 0.53, P < 0.001), and percent of children living in single parent households (r = 0.58, P < 0.001). In linear regression analyses, FI was associated with increased FHM, with 1.3 additional FHM events for each unit increase in FI (β = 1.33, 95% CI 0.27-2.39, P = 0.02). The percent of a population that is Black/AA was also associated with FHM, with more than 4 additional cases for each 1% increase in the population (β = 4.32, 95% CI 3.26-5.38, P < 0.001)., Conclusion: Food insecurity may influence FHM in major US metropolitan cities. Community- and hospital-based programs that target FI may help combat the gun violence epidemic and decrease gun violence., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Competing interests: None declared.

Providing social support to tuberculosis (TB) patients is a recommended strategy as households having TB patients find themselves in a spiral of poverty because of high cost, huge income loss and several other economic consequences associated with TB treatment. However, there are few examples of social support globally. The Indian government introduced the 'Nikshay Poshan Yojana' scheme in 2018 to provide nutritional support for all registered TB patients. A financial incentive of 500 Indian Rupee (6 United States Dollars) per month was proposed to be transferred directly to the registered beneficiaries' validated bank accounts. We examined the reach, timing, amount of benefit receipt and the extent to which the benefit alleviated catastrophic costs (used as a proxy to measure the impact on permanent economic welfare as catastrophic cost is the level of cost that is likely to result in a permanent negative economic impact on households) by interviewing 1482 adult drug-susceptible TB patients from 16 districts of four states during 2019 to 2023, using the methods recommended by the World Health Organization for estimating household costs of TB nationally. We also estimated the potential amount of social support required to achieve a zero catastrophic cost target. At the end of treatment, 31-54% of study participants received the benefit. In all, 34-60% of TB patients experienced catastrophic costs using different estimation methods and the benefit helped 2% of study participants to remain below the catastrophic cost threshold. A uniform benefit amount of Indian Rupee 10 000 (127 United States Dollars) for 6 months of treatment could reduce the incidence of catastrophic costs by 43%. To improve the economic welfare of TB patients, levels of benefit need to be substantially increased, which will have considerable budgetary impact on the TB programme. Hence, a targeted rather than universal approach may be considered. To maximize impact, at least half of the revised amount should be given immediately after treatment registration., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records., Methods: Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes., Results: We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles., Conclusion: Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The reform of rural collective property rights is pivotal in advancing agricultural modernization and comprehensive rural revitalization. This study aims to explore the impact of this reform on income growth and poverty reduction in rural areas, as well as its underlying mechanisms. Utilizing data from the China Rural Revitalization Survey (CRRS), the propensity score matching (PSM) method was employed to empirically analyze the effects of rural collective property rights reform on income growth and poverty reduction. The findings reveal that the reform has a significant positive impact on rural income levels, indirectly enhancing income through two channels: increasing village collective assets and promoting land transfer. Additionally, the reform has a significant negative impact on rural poverty levels, effectively alleviating poverty in rural areas. Heterogeneity analysis further reveals the differential effects of property rights reform, indicating that non-poor villages, villages with higher educational levels among village leaders, and rural areas in the western regions benefit more from the reform. This study provides precise evidence for policymakers, offering a scientific basis for deepening rural collective property rights reform, promoting income growth, and fostering sustainable rural development., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xiang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Research has long emphasized the adverse effects of poverty on children; however, within-family processes of how safety nets offset the effects of poverty differ by race and ethnicity are unclear. Guided by the context-sensitive family stress model, the current study investigated within-family processes among safety nets, maternal parenting stress, and child behavioral problems among low-income families and revealed differences in these processes among Hispanic, Black, and White mothers. Using The Future of Families and Child Wellbeing Study (FFCWS), participants included 2251 low-income mothers and their children, repeatedly surveyed when children were 1, 3, 5, and 9 years old. Mothers reported their public and private safety nets, their parenting stress levels, and children's behavioral problems at each time point. Multilevel models revealed within-family mediation pathways from mothers' perceived private safety net supports, maternal parenting stress, and child externalizing and internalizing problems, but only for Black, not for White or Hispanic mothers. Prospective within-family associations were found between receiving a high number of public safety net programs and higher child externalizing problems, as well as between receiving private safety nets and higher maternal parenting stress and higher child behavioral problems. Findings were discussed in light of the context-sensitive family stress model, with implications for theory and intervention practices., (© 2024 Family Process Institute.)

Competing Interests: Conflict of interest: none declared.

Many nations and communities have reinvigorated discussions around universal basic income (UBI) as a means to address growing inequity. Research to date suggests that such systems can have profound positive public health and social impacts. Substance use, however, has not been explored as an area that may be impacted by UBI. This essay explores the current UBI literature and suggests how such a program could impact substance use health concerns within the Canadian context. Specifically, a UBI program in Canada could significantly reduce the negative health concerns of substance use and reduce the nation's current expenditures on healthcare interventions. Canada and other nations should consider UBI as a means to address substance use concerns and future research should include reviewing substance use data as part of any basic income intervention., Competing Interests: Declaration of competing interest The author has no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier B.V.)

Background: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra., Methods: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion., Results: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55-118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden., Conclusion: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions., (© 2024. The Author(s).)

Social determinants of health are known to underly excessive burden from infectious diseases. However, it is unclear if social determinants are strong enough drivers to cause repeated infectious disease clusters in the same location. When infectious diseases are known to co-occur, such as in the co-occurrence of HIV and TB, it is also unknown how much social determinants of health can shift or intensify the co-occurrence. We collected available data on COVID-19, HIV, influenza, and TB by county in the United States from 2019-2022. We applied the Kulldorff scan statistic to examine the relative risk of each disease by year depending on the data available. Additional analyses using the percent of the county that is below the US poverty level as a covariate were conducted to examine how much clustering is associated with poverty levels. There were three counties identified at the centers of clusters in both the adjusted and unadjusted analysis. In the poverty-adjusted analysis, we found a general shift of infectious disease burden from urban to rural clusters., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Blake et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Major power outages have risen over the last two decades, largely due to more extreme weather conditions. However, there is a lack of knowledge on the distribution of power outages and its relationship to social vulnerability and co-occurring hazards. We examined the associations between localized outages and social vulnerability factors (demographic characteristics), controlling for environmental factors (weather), in Washington State between 2018-2021. We additionally analyzed the validity of PowerOutage.us data compared to federal datasets. The population included 27 counties served by 14 electric utilities. We developed a continuous measure of daily outage burden using PowerOutage.us data and operationalized social vulnerability using four factors: poverty level, unemployment, disability, and limited English proficiency. We applied zero-altered lognormal generalized additive mixed-effects models to characterize the relationship between social vulnerability and daily power outage burden, controlling for daily minimum temperature, maximum wind speed, and precipitation, from 2018 to 2021 in Washington State. We found that social vulnerability factors have non-linear relationships with outages. Wind and precipitation are consistent drivers of outage occurrence and duration. There are seasonal effects that vary by county-utility area. Both PowerOutage.us and federal datasets have missing and inaccurate outage data. This is the first study evaluating differential exposure to localized outages as related to social vulnerability that has accounted for weather and temporal correlation. There is a lack of transparency into power outage distribution for those most vulnerable to climate impacts, despite known contributions by electric utilities to climate change. For effective public health surveillance of power outages and transparency, outage data should be made available at finer spatial resolution and temporal scales and/or utilities should be required to report differential exposure to power outages for socially vulnerable populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Richards et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This mini review delves into the complex issue of mortality linked to malnutrition, highlighting its multifaceted nature beyond just biomedical factors, presenting it as an intricate intersectional phenomenon., Method: The mini-review methodology involved a systematic literature search across databases like PubMed and Scielo, focusing on malnutrition and infant mortality in Colombia. We used specific keywords and Boolean operators to identify relevant studies, emphasizing socio-economic, gender, and ethnic factors, while excluding non-peer-reviewed and outdated publications., Results: The relationship between gender and food/nutrition has deep historical and cultural roots. Patriarchal norms influence dietary habits based on gender roles, often placing undue responsibility on mothers for children's nutritional health, reflecting profound social intersections. Mortality due to malnutrition is most prevalent among indigenous and Afro-descendant children in rural, conflict-affected areas with limited access to healthcare. Unpaid domestic work restricts women's economic independence, intensifying challenges for single-parent households., Conclusion: A comprehensive understanding can shift institutional attitudes toward mothers, leading to more coherent policy strategies and effective interventions., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Taborda Restrepo.)

Background: In Nigeria, since 2002, Imatinib mesylate (glivec ® ) has been available freely to chronic myeloid leukaemia (CML) patients but only at a tertiary health care centre in the southwestern part of the country. Despite this, it is not readily accessible to many patients due to the distance and other challenges including low socioeconomic status and political problems, preventing timely access to specialist care. This study evaluated the effect of the baseline characteristics on the prognostic implication and treatment outcome of CML patients in Nigeria., Method: This study retrospectively evaluated the baseline characteristics, clinical presentations and treatment outcomes of 889 CML patients over 18 years (2002-2020). Of these, 576 (65%) patients had complete information with up-to-date BCR::ABL1 records. These 576 patients were categorized based on their responses to Imatinib therapy into three groups viz.; Optimal response (OR) defined as BCR::ABL1 ratio of < 0.1% or major molecular remission (≥ 3-log reduction of BCR::ABL1 mRNA or BCR::ABL1 ratio of < 0.1% on the International Scale), Suboptimal response (SR) with BCR::ABL ratio of 0.1-1%, and Treatment failure (TF) when MMR has not been achieved at 12 months. The variables were analyzed using descriptive and inferential statistics and a p-value < 0.05 was considered statistically significant., Results: The result revealed a median age of 37 years at diagnosis with a male-to-female ratio of 1.5:1. The majority (96.8%) of the patients presented with one or more symptoms at diagnosis with a mean symptom duration of 12 ± 10.6 months. The mean Sokal and EUTOS scores were 1.3 ± 0.8 and 73.90 ± 49.09 respectively. About half of the patients presented with high-risk Sokal (49%) and EUTOS (47%) scores. Interestingly, both the Sokal (r = 0.733, p = 0.011) and EUTOS (r = 0.102, p = 0.003) scores correlated positively and significantly with the duration of symptoms at presentation. Based on response categorization, 40.3% had OR while 27.1% and 32.6% had SR and TF respectively., Conclusion: This study observed a low optimal response rate of 40.3% and treatment failure rate of 32.6% in our CML cohort while on first-line Imatinib therapy. This treatment response is strongly attributable to the long duration of symptoms of 12 months or more and high Sokal and EUTOS scores at presentation. We advocate prompt and improved access to specialist care with optimization of tyrosine kinase inhibitor therapy in Nigeria., (© 2024. The Author(s).)

Purpose: Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program., Method: Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density-matched case-control study and multiple linear regression analyses., Results: Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density-matched case-control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times., Conclusions: Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.

Background: Despite Africa's significant infectious disease burden, it is underrepresented in global vaccine clinical trials. While this trend is slowly reversing, it is important to recognize and mitigate the challenges that arise when conducting vaccine clinical trials in this environment. These challenges stem from a variety of factors peculiar to the population and may negatively impact adverse event collection and reporting if not properly addressed., Methods: As a team of clinical researchers working within the MRCG (Medical Research Council Unit The Gambia), we have conducted 12 phase 1 to 3 vaccine trials over the past 10 years. In this article, we discuss the challenges we face and the strategies we have developed to improve the collection and reporting of adverse events in low-income settings., Outcome: Healthcare-seeking behaviors in the Gambia are influenced by spiritual and cultural beliefs as well as barriers to accessing orthodox healthcare; participants in trials may resort to non-orthodox care, reducing the accuracy of reported adverse events. To address this, trial eligibility criteria prohibit self-treatment and herbal product use during trials. Instead, round-the-clock care is provided to trial participants, facilitating safety follow-up. Constraints in the healthcare system in the Gambia such as limitations in diagnostic tools limit the specificity of diagnosis when reporting adverse events. To overcome these challenges, the Medical Research Council Unit maintains a Clinical Services Department, offering medical care and diagnostic services to study participants. Sociocultural factors, including low literacy rates and social influences, impact adverse event collection. Solicited adverse events are collected during home visits on paper-based or electronic report forms. Community engagement meetings are held before each study starts to inform community stakeholders about the study and answer any questions they may have. These meetings ensure that influential members of the community understand the purpose of the study and the risks and benefits of participating in the trial. This understanding makes them more likely to support participation within their communities., Conclusion: Conducting ethical vaccine clinical trials in resource-limited settings requires strategies to accurately collect and report adverse events. Our experiences from the Gambia offer insights into adverse event collection in these settings., (© 2024. The Author(s).)

Background and Objectives: Comprehensive definitions of social issues and populations can set the stage for the development of responsive policies and practices. Yet despite the rise of late- life homelessness, the phenomenon remains narrowly understood and ill-defined., Research Design and Methods: This paper and the definition that ensued is based on the reconceptualization of interview data derived from a critical ethnography conducted in Montreal, Canada with older homeless persons (N=40) and service providers (N=20)., Results: Our analysis suggests that definitions of late life homelessness must include four intersecting components: 1) age, eligibility, and access to services ; 2) disadvantage over the life course and across time; 3) social and spatial processes of exclusion that necessitate aging in 'undesirable' places; and 4) unmet needs that result from policy inaction and non-response., Discussion and Implications: The new definition derived from these structural and relational components captures how the service gaps and complex needs identified in earlier works are shaped by delivery systems and practices whose effect is compounded over time. It provides an empirically grounded and conceptually solid foundation for the development of better responses to address homelessness in late life., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

In this paper, we analyze the influence of the perceived level of economic inequality in daily life on people's recognition of the perceived humanity gap between low- and high-socioeconomic groups within society. To achieve this purpose, in Studies 1A-B, we analyzed the relationship between economic inequality and the humanity gap. In Studies 2A-B, we manipulated the level of inequality (low vs. high) to identify differences in the humanity gap. Results indicated that higher perceptions of economic inequality lead individuals to recognize a wider humanity gap between low- and high-socioeconomic groups in society. Implications are discussed.

The present cross-sectional study was conducted to evaluate various caries risk factors in children from low socio-economic groups and to assess if children with broad contacts between one or more primary molars (type I and S) should be categorized as at high caries risk. Clinical examinations were performed on 107, 3- to 10-year-old children from low socio-economic settings. Contact types along with other caries risk factors (insurance, diet, plaque, and fluoride use, and diet habits) were analyzed for effect on presence of caries lesions (prevalence) and caries experience (decayed, missing, filled teeth). 78% of the study population had dental caries lesions, with an average dmft of 5.6. Of the 277 evaluated contacts, 88% were categorized as broad contacts. Multivariate analyses failed to validate that broad contacts were a predictor of dental caries lesions. However, the analysis showed an association of insurance status, plaque index with dmft. In conclusion, the present study could not implicate broad contacts as a factor that increased caries risk in the studied population; however, it validates the importance of insurance status, plaque index, as well as diet frequency as predictors of dental caries lesions., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Offering fresh perspectives on the lived experience of ageing in extreme poverty, this article delves into unpacking the relationally driven processes of social, institutional, and self-othering that contribute to agency erosion in older adults. Positing that the context of extreme poverty in which a person ages is micropolitically shaped, where society, institutions, and ageing self interact in a complex way, it is argued that ageing in extreme poverty, inter alia, means ageing in subaltern conditions. A critical consequence of this process is the subjugation of older adults, leading to a life marked by the state of 'social death'. Additional research is needed to unpack such nuances to better understand ageing processes in extreme poor societies. This necessitates an approach informed by postcolonial perspectives that take into account the dynamics of othering and agency erosion. It concludes by asserting that to reverse extreme poverty among older adults as well as to reverse their subaltern conditions requires a political project that empowers the older adults in society, restores agency and strengthens their 'relational security'., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author. Published by Elsevier Inc. All rights reserved.)

In Brazil, several limitations are imposed upon the access of women undergoing abortion to the healthcare network, primarily caused by the influence of moral and religious values and gender iniquities. In this light, the present study aimed to analyze the experience of women who had an abortion regarding the care provided by healthcare services as part of the abortion itinerary. This is a qualitative study, carried out with 18 women in three cities - one small city, one mid-sized, and one big - in the state of Bahia. Data were produced by face-to-face or online interviews. The empirical material was analyzed using the discourse analysis technique. The results show, in the three municipalities, abortion itineraries under social and gender iniquities, with greater access difficulties for low-income women. Better financial conditions allow access to clandestine private clinics but without guaranteeing humanized care. In the three municipalities, economically disadvantaged women self-induced abortions and delayed seeking services, having faced embarrassing and prejudicial professional attitudes. The results point to the urgency of implementing public policies in which reproductive rights are as effective as human rights.

In the peripartum, putative mechanisms in the transmission of prenatal contextual risk and maternal psychological distress include biological and social processes. In this study, path analyses were used to test unique, cascading pathways of prenatal contextual risk and pre- and postnatal maternal psychological distress through social mediators (parenting) and biological mediators (infant stress physiology) on infant temperament and toddler adjustment. The sample is comprised of racially and ethnically diverse first-time mothers ( N = 200) living in low-income contexts (< 200% poverty) who were followed from pregnancy to 18-36 months postpartum. In pregnancy, mothers reported contextual risk and psychological distress (anxiety, depression). In the postpartum, mothers reported their psychological distress. At 2-4 months postpartum, observed mother-infant interactions were coded for sensitive responsiveness. Infant cortisol baseline and reactivity to a lab stressor were collected when infants were 4-6 months old. Mothers reported on infant's temperament (negative affect, effortful control) at 10-12 months and on child adjustment (internalizing, externalizing symptoms) at 18-36 months. Prenatal contextual risk predicted infant cortisol reactivity. Prenatal psychological distress predicted postnatal distress but, when accounting for postnatal distress, did not predict putative mediators or indicators of child adjustment. In contrast, maternal postnatal depression predicted subsequent maternal sensitive responsiveness, which in turn predicted later infant baseline cortisol and cortisol reactivity. Baseline cortisol predicted infant negative affectivity, which predicted toddler internalizing and externalizing symptoms. There was no evidence of mediated effects of prenatal variables on child adjustment outcomes, whereas contextual risk, postnatal psychological distress, and parenting were more salient predictors of child adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This work discusses the health promotion challenges of men who have sex with men (MSM) through the use of data from a conversation circle with people from institutions that provide services to MSM in the Metropolitan Region of Recife. The results allow for the identification of the following challenges for health promotion work, not only for MSM but also for sex dissidents: difficulties with the use of identity categories, stigmatization for providing them with sexual health care, structural racism, the deprivation of liberty, extreme poverty, and literacy.

Objectives: The purpose of this study was to develop, pilot, and evaluate a culturally grounded, family-based program to prevent adverse childhood experiences (ACEs) among low-income and Indigenous children aged 10 to 14. The Tiwahe Wicagwicayapi program (TWP) is a 7-session program that teaches skills to prevent ACEs and is rooted in Lakota culture, language, and history., Methods: A total of 124 families (124 caregivers [96% Indigenous; 90% reported yearly income <$40 000] with 194 children aged 10 to 14 [93% Indigenous]) were randomly assigned to treatment (N = 66 families and 173 individuals) or waitlist (N = 58 families and 145 individuals) control groups. Caregivers and children completed a baseline, immediate posttest, and 6-month follow-up survey., Results: Treatment effects were detected, indicating, compared with control participants, reductions in the incidence of child ACEs (incidence rate ratio [IRR] = 0.64), bullying victimization (odds ratio = 0.53), depression (d = -0.20), and externalizing behaviors (d = -0.23) and increased parent-child communication (g = 0.27) and child help-seeking behaviors (d = 0.28). For caregivers, the effects indicated that the program prevented intimate partner violence victimization (IRR = 0.36) and perpetration (IRR = 0.45), harsh parenting (g = -0.35), and depression (d = -0.24) and increased emotion regulation (d = 0.37), social support (d = 0.33), and cultural connection (d = 0.34)., Conclusions: The TWP holds great promise in preventing ACEs among low-income, Indigenous children, showing potential promise for widespread public health impact. Future rigorous research on the TWP is warranted., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Nutrition security encompasses stable and equitable access, availability, affordability, and utilization of healthy foods., Aim: To evaluate the relationship of two newly created dichotomous measures that represent aspects of nutrition security (i.e., perceived limited availability and healthfulness choice) with Supplemental Nutrition Assistance Program (SNAP) participation., Methods: Logistic regression models were run for each outcome separately with adjustment for age, income-to-poverty ratio, gender, education, race, and food security., Results: Adults using social services (e.g., food pantries) were enrolled (N = 402) in this cross-sectional analysis. SNAP participants (61.7%) were not different from non-SNAP participants in perceiving limited availability (aOR [95% CI]: 1.21 [0.75, 1.95]) or limited ability to choose (aOR [95% CI]: 0.69 [0.43, 1.12]) healthy foods., Conclusions: Both SNAP and non-SNAP participants with low socioeconomic status report limited availability of healthy foods in their environment and a limited ability to choose healthy foods., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening., Methods: Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility., Results: In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility., Conclusions: State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: Improved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement., Methods: This was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N = 15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment., Results: Greater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained., Conclusions: Neighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes., Competing Interests: Declaration of competing interest David Eddie is on the scientific advisory boards of mental-healthcare companies ViviHealth and Innerworld and is a partner in Peer Recovery Consultants. The remaining authors declare that they have no known potential competing financial or personal interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood., Study Design: This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age., Methods: Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years., Results: The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57)., Conclusion: Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Social stratifications in youth wellbeing are a concern for social policy. Using data from the Gallup World Poll (2009-2022), we examined time trends and income differences in youth wellbeing and their associations with area-level income and income inequality. Results showed that a growing proportion of youth have experienced emotional distress in recent years, and this trend disproportionately affected youth at lower incomes. Higher income inequality relates to lower life satisfaction and larger income differences in life satisfaction. Socioeconomic inequality in youth wellbeing underscores the need for coordinated policy actions that reduce economic inequality and its impacts on youth wellbeing., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC)., Method: In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC., Results: Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination., Interpretation: The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type., (© 2024 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

In this article, the authors explore the intricate relationship between poverty and surgical care, underscoring its multifaceted nature and its profound impact on access and outcomes. Poverty extends beyond financial constraints to encompass barriers related to healthcare infrastructure, geographic isolation, education, mental health, and social determinants of health, resulting in persistent disparities in access to high-quality surgical care, especially for those in persistently impoverished areas and access-sensitive surgical conditions. Additionally, the authors delve into the complex intersection of poverty, race, and ethnicity, emphasizing the heightened risks faced by minority patients in surgical care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: Test an obesity intervention for families with low incomes., Methods: A total of 208 families were included (a parent with a body mass index [BMI] ≥ 30 and a child aged 6-12 years). A 12-month randomized controlled trial combining family health coaching (motivational interviewing) and connection to community resources. Comparison group: referrals for basic needs, written educational materials. Questionnaires, accelerometry, and anthropometrics. Intention-to-treat analysis of change in outcomes. Two-sided t test with multiple imputation., Results: Parents were 95% female, 31% Black, and 27% Hispanic. Children had a mean BMI-Z score of 1.15. Primary outcomes did not differ between groups at 12 months. Both groups significantly (P < 0.05) improved on the Family Nutrition and Physical Activity Scale for behaviors related to childhood obesity (mean ± SE: comparison, 2.8 ± 1.0; intervention, 2.2 ± 0.9), increased child sedentary activity (comparison, 32.5 ± 12.1; intervention, 39.9 ± 12.4 min/d), and decreased child moderate-vigorous physical activity (comparison, -9.6 ± 3.3; intervention -7.0 ± 3.0 min/d). Parents had no change in BMI., Conclusions and Implications: We successfully embedded screening and referral to address social needs within an obesity intervention. The coaching intervention did not provide additional benefits. Future research could explore ways to make these interventions more accessible, valuable, and effective for families., (Copyright © 2024 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Introduction: Adolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia., Methods: A hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies., Results: A monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21-9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97-9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16-3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes., Conclusion: Several socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA&#95;kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA&#95;kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA&#95;kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Exposure to maternal stress in early childhood can increase risk for learning and behavior challenges. We sought to gain in-depth understanding of how mothers perceive stressors to impact child wellbeing and identify mothers' strategies for navigating stressors with their young children., Methods: We recruited English- and Spanish-speaking mothers from a primary care clinic serving predominantly publicly insured children. Twenty-one mothers (aged >18 years) of children (aged 6-29 months) participated in in-depth, semi-structured interviews to discuss their experiences and beliefs regarding stress and parenting. Interviews were recorded, transcribed verbatim, and analyzed using the constant comparative method associated with a grounded theory approach., Results: We developed the following hypothesized explanatory model based on our key thematic findings: Mothers described a dyadic model of stress, whereby both their children's and their own experiences of and responses to stressors are interdependent. Mothers use preventive and responsive buffering to mitigate the impact of stress on their children; however, their access to resources, including social and financial support, shapes their capacity for implementing such strategies. Affection and other forms of relational support may function to protect against the negative impacts of stress., Conclusion: In the setting of poverty-related chronic stressors, mothers play an active role in mitigating the impact of stress on their children's wellbeing through responsive caregiving. Policies aimed at reducing poverty-related stress exposures and experiences among low-income families may be key interventions for promoting responsive caregiving during a critical time in child development., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)