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BackgroundHousehold food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.ObjectiveOur aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.DesignSecondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.Participants/settingParticipants in study 1 (n= 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n= 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.Main outcome measuresThe primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.Statistical analysisMultivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.ResultsIn study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P= .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P= .045).ConclusionsThese findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.

This paper empirically examines the behavioral precautionary saving hypothesis that uncertainty about future income triggers an increase in saving because of loss aversion. Guided by the theoretical model of Koszegi and Rabin (2009), we first extend their theoretical analysis to also consider the internal margin, i.e., the strength, of loss aversion, and then empirically study the relation between income risk, experimentally elicited loss aversion, and precautionary savings. We do so using a sample of 640 individuals from the low-income population of Bogotá, characterized by limited financial education and subject to substantial income risk. In line with the theoretical predictions, we find that an increase in income risk is associated with higher savings for loss-averse individuals, and that this increase in savings grows with the degree of loss aversion. An accompanying laboratory experiment confirms that an exogenous increase in income risk causally leads to this observed pattern. Thus, consistent with the theoretical predictions derived from the model of Koszegi and Rabin (2009), but in contrast to common assumptions, our findings establish that loss aversion is not necessarily an obstacle to saving, and thus identify new approaches of increasing saving among individuals with low financial education.

During the summer of 2022, the Finance Platform team in an American banking firm headquartered in Virginia noticed that its data preview and download feature was malfunctioning. More specifically, miscommunication between the feature’s backend microservice and the frontend User Interface (UI) component caused erroneous behavior in the application when users attempted to preview larger and more complex datasets. Because this feature’s user base consisted primarily of the firm’s employees due to it comprising a portion of their internal application, my internship focused on replacing the existing feature with an improved version. My technical report details the steps that my internship team and I took to create an upgraded data preview and download backend service and its respective UI component. We hoped that doing so would rectify the previous feature’s shortcomings. My summer internship, which also served as my technical project, was managed using agile methodologies. Moreover, its technology stack included the Spring framework and Apache Spark for the backend, the Angular framework for the frontend, and Amazon Web Services (AWS) to satisfy data storage requirements. Utilizing the provided combination of tools and technologies allowed us to efficiently replace the existing service with one that incorporated a more comprehensive set of endpoints (e.g., preview, download, download zip) and a redesigned preview response object. To maintain consistency with the company’s coding practices, our team also created a UI component using Angular to facilitate a more user-friendly experience when previewing and downloading the selected datasets. Although the newly created service and UI component performed slower than we had originally anticipated, they allowed users to successfully preview and download a more diverse range of datasets with minimal challenges. However, potential next steps would include extensive regression and performance testing, improving performance time by leveraging newer technologies, and integrating this feature into the firm’s production environment. Despite my technical project focusing on modifying the existing data preview and download feature in the firm’s internal web application, this company also offers a myriad of other technological products and services to its customers. Even though I was only able to interact with a subset of the firm’s products, I was the most intrigued by Eno, its chatbot. Over the past few decades, advancements in fields including Artificial Intelligence (AI) and Machine Learning (ML) have helped revolutionize how businesses communicate with their customer base. More specifically, a majority of these companies across various industries have been rapidly transitioning away from customer support teams and into adopting chatbots. While chatbots have undoubtedly aided businesses by increasing productivity and minimizing cost, the STS paper investigates how generative chatbots in the banking industry impact the retention rate of low-income customers. Chatbots are merely computer programs that are designed with the intent of simulating and comprehending ordinary human conversation. Although earlier chatbots such as ELIZA, PARRY, and ALICE typically exhibited limited functionality because of their underlying rule-based technology, the progression of computer science has allowed the creation of generative chatbots such as Capital One’s Eno and Amazon’s Alexa among many others. In an attempt to narrow down the scope of the research topic, the STS paper solely focuses on generative chatbots. While chatbots have been widely popularized and even idolized in certain circumstances, this paper draws on various research (e.g., academic papers, research articles) to examine how aspects of a chatbot including functionality, credibility, and emotional objectivity are perceived by different social groups. Due to the nature of my topic, the social groups are stratified by both income and race. Moreover, a majority of the research focuses on the relationship between chatbots and the low-income community. To better understand the relationships between chatbots and the impacted social groups, the STS paper relies on the Social Construction of Technology (SCOT) framework. Given that this framework revolves around the concept that society shapes technology, it effectively supplements my analysis of how this technology is being continuously adapted in response to both the approvals and criticisms of different social groups such as the low-income population. Finally, a paper that concentrates on chatbots and their implications within communities would be incomplete without discussing the new chatbot that has taken the AI and ML fields by storm – ChatGPT. To acknowledge chatbots of this caliber, my research paper briefly examines how ChatGPT can potentially modify the banking landscape. Additionally, it touches on what this may mean when considering the ever-evolving relationship between the low-income population and this technology.

The cost of transportation can present challenges for low-income Washingtonians: making it harder to get a job, maintain a job, access social services, obtain healthcare, and care for their families. Building on the District’s efforts to address cost as a barrier to transit equity—such as Mayor Muriel Bowser’s 2019 Free Circulator trial and Kids Ride Free program—the District of Columbia government and the Washington Metropolitan Area Transit Authority are conducting a randomized evaluation of free and discounted transit fares. We will measure the impact of transit cost on low-income residents’ mobility, employment, and well-being. The findings may help shape initiatives to make public transit more affordable to low-income residents.

Objectives To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity. Methods A multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged. Results Among the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities. Conclusions A multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

This cross-sectional study examined the relationships of financial literacy (FL) and financial behaviour (FB) with health-related quality of life (HRQOL) during the COVID-19 pandemic among low-income working population (20–60 years old) in Malaysia. A self-administered questionnaire survey was used with HRQOL data were gathered using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool. A generalised linear model was employed to examine the hypothesised relationships between the constructs. From 1186 respondents, the majority were employed (73.9%), had a monthly household income of less than RM 2500 (74.5%), and did not have any chronic medical conditions (74.5%). The mean (SD) values of FL, FB, and EQ-5D-5L were 5.95 (1.48), 22.08 (4.79), and 0.96 (0.10), respectively. The results of the adjusted model revealed lower age group, Malay ethnicity, Indian ethnicity, and increased FB score as significant determinants of higher EQ-5D-5L scores. With the addition of the chronic medical condition factor into the saturated model, the lower age group, ethnicity, and no chronic medical condition were significant determinants of higher HRQOL. The effects of FB on QOL were confounded by chronic diseases, implying that interventions that focus on improving FB for those with chronic medical condition may help to improve the QOL among the low-income working population.

The complexity of the American tax code disproportionately affects low-income college students who rely heavily on information from their tax returns for important financial resources (e.g. financial aid) but are unable to afford assistance from costly tax-filing services. As a result, low-income college students benefit from return-free filing services. This paper assesses the potential of using return-free tax filing as a resource to support low-income college students with identifying their eligibility and applying for financial resources such as financial aid and SNAP benefits. Using survey data from low-income students attending UCLA, we describe the difficulties faced in filing taxes and applying for financial resources. We find that students are interested in receiving assistance from return-free filing services for both processes. Then, we determine how interest varies by gender, racial identity, parental education, past filing experience, and primary language spoken at home.

Previous research highlights several benefits of shared book reading (SBR) for child development, but less studies exist about its predictors (Yarosz & Barnett, 2001). Literature on home SBR in Portugal is scarce (Araújo & Costa, 2015; Peixoto et al., 2008), and studies on its predictors in families at socioeconomic risk or Roma families in this context are, respectively, reduced (Gamelas et al., 2003) or inexistent. This study aimed to investigate the predictors of the frequency of SBR in two ethnically diverse groups of families. Specifically, we studied the associations between child and family (mother) characteristics, parental aspirations, and parental involvement in preschool events and frequency of home SBR. Two hundred and six caregivers of Portuguese Roma ( n = 101) and non-Roma ( n = 105) low-income preschoolers (109 boys; M age = 5, SD age = 0.94) living in the Metropolitan areas of Lisbon and Oporto, Portugal, completed a survey, in face-to-face meetings. A multiple regression model, using AMOS (v. 25), showed that mothers’ educational level, educational aspirations for their child, and involvement in informal (but not formal) events in preschool were positively associated with frequency of SBR. Ethnicity did not moderate these associations. The overall similar pattern results for Roma and non-Roma low income families is an important finding, suggesting that these families may experience similar challenges in engaging in SBR with their preschool children and, therefore, may benefit from interventions with similar features. info:eu-repo/semantics/acceptedVersion

Objective: The objective of this study was to examine whether delivering technology-assisted case management (TACM) with medication titration by nurses under physician supervision is cost effective compared with usual care (standard office procedures) in low-income rural adults with type 2 diabetes. Methods: One hundred and thirteen low-income, rural adults with type 2 diabetes and hemoglobin A1c (HbA1c) ≥8%, were randomized to a TACM intervention or usual care. Effectiveness was measured as differences in HbA1c between the TACM and usual care groups at 6 months. Total cost per patient included intervention or usual care cost, medical care cost, and income loss associated with lost workdays. The total cost per patient and HbA1c were used to estimate a joint distribution of incremental cost and incremental effect of TACM compared with usual care. Incremental cost-effectiveness ratios (ICERs) were estimated to summarize the cost-effectiveness of the TACM intervention relative to usual care to decrease HbA1c by 1%. Results: Costs due to intervention, primary care, other health care, emergency room visits, and workdays missed showed statistically significant differences between the groups (usual care $1,360.49 vs. TACM $5,379.60, p=0.004), with an absolute cost difference of $4,019.11. Based on the intervention cost per patient and the change in HbA1c, the median bootstrapped ICERs was estimated to be $6,299.04 (standard error=731.71) per 1% decrease in HbA1c. Conclusion: Based on these results, a 1% decrease in HbA1c can be obtained with the TACM intervention at an approximate cost of $6,300; therefore, it is a cost-effective option for treating vulnerable populations of adults with type 2 diabetes.

Purpose: To assess state-level variation in changes in uninsurance among Black, Hispanic, and low-income Americans after implementation of the Affordable Care Act (ACA). Methods: We analyzed data from the Behavioral Risk Factor Surveillance System from 2012 to 2016, excluding 2014. For Black, Hispanic, and low-income (

Scoping review of business models used to reach lower-income consumers with food products.

Background: A disparity is witnessed between low and low-middle-income countries (L-LMIC), and high-income countries regarding critically ill patient outcomes. L-LMICs experience hindrances that prevent the execution of care according to international best practices. Aim: This scoping review project aims to determine barriers and limitations to patient outcomes in L-LMIC, with the overall goal of synthesizing information and guiding future policy recommendations. Methods: The scoping review protocol is guided by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guideline.

Conference proceeding for https://osf.io/view/HumforSTEM2018/

As of January 2021, eligibility for CalFresh (the Supplemental Nutrition Assistance Program in California) has been temporarily expanded to include students with zero Expected Family Contribution (EFC) or who are eligible for Work Study. To notify zero EFC students of this expansion and encourage CalFresh participation, CDSS and CSAC sent email notifications to 285,731 zero EFC students in California in February 2021. In this first phase of the project (https://osf.io/8rkvw/), CPL worked with CDSS and CSAC to randomly vary the timing of the notification emails in order to evaluate whether people who received earlier emails registered more quickly for CalFresh. In the second phase of the project, launching in May 2021, CDSS and CSAC are sending a second round of outreach to 285,325 zero EFC students in the form of emails and postcards. CPL has provided support to enhance the notification emails, design additional postcard notifications, and design and implement this outreach in a randomized controlled trial in partnership with CSAC and CDSS. Our main analysis will test variation in the messaging language and modality of outreach and explore whether students who receive a de-stigmatizing message about accessing CalFresh benefits, and/or a postcard in addition to an email, are more likely to apply for and enroll in CalFresh benefits.

The current study examines the trajectory of sexual satisfaction during and after couples complete the OurRelationship Program. This study will be a replication study between two separate phases of the program.

Data and Stata code supporting my paper, "Wealth in Poverty: Why 'Stable' Family Structures Are Associated with Increased Net Worth for the Middle-Class but Not for the Poor." The Stata .do file ("Wealth in Poverty FINAL.do") begins by setting the directory and creating shorthand names for the survey files, summary files, and replicate weight files, which can all be downloaded from the Federal Reserve Board's website on the Survey of Consumer Finances (years 2001, 2004, 2007, 2010, 2013, 2016, 2019): https://www.federalreserve.gov/econres/scfindex.htm. The main data file analyzed ("survey01to19scfcombo.dta") is the product of the code that compiles/names the relevant variables and combines the data from all survey years.

This project is a scoping literature review to identify all publications related to social marketing campaigns regarding healthy eating, physical activity, and smoking cessation in rural, low-income populations of the United States. Inclusion criteria – • Qualitative (formative or qualitative evaluation) or quantitative evaluation (fidelity, program, or impact evaluation) of a social marketing program or a social marketing component of an intervention about healthy eating, physical activity, or smoking cessation targeting a low-income rural county/community in US. • Results may be presented separately for the rural, low-income population, or may be exclusively rural, or may be combined with non-rural if researchers determined findings were similar for geographical areas. • Full-text is available. • Study must identify that “social marketing” (as defined by Andreasen, but not required to present all criteria) is implemented or social marketing process is used in the study.

Part of my dissertation research will be a replication and extension of Stephens, N. M., Hamedani, M. G., & Destin, M. (2014). Closing the social-class achievement gap: A difference-education intervention improves first-generation students’ academic performance and all students’ college transition. Psychological Science, 25, 943-953. The entire committee-approved dissertation proposal (2015_04_27_dissertation_proposal_Clark.pdf) is included, but only Parts I and III are relevant to this registered replication and extension (refer to this document for background and hypotheses). Explicit description of what will be directly replicated and what will constitute extension is included as a separate document in the project descriptions folder (replication_and extension.docx). A third document in the project descriptions folder (analysis_plan) reiterates and elaborates on analysis plan information contained in the proposal. The fourth document in the project descriptions folder is an update about logistical and administrative challenges that will affect wave 0 (i.e., baseline) surveying, but will ultimately not affect analysis replication. Materials to be used in the intervention itself (e.g., scripts) are further developed from the original proposal and are included in the project materials folder. Materials to be used in surveys (i.e., measurements) are also included in the project materials folder. The committee-approved proposal contains known typos that suggest more than one intervention will be conducted. The proposal prior to defense was to implement Stephens and colleagues' (2014) difference-education intervention and Walton and Cohen's (2011) social-belonging intervention for side-by-side comparison. Upon defense, my committee recommended focusing on and maximizing sample size for the difference-education intervention. Only the difference-education intervention will be implemented, and if the target sample size (n=450) is reached, it will be triple the size of the sample in the original study.

This is a protocol for a scoping review exploring the effect of income transfers on health in high-income countries.

Increasing life expectancy has led to a global rise in late-life diseases. Quality of Life (QOL) is important for healthy life expectancy. The active ageing framework serves as a guide for policymakers to design policies that enhance the QOL of older people. This study aims to determine the association between awareness of active ageing and QOL. The Malay version of the 26-item WHOQOL-BREF questionnaire was utilised along with the 14-item Active Ageing Awareness Questionnaire (AAAQ). A total of 532 participants had a mean (SD) age of 50.2 (5.9), were largely ethnic Malay (96.2%), female (52.8%), and comprised largely of low-income households (65.4%). The median (IQR) AAAQ score was 71.4 (19.1). The hierarchical multiple regression analysis revealed significant positive association between AAAQ and the QOL domains of physical (β = 0.154, p < 0.001), psychological (β = 0.196, p < 0.001), social relationship (β = 0.175, p < 0.001), and environment (β = 0.145, p < 0.001) after adjusting for all covariates. Awareness of active ageing was found to have a positive effect on all domains of QOL among pre-elder employees, and thus, we recommend that policies to improve active ageing awareness should be implemented for healthy life expectancy in ageing populations.

Evidence-based and culturally relevant parenting programs strengthen adults’ capacity to support children’s health and development. Optimizing parent participation in programs implemented at scale is a prevailing challenge. Our collaborative team of program developers, implementers, and researchers applied insights from the field of behavioral economics (BE) to support parent participation in ParentCorps—a family-centered program delivered as an enhancement to pre-kindergarten—as it scaled in a large urban school district. We designed a bundle of BE-infused parent outreach materials and successfully showed their feasibility in site-level randomized pilot implementation. The site-level study did not show a statistically significant impact on family attendance. A sub-study with a family-level randomization design showed that varying the delivery time of BE-infused digital outreach significantly increased the likelihood of families attending the parenting program. Lessons on the potential value of a BE-infused approach to support outreach and engagement in parenting programs are discussed in the context of scaling up efforts. Supplementary Information The online version contains supplementary material available at 10.1007/s11121-021-01249-0.

Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families’ engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile-application and therapist web-portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed., Highlights • Treatment engagement is a perennial challenge in children’s mental health • BPT engagement is particularly difficult for low-income families • Results suggest technology-enhanced BPT can improve some engagement outcomes • Additional personalization of technology-enhanced BPT may further improve engagement

Currently, many people live in urban areas and more than 30% of them live in slums or squatter settlements. Urbanization is one of the most transformative trends occurring worldwide, especially in developing countries like Indonesia. At present, more than half of the total population in Indonesia lives in urban areas. The dominance of the urban population shows the urgency to make the urban environment inclusive, safe, resilient, and sustainable as it is intended to be realized through Goal No. 11 - SDGs 2030. Cities require large spaces and are a major source of wealth and centers of innovation, culture, and politics. The urban area has become the most important arena for people, including low-income communities that live in informal urban spaces that develop spontaneously. This article will share research experiences on the settlements of marginalized communities. With the help of several institutions, the communities are trying to improve the quality of their settlements to become inclusive, safe, resilient, and sustainable. The method used in this research is the descriptive-qualitative method exploring the potential and resources within urban kampong to improve the quality of urban poor settlements. With the discovery of informal urban space patterns and community efforts to improve the quality of their settlements, a sustainable development strategy can be developed to improve urban areas inhabited by low-income people.

Children from low-income households and minority families have high cardiometabolic risk. Although breakfast consumption is known to improve cardiometabolic health in children, limited randomized control trials (RCT) have explored this association in low-income and racial/ethnic U.S. minority families. This study conducted secondary analyses from TX Sprouts, a school-based gardening, cooking, and nutrition education RCT, to examine the intervention effect on breakfast consumption and how changes in breakfast consumption impact cardiometabolic risk in predominately low-income, multi-ethnic children. TX Sprouts consisted of 16 schools (8 intervention; 8 control) in greater Austin, TX. A total of 18 lessons were taught, including topics on breakfast consumption benefits and choosing healthy food options at school. Children completed clinical measures (e.g., anthropometrics, body composition via bioelectrical impedance), and the number of breakfast occasions (BO) per week (at home and school) was captured via validated survey at baseline and post-intervention. Post-study—Baseline changes in breakfast consumption were used to categorize students as: maintainers (BO −1 to 1 day/week), decreasers (BO ≤−2 day/week), and increasers (BO ≥2 day/week). Optional fasting blood draws were performed on a subsample. Generalized weighted linear mixed modeling tested differences between intervention and control, with schools as random clusters. Analysis of covariance and linear regression examined changes in breakfast consumption on cardiometabolic outcomes, controlling for age, sex, race/ethnicity, free and reduced-price school meal participation (FRL), school site, breakfast location, physical activity, baseline cardiometabolic measures, and BMI z-score. This study included 1417 children (mean age 9 years; 53% male; 58% Hispanic, 63% FRL; breakfast consumption patterns: 63% maintainers, 16% decreasers, and 21% increasers). There was no intervention effect on changes in breakfast consumption. Compared to decreasers, increasers had an increase in insulin (−0.3 µIU/mL vs. +4.1 µIU/mL; p = 0.01) and a larger increase in HOMA-IR (+0.4 vs. +1.5; p < 0.01). Every one-day increase in breakfast consumption decreased fasting insulin by 0.44 µIU/mL, HOMA-IR by 0.11, and hemoglobin A1c by 0.01% (p ≤ 0.03). Increased breakfast consumption was linked to improved glucose control, suggesting breakfast can mitigate risk in a high-risk population. To better understand underlying mechanisms linking breakfast consumption to improved metabolic health, RCTs focusing on breakfast quality and timing are warranted.

The need for effective and efficient emergency medical care is ever-present as mass-injury events such as school shootings and the Boston Marathon bombing remain prevalent. Society needs to be able to rely on emergency medical services (EMS) to be competent and responsive. Therefore, this portfolio explores two different facets of EMS: the training and the response. The technical research topic covers the training aspect; the final product is a device that examines the effectiveness of a bleeding control training product: the TrueClot® Tourniquet Application Trainer, designed by Luna Labs USA, LLC. The EMS response, on the other hand, is addressed by the STS research topic, for which the final deliverable is a paper that analyzes the variables that affect the answer to an overarching research question: what is the sociotechnical relationship between marginalized communities and emergency medical services in the United States? The combination of these two topics provides a broad view of the processes surrounding EMS and any disparities that need to be addressed. The technical portion of this portfolio examines the clinical relevance of the TrueClot® Tourniquet Application Trainer (TAT) through the design of a sensor-enabled testing device. The TAT is a heavily-padded cuff that can be secured around the wearer’s left shoulder and upper arm, and it contains a synthetic wound and blood vessel. The synthetic blood vessel is constructed with flexible tubing, representing the brachial artery, and it ends at a silicone wound at the base of the cuff. In order to use this product during tourniquet application training, an individual wears the TAT while synthetic blood is pumped through the tubing and out of the wound via a plastic squeeze bottle. The trainee then applies a tourniquet over the TAT and tightens the tourniquet until they observe the stoppage of synthetic blood flow out of the wound. Luna Labs requested the formulation of a validation project that will assess whether the tubing within the trainer occludes within the same pressure range as the brachial artery in an arm. Therefore, the sensor-enabled testing device will be implemented between the tubing and the foam padding within the TAT, and it will measure the pressure applied to the tubing by a variety of tourniquets. The results of the tests performed with the device will inform Luna Labs of the clinical relevance of their device and whether changes need to be made to the design of the TAT. The STS portion of this portfolio investigates EMS response, as the amount of time it takes EMS to respond to a distress call can be the difference between life and death. Unfortunately, evidence shows that low-income communities experience slower emergency response times than high-income communities, and that the amount of time it takes EMS to respond to a distress call impacts the severity of health complications that patients experience. Therefore, there are disparities in the overall health of high- versus low-income communities. The final research paper aims to determine what factors are involved in creating these disparities through the analysis of the main research question: what is the sociotechnical relationship between marginalized communities and emergency medical services in the United States? The factors and how they interact with one another are determined through the use of the STS framework actor-network theory. This analysis provides insight into how the resources that are available to different communities are influenced by the wealth of each respective community. The results of the research are expected to show that the EMS response system is largely influenced by money (e.g., hospital availability and private ambulance companies), and thus, people who belong to lower-income neighborhoods do not receive the highest level of care because they pay lower taxes or are less able to afford the cost of healthcare. As previously stated, the combination of the two research projects within this portfolio provides a broad overview of the processes and problems within emergency medical services. Although the technical topic focuses only on one aspect of EMS training, the simultaneous STS research allows for a deeper understanding of the necessity of proper training of EMS employees. Proper training not only applies to tourniquet application, but it also involves reducing bias regarding marginalized communities, which is not something that is well managed across the United States. It is important to ensure that all communities receive the same level of emergency medical care, and the research shows that medical training scenarios are not necessarily enough to accomplish that goal. Thorough training, including scenarios involving social factors, such as race and household income, would increase the efficiency and competency of EMS.

Conduct problem is an ongoing concern among youth placed in group homes. The concern could sometimes become more challenging due to negative peer influences. The risks associated with negatively influential peers are well-known across diverse residential treatment contexts in the USA, but not in Canada. This 3-year retrospective cohort study observed the influence of positive and negative peers on conduct problems among 173 youths in Ontario group home care between 2012 and 2016 (initial participation rate = 90.0% and follow-up rate = 95.1%). Having previously observed that group home resources matter (Osei in Peer influences on antisocial and prosocial behaviors in group home foster care: Evidence of greater protections in better resourced homes and higher income neighborhoods, Doctoral thesis, University of Windsor, Windsor, Ontario, Canada, 2019, https://scholar.uwindsor.ca/etd/7727/ ), here it was hypothesized that neighborhood income also matters. Specifically, that neighborhood income would moderate peer influences such that low-income neighborhoods would be relatively risky places, while higher-income neighborhoods would be relatively protective places. Positive and negative peer influences were, respectively, protective and risky, but the main effect of neighborhood income was null. As hypothesized, a significant negative peer influence by neighborhood income interaction was also observed. Higher income neighborhoods attenuated the negative peer influence-youth conduct problem association. Negative peers were less risky in higher income neighborhoods. The main protective influence of positive peers was robust across socioeconomically diverse neighborhoods. Clinical, policy and future research implications are discussed.

BackgroundMany individuals with diabetes live in low- or middle-income settings. Glycemic control is challenging, particularly in resource-limited areas that face numerous healthcare barriers.ObjectiveTo compare HbA1c outcomes for individuals randomized to TIME, aTelehealth-supported,Integrated care with CHWs (Community Health Workers), andMEdication-access program (intervention) versus usual care (wait-list control).DesignRandomized clinical trial.ParticipantsLow-income Latino(a) adults with type 2 diabetes.InterventionsTIME consisted of (1) CHW-participant telehealth communication via mobile health (mHealth) for 12 months, (2) CHW-led monthly group visits for 6 months, and (3) weekly CHW-physician diabetes training and support via telehealth (video conferencing).Main MeasuresInvestigators compared TIME versus control participant baseline to month 6 changes of HbA1c (primary outcome), blood pressure, body mass index (BMI), weight, and adherence to seven American Diabetes Association (ADA) standards of care. CHW assistance in identifying barriers to healthcare in the intervention group were measured at the end of mHealth communication (12 months).Key ResultsA total of 89 individuals participated. TIME individuals compared to control participants had significant HbA1c decreases (9.02 to 7.59% (− 1.43%) vs. 8.71 to 8.26% (− 0.45%), respectively,p = 0.002), blood pressure changes (systolic: − 6.89 mmHg vs. 0.03 mmHg,p = 0.023; diastolic: − 3.36 mmHg vs. 0.2 mmHg, respectively,p = 0.046), and ADA guideline adherence (p > 0.50% HbA1c reductions (88.57% vs. 43.75%,p > 1 barrier to care, of whom 91.7% had medication issues. CHWs identified the majority (87.5%) of barriers.ConclusionsTIME participants resulted in improved outcomes including HbA1c. CHWs are uniquely positioned to identify barriers to care particularly related to medications that may have gone unrecognized otherwise. Larger trials are needed to determine the scalability and sustainability of the intervention.Clinical TrialNCT03394456, accessed athttps://clinicaltrials.gov/ct2/show/NCT03394456

This study investigates the extent to which migrants’ embeddedness in two formal social protection systems (country of origin and host country) influences the resources they exchange in their informal supportive relationships. I analyze the support networks of a matched sample of Turkish migrants in Germany and their significant others in Turkey to illuminate the conditions and meaning of reciprocal resource exchanges, finding that both migrants and nonmigrants perceive formal social protection offered by Germany as superior to that of Turkey. I show that those perceptions have implications for how financial support is exchanged with the family but have less impact on friendships. These implications for family included unequal power relationships, changes in equity among siblings and family, different valuation processes of resources, and thus, (reciprocal) exchanges.

This study explored the spillover and crossover associations between work-life balance and satisfaction with life, food-related life and family life in dual-earner parents. Questionnaires were administered to 303 dual-earner couples with adolescent children in Temuco, Chile. Both members of the couples answered the Work-life Balance (WLB) scale, Satisfaction with Life Scale (SWLS), Satisfaction with Food-related Life scale (SWFoL) and the Satisfaction with Family Life scale (SWFaL). Using the actor-partner independence model and structural equation modeling and having controlled for the effects of age, number of children, number of family members and family socioeconomic status, we found that the man’s work-life balance was positively associated with his own levels of satisfaction with life, family life and food related life, as well as with his partner’s (the woman’s) levels of satisfaction with life, food related life and family life. Likewise, the woman’s work-life balance was positively associated with her own levels of satisfaction with life, family life and food related life, as well as with her partner’s (the man’s) levels of satisfaction with food related life and family life, but not with his level of life satisfaction. These findings suggest the need to improve work-life balance for employees of both genders in order to enhance their overall life satisfaction, as well as their satisfaction in the family and food domains.

International audience; Purpose: Worldwide, hypertension awareness remains largely insufficient. This is particularly true in some population subgroups with a low socioeconomic status or in young adults who have limited interactions with healthcare systems. Performing Blood Pressure (BP) screening in non-conventional settings, such as in barbershops, has been suggested by a number of American authors. Whether this approach is feasible in Europe or in North Africa has not been evaluated, however. We, therefore, undertook a study to assess the value of BP screening at hairdressers in France and in Morocco.Materials and Methods: This was a prospective multicenter feasibility study. Twenty-three hairdressers in France and six in Morocco participated in the study. After being provided the relevant information, all consenting customers aged over 18 years were included. Three BP measurements were performed by the customers themselves using a validated Omron M7 automatic BP device connected to a printer.Results: In France, 1025 subjects were enrolled, while 300 subjects participated in Morocco. Three hundred and seventy French participants (36%) had an elevated BP. Among the subjects claiming to be normotensive or who did not know their hypertension status, 31.7% had a BP ≥ 135/85 mmHg. Only 42% of the subjects with an elevated BP contacted their physician within 3 months, although hypertension was confirmed in ¾ of them. In Morocco, the participants were older, with only 11.7% of the subjects aged

The COVID-19 pandemic has presented challenges for all age groups, with older adults being disproportionately affected as some of the most vulnerable people in society. Low-socioeconomic status (SES) older adults experience further challenges surrounding mental health, social wellbeing, and food insecurity. Given the unprecedented nature of the pandemic, it is important to understand the extent of the impact COVID-19 has had on this population, with the ultimate goal of identifying gaps in care services for low-SES seniors and opportunities for improved programming. In this cross-sectional mixed methods study, 93 low-SES seniors living in two affordable housing communities in the East Bay Area were surveyed. Around 76% of participants were aged 70 or older, 72% were female, and 58% identified as non-Hispanic White. In the printed 6-page questionnaire, participants were asked to reflect on their experiences prior to the pandemic and compare them to their present state, one year into the pandemic. Following survey collection, a subset of five respondents was interviewed over the phone to identify key themes. Statistical analyses on the survey data showed that as compared to pre-COVID-19, participants indicated a significant decline in their diet and nutrition, physical health, sleep quality, mental health, and social networks. In terms of social wellbeing, there was a decline in feelings of connectedness to one’s community and time spent eating in the company of others, and an increase in feelings of loneliness and isolation. However, perceptions of general support and having people to turn to did not decline. Interview data generally confirmed survey findings, with participants, two of whom had lost partners during the pandemic, frequently citing feelings of anxiety and intense isolation from friends. Finally, participants indicated a need for better COVID-19 informational services and programming. These results reveal the need for increased safe social programming and outlets for low-SES seniors who often suffer from poorer mental and physical health at baseline. The findings help reveal the changing needs of seniors during this challenging time and urge the development of solutions to improve health and wellbeing in the low-SES senior population, especially during periods of crisis involving social restrictions.

Residents in small urban and rural areas frequently depend on unreliable personal transportation to maintain their lifestyle and get to essential destinations within their society. Especially, vulnerable populations, such as seniors and low-income residents, have lower access to personal vehicles and therefore are mobility-challenged. Being challenged in terms of mobility has effects on the health of the population concerned as this constraint not only limits economic activity that leads to perpetuation of lower means and poverty but also social activity that leads to physical and mental isolation. In a study of Michigan public and nonprofit transit systems, the customer satisfaction, particularly of vulnerable populations, with transit services is analyzed through on-board intercept surveys. Results illustrate the significance of employment, age, income, disability, and demand-response services in public transit planning and ultimately public health.

Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants’ aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field’s most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field’s margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.

In this work, we present a new dataset and a computational strategy for a digital coach that aims to guide users in practicing the protocols of self-attachment therapy. Our framework augments a rule-based conversational agent with a deep-learning classifier for identifying the underlying emotion in a user's text response, as well as a deep-learning assisted retrieval method for producing novel, fluent and empathetic utterances. We also craft a set of human-like personas that users can choose to interact with. Our goal is to achieve a high level of engagement during virtual therapy sessions. We evaluate the effectiveness of our framework in a non-clinical trial with N=16 participants, all of whom have had at least four interactions with the agent over the course of five days. We find that our platform is consistently rated higher for empathy, user engagement and usefulness than the simple rule-based framework. Finally, we provide guidelines to further improve the design and performance of the application, in accordance with the feedback received.

Despite challenges due to the COVID-19 pandemic, reports from regional and national meetings of the Expanded Food and Nutrition Education program (EFNEP) have provided anecdotal evidence that the program has persevered, pivoted, and continued to positively impact the lives of some of the nation’s most vulnerable populations. However, there have been necessary changes to program delivery, inevitable changes in the lives of participants, and changes in the food environment that may have impacted program outcomes. This study compares national EFNEP data (demographics, behavior change data, and 24 h dietary recall data) of participants from two federal fiscal years, before the COVID-19 pandemic and during the pandemic. Linear mixed model analysis of variance and covariance were used to assess the effects of year on program outcomes. Results of this study provide quantitative evidence of the resiliency of EFNEP to facilitate positive behavior changes related to diet quality, physical activity, food safety, food resource management, and food security. Amidst changes in the food environment during the COVID-19 pandemic, these results emphasize the importance and value of federal nutrition education programs in any food environment.

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required.

Author(s): Dewey, Kathryn G; Wessells, K Ryan; Arnold, Charles D; Prado, Elizabeth L; Abbeddou, Souheila; Adu-Afarwuah, Seth; Ali, Hasmot; Arnold, Benjamin F; Ashorn, Per; Ashorn, Ulla; Ashraf, Sania; Becquey, Elodie; Bendabenda, Jaden; Brown, Kenneth H; Christian, Parul; Colford, John M; Dulience, Sherlie JL; Fernald, Lia CH; Galasso, Emanuela; Hallamaa, Lotta; Hess, Sonja Y; Humphrey, Jean H; Huybregts, Lieven; Iannotti, Lora L; Jannat, Kaniz; Lartey, Anna; Port, Agnes Le; Leroy, Jef L; Luby, Stephen P; Maleta, Kenneth; Matias, Susana L; Mbuya, Mduduzi NN; Mridha, Malay K; Nkhoma, Minyanga; Null, Clair; Paul, Rina R; Okronipa, Harriet; Ouedraogo, Jean-Bosco; Pickering, Amy J; Prendergast, Andrew J; Ruel, Marie; Shaikh, Saijuddin; Weber, Ann M; Wolff, Patricia; Zongrone, Amanda; Stewart, Christine P | Abstract: ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce stunting and wasting prevalence among infants and young children. Identification of subgroups who benefit most from SQ-LNS may facilitate program design.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child growth outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n=37,066). We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models, with random-effects models as sensitivity analyses. We used random effects meta-regression to examine study-level effect modifiers. Heterogeneity was assessed using I2 and Tau2 statistics. Sensitivity analyses were conducted to examine whether results differed depending on inclusion criteria for arms within trials and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z-score l −2) by 12% (relative reduction), wasting (weight-for-length (WLZ) z-score l −2) by 14%, low mid-upper arm circumference (MUAC l 125 mm or MUACZ l −2) by 18%, acute malnutrition (WLZ l −2 or MUAC l 125 mm) by 14%, underweight (weight-for-age z-score l −2) by 13%, and small head size (head-circumference z-score l −2) by 9%. Effects of SQ-LNS on growth outcomes generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact or average reported compliance with SQ-LNS. Effects of SQ-LNS on stunting, wasting, low MUAC and small head size were greater among girls than among boys; effects on stunting, underweight and low MUAC were greater among later-born (vs. first-born) children; and effects on wasting and acute malnutrition were greater among children in households with improved (vs. unimproved) sanitation. Results were similar across sensitivity analyses.ConclusionsThe positive impact of SQ-LNS on growth is apparent across a wide variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNS in the mix of interventions to prevent both stunting and wasting. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Background:Previously, we demonstrated that a water, sanitation, handwashing, and nutritional intervention improved linear growth and was unexpectedly associated with shortened childhood telomere length (TL) (Lin et al., 2017). Here, we assessed the association between TL and growth.Methods:We measured relative TL in whole blood from 713 children. We reported differences between the 10th percentile and 90th percentile of TL or change in TL distribution using generalized additive models, adjusted for potential confounders.Results:In cross-sectional analyses, long TL was associated with a higher length-for-age Z score at age 1 year (0.23 SD adjusted difference in length-for-age Z score [95% CI 0.05, 0.42; FDR-corrected p-value = 0.01]). TL was not associated with other outcomes.Conclusions:Consistent with the metabolic telomere attrition hypothesis, our previous trial findings support an adaptive role for telomere attrition, whereby active TL regulation is employed as a strategy to address ‘emergency states’ with increased energy requirements such as rapid growth during the first year of life. Although short periods of active telomere attrition may be essential to promote growth, this study suggests that a longer overall initial TL setting in the first 2 years of life could signal increased resilience against future telomere erosion events and healthy growth trajectories.Funding:Funded by the Bill and Melinda Gates Foundation.Clinical trial number:NCT01590095

Emerging data suggest that adults with low income are at highest risk for COVID-19-related stressors and mental health disorders. This study aimed to determine if COVID-19-related stressors were associated with worsening depression and anxiety in a cohort of low-income adults one year after the start of the pandemic. Participants included 253 Medicaid and commercial accountable care organization recipients from 5 community health centers around Boston, MA who enrolled December 2019-March 2020 in a larger longitudinal study of a Medicaid program. Participants completed surveys at baseline and one-year follow-up that measured depression (Patient Health Questionnaire-8 [PHQ-8]) and anxiety (Generalized Anxiety Disorder-7 [GAD-7]) symptoms. Follow-up surveys assessed COVID-19-related stressors experienced over the prior 12 months. A stressor score included COVID-19-related infectious, social, and economic stressors categorized into tertiles (low, 0-3; medium, 4-6; high, 7-19). Mean age (SD) was 45.2 (11.5) years; 71.2% were female, 42.3% Hispanic and 14.6% Black. At baseline, 126 (49.8%) had moderate or severe depression (PHQ-8 ≥ 10), and 109 (43.1%) had moderate or severe anxiety (GAD-7 ≥ 10). The mean (SD) number of COVID-19 stressors was 4.9 (3.1); the most frequent were food insecurity (52.2%) and job or income loss (43.9%). Compared to the low tertile, those in high and medium tertiles had significantly greater one-year increases in depression and anxiety symptoms. Low-income adults facing multiple COVID-19-related stressors, particularly health-related social needs, had worsening mental health symptoms over one year. Interventions are urgently needed to address the dual burden of health-related social needs and poor mental health exacerbated by COVID-19.

In the United States (U.S.), up to 40% of the entire food supply is lost or wasted, which contributes to negative environmental, economic, and social outcomes, with the majority of food waste occurring in the retail and consumer sectors of the food supply chain. Concurrently, 10.5% of U.S. households experienced food insecurity in 2019. Food insecurity rates are higher among individuals with low income and disproportionately affects ethically and racially diverse people living in poverty. Diverting excess food from retail and institutional settings to people in need is one method to reduce food waste and enhance individual, household, and community food security. This PhD dissertation describes four studies that explored food waste management in the U.S. among households with low-income and within U.S. food pantries, which are a critical component of the emergency food system. Study 1 consisted of a systematic review that examined differences in food waste attitudes and practices among consumers of across income levels. Study 2 was a quantitative research methods approach to examine food waste attitudes and practices of SNAP-eligible households (n=17). Study 3 was a cross-sectional quantitative approach to examine the impact of the novel coronavirus disease (COVID-19) pandemic on food waste management within U.S. food pantries (n=290). Study 4 assessed the feasibility of food pantries in Virginia (n=68) to implement marketing-mix and choice-architecture (MMCA) strategies within their food pantries given the changes they had to make in their food distribution models in response to COVID-19 physical distancing requirements. Collectively, the studies described in this PhD dissertation address knowledge gaps and may be used to inform policies and initiatives to increase food security and decrease food waste among households with low-income and organizations aimed at serving them. Doctor of Philosophy Food waste in the U.S. is a major challenge that impacts the environment, economy, and society. The largest amounts of food waste are generated within food retail and consumer household settings. Concurrently, food insecurity, which is defined as obtaining and having access to enough food for an adequate, nutritious diet, is also another complex food systems challenge in the U.S. Food insecurity rates are higher among people with low income and disproportionately affects ethnically and racially diverse people. The novel coronavirus (COVID-19) pandemic placed further pressure on these two food systems challenges. Diverting excess, wholesome food from retail and institutional settings to people with hunger is a preferred method to mitigate both food waste levels and food insecurity rates. The U.S. emergency food system, which is a network of food recovery organizations that aim to receive excess food from retail settings and redistribute the food to people with hunger, play a pivotal role in addressing these two challenges. This PhD dissertation described four studies that address these two challenges. While this dissertation examined food waste management, the first half of the dissertation explored this topic within households and the second half explored food waste management within food pantries, which are a critical component to the U.S. emergency food system. Study 1 utilized a systematic procedure to review previously published consumer food waste research. The purpose of this study was to examine differences in food waste attitudes and practices among consumers of various income levels. Study 2 used a survey to examine food waste attitudes and practices of households eligible for Supplemental Nutrition Assistance Program (SNAP) benefits. Study 3 explored the impact of COVID-19 physical distancing requirements on food waste management within U.S. food pantries. Lastly, study 4 explored the feasibility of food pantry staff/volunteers on implementing behavioral economics strategies, which are changes to a setting that can promote selection of a certain food item, within their food pantry. Collectively, the studies described in this PhD dissertation address knowledge gaps and may inform policies and initiatives to mutually increase food security and decrease food waste among households with low-income and organizations aimed at serving them.

Background The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia. Methods Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant. Results A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value < .0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms. Conclusions Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center.

Objective The objective of this study was to explore barriers and facilitators to healthy eating among low-income Latino adolescents using an intervention development framework. Methods Semi-structured interviews (n = 30) were conducted with Latino youth ages 13–17 who had overweight or obesity at a safety-net clinic in San Francisco, CA. Adolescent beliefs and attitudes regarding healthy eating and individual, family, and community level barriers and facilitators were elicited. Interviews were analyzed using an inductive approach and the Capability-Opportunity-Motivation (COM-B) model. Results Participants had capability gaps; while they demonstrated basic nutrition knowledge, they also held significant misconceptions about healthy eating, equating “organic” with healthy and failing to recognize sugar in a number of beverages and foods. Families were a source of support through role modeling and purchasing fresh produce, yet in many cases also undermined adolescents’ healthy eating goals through purchases of high calorie low nutrient food, an opportunity facilitator and challenge. By contrast, peers were mostly a negative influence due to frequent consumption of high calorie low nutrient food. The school environment posed opportunity challenges as participants found school lunch unpalatable and had ready access to unhealthy options nearby. Participants were motivated to improve their eating habits but often not resilient in the face of obstacles. Conclusions Interventions to promote healthy eating among low-income Latino adolescents should address common nutritional misconceptions, target families as well as teens, consider peer influences, and advocate for policy approaches that improve the school food environment.

Objective: Identify factors perceived to influence implementation of healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children. Design: This mixed-methods study, conducted in 2015–2016, used semi-structured interviews (n = 18), focus groups (n = 23), and an expert panel. Participants: Public health (n = 11) and Supplemental Nutrition Assistance Program–Education practitioners (n = 9) and community residents (n = 174) from 9 counties in Ohio. Expert panelists (n = 10) had experience implementing PSEs in child care settings. Phenomenon of Interest: Implementation factors influencing healthy eating PSEs in child care settings. Analysis: Qualitative thematic analysis of 41 transcripts using a grounded theory approach. Indicators for each theme were operationalized. Consensus feedback from an expert panel weighted themes and indicators based on perceived importance for implementation. Results: Identified themes relevant to implementation of PSEs included (1) organizational and practitioner capacity, (2) child care capacity, (3) networks and relationships, and (4) community resources and motivations. Nineteen indicators related to the 4 themes were identified and weighted. Conclusions and Implications: Findings highlighted key factors within domains of influence and informed the operationalization of the indicators and the development of an assessment tool. The assessment tool is designed to tailor PSE implementation to the realities of different child care settings. Fil: Parsons, Allison A.. Cincinnati Children's Hospital Medical Center; Fil: Monteban, Madalena. Case Western Reserve University; Estados Unidos Fil: Lee, Eunlye. Case Western Reserve University; Estados Unidos Fil: Bebo, Pat. Ohio State University; Estados Unidos Fil: Zubieta, Ana Claudia. Ohio State University; Estados Unidos Fil: Ginnetti, Sarah. Ohio Department Of Health; Fil: Hewitt, Julie. Case Western Reserve University; Estados Unidos Fil: Freedman, Darcy. Case Western Reserve University; Estados Unidos

Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens’ daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.

The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service ['other']) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes

Housing is one of the basic needs of humans. Families in different countries with various cultures, who have different lifestyles respond to their individual needs including physical and mental in a safe place that is called house. The world population is increasing day by day. In parallel to this population growth, housing demand increases rapidly. Iran is also a country, which has a rapid population growth and has developed a series of policies to solve the housing problems. Affordable housing is one of solution for providing the house by governments. These type of houses is the ways to answer the demand for low-income people or the people that their income is not sufficient to the owner a house. Since 2007, the government has built a new type of affordable housing in different cities of Iran. These houses are named as Mehr Housing, which is generally medium and high-rise buildings for low-income people. In this study, it is intended to make an evaluation of the strengthens and weaknesses of Mehr Housing projects in Iran in terms of housing quality. These analyses are mainly done based on location and accessibility, safety and security, public open spaces and recreational activities, plan layout of housing units and physical features. By this discussion, it is expected to create a guide for the policymakers, designers, users and other shareholders.

We analyzed decision making under risk in a group of 50 poor individuals and a group of 50 rich individuals from the city of Lima, Peru, using the Columbia Card Task game. Contrary to the decisions of the rich, the decisions of the poor were insensitive to changes in the magnitude of potential losses: the risk taking of the poor did not increase when potential losses were low compared to when they were high. The decisions of the poor were also significantly less sensitive to changes in the probability of potential losses, compared to those of the rich. On the contrary, similarly to the decisions of the rich, the decisions of the poor were significantly sensitive to changes in the gain amount: risk taking was higher when the gain amount was higher than when it was lower. The rich sample from Lima showed a similar pattern of risk-taking behavior as other non-poor populations from previous studies. Furthermore, the poor scored higher on the perceived constraints scale and showed the same level of unrealistic optimism for negative events, but less unrealistic optimism for positive events, than the rich.

Introduction The world’s first global health treaty, WHO Framework Convention on Tobacco Control (FCTC) aims to reduce tobacco product demand by focusing on tobacco taxes, smoking bans, health warning labels, and tobacco advertising bans. Previous studies almost unanimously suggest that FCTC has prompted countries to implement more effective tobacco demand reduction policies. Aims and Methods By taking into account the pre-FCTC status, country income level, and state capacity we studied if ratifying FCTC was associated with tobacco demand reduction measures in 2018/2019. We used logistic regression to assess the association of FCTC ratification with adoption demand reduction measures, accounting for years since ratification, baseline status, and other covariates. Results Except for taxes, state of tobacco policy implementation before FCTC ratification did not predict adoption of FCTC policies. Time since FCTC ratification was associated with implementing smoking bans and pictorial HWLs. In contrast, while the tax rate prior to FCTC ratification was positively associated with increased taxes after FCTC ratification, time since FCTC ratification was marginally negatively associated with increases in tobacco taxes. Conclusions While the FCTC was followed by implementation of compliant demand reduction policies, there are still many parties that have not implemented the FCTC, particularly increasing taxes and ending tobacco advertising and promotions. Implications We assessed changes in tobacco demand reductions measures over 22 years in 193 countries. By using internal tobacco industry documents, we were able establish a baseline before the FCTC negotiations. Unlike previous studies, we included four tobacco demand reductions measures: tobacco taxes, smoking bans, health warning labels, and tobacco advertising ban. The limitation of the study is that we do not have data to describe if demand reduction measures are actually enforced or what their effect on tobacco consumption is.

Acinetobacter baumannii is an emerging pathogen, and over the last three decades it has proven to be particularly difficult to treat by healthcare services. It is now regarded as a formidable infectious agent with a genetic setup for prompt development of resistance to most of the available antimicrobial agents. Yet, it is noticed that there is a gap in the literature covering this pathogen especially in countries with limited resources. In this review, we provide a comprehensive updated overview of the available data about A. baumannii, the multi-drug resistant (MDR) phenotype spread, carbapenem-resistance, and the associated genetic resistance determinants in low-income countries (LIICs) since the beginning of the 21st century. The coverage included three major databases; PubMed, Scopus, and Web of Science. Only 52 studies were found to be relevant covering only 18 out of the 29 countries included in the LIC group. Studies about two countries, Syria and Ethiopia, contributed ~40% of the studies. Overall, the survey revealed a wide spread of MDR and alarming carbapenem-resistance profiles. Yet, the total number of studies is still very low compared to those reported about countries with larger economies. Accordingly, a discussion about possible reasons and recommendations to address the issue is presented. In conclusion, our analyses indicated that the reported studies of A. baumannii in the LICs is far below the expected numbers based on the prevailing circumstances in these countries. Lack of proper surveillance systems due to inadequate financial resources could be a major contributor to these findings.