Search

Abstract Natural soundscapes experienced in parks are increasingly recognised as a valuable ecosystem service, yet urban parks soundscapes also commonly contain anthropogenic noise. While studies show bird calls can promote psychological restoration, the factors that might influence actual experiences of these sounds by individuals in urban parks are less clear. Equally, continual exposure to anthropogenic noise, such as vehicle traffic, is associated with negative health outcomes, but determinants influencing negative experiences of such sounds within a park soundscape are poorly understood. To address this gap we used an ex situ survey of over 4000 Australian residents and examined a range of spatial and social factors in influencing perceptions towards noticing and pleasantness of bird sounds and traffic noise within urban parks. The results indicate older age, recent park use, and valuing parks for uses such as exercising, socialising and to hear nature, were positively associated with pleasant bird sound experiences in parks. For traffic sounds, we found indicators of disadvantage, such as renting a home were associated with a higher likelihood of unpleasant experiences of traffic noise within parks. Notably, individuals using parks for social activities were still positively associated with pleasant bird sound experiences and less likely to perceive traffic sounds as unpleasant. Conversely, whilst those with greater nature‐relatedness had a strong positive association with pleasant bird sound experiences, they were more likely to perceive traffic as unpleasant. Overall, these findings suggest that whilst many types of park users can potentially experience the beneficial effects from bird sounds, the detrimental effects of traffic noise may constrain these benefits in certain social groups, particularly those of greater socio‐economic disadvantage. We discuss strategies to promote greater equity of therapeutic experiences of bird sounds in parks, whilst outlining traffic mitigation measures within urban parks. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background In Australia, tobacco smoking rates have declined but inequalities remain with significantly higher smoking prevalence among low-socioeconomic populations. Clinical trial data suggest vaporized nicotine products (VNPs) aid smoking cessation. Most VNP trials have used refillable tank systems, but newer generation (pod) devices now comprise the largest market share yet have limited clinical trial evidence on safety and effectiveness. This study evaluates the effectiveness, safety and cost-effectiveness of VNPs (pod and tank device) compared with nicotine replacement therapy ([NRT]—gum or lozenge) for smoking cessation. Methods This is a two-arm, open-label, superiority, parallel group, randomized controlled trial (RCT) with allocation concealment and blinded outcome assessment. The RCT is conducted at the National Drug and Alcohol Research Centre at the University of New South Wales, Sydney, Australia. Participants are people who smoke daily, are interested in quitting and receive a government pension or allowance (N = 1058). Participants will be randomized (1:1 ratio) to receive 8 weeks of free: VNPs, with pod (40 mg/mL nicotine salt) and tank device (18 mg/mL freebase nicotine) in mixed flavours; or NRT (gum or lozenge; 4 mg). All participants will receive daily text message behavioural support for 5 weeks. Assessments will be undertaken by telephone at baseline, with three follow-up calls (two check-in calls within the first month and final follow-up at 7 months post randomization) to ascertain smoking status, treatment adherence and adverse events. The primary outcome is 6-month continuous abstinence verified by carbon monoxide breath test of ≤5ppm at 7-month follow-up. Safety and cost-effectiveness of VNPs versus NRT will also be evaluated. Discussion Further data are required to strengthen certainty of evidence for VNPs aiding smoking cessation, particularly for newer generation pod devices. To our knowledge, this trial is the first to offer choice of VNPs and no comparative effectiveness trial data exists for new pod devices. If effective, the findings can inform wider implementation of VNPs to aid smoking cessation in a priority group. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621000076875. Registered on 29 January 2021. https://www.anzctr.org.au

Abstract Background Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. Methods A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007—March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13–19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. Results Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. Conclusions There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.

The question, whether and how spatial and social disadvantages overlap and what this means in terms of individual achievements is of crucial importance to rural sociology. Empirically, however, only few studies on this topical issue are available so far. The paper presents the conceptual and methodological approach as well as selected findings of a recently completed cross-national, German-Czech research project. Our research focusses on three socially disadvantaged groups: persons experiencing difficulties in the labour market, single parents and elderly persons living alone. They are living in four rural peripheries in Eastern Germany and Czechia, regions which are similar in their distance to metropolitan areas, low population density, weak economic structure and poor accessibility of public and private services. Our main interest is on the question whether social and spatial disadvantages accumulate and lead to a double disadvantage. We conducted 113 qualitative interviews in both countries. Overall, most respondents rate their lives in the four regions positively. Often, they describe a rural idyll, naming for example direct access to nature as important source of their well-being. However, they also point to a variety of everyday challenges due to a lack of services and infrastructures and the need to have access to a car and to travel long distances. They highlight the important role played by rural and small towns (and their supply services) in rural peripheries. Social relationships are also important for well-being. The respondents’ everyday narratives attest to the fact that they have found multiple ways of dealing with spatial constraints. Thus, our results paint a nuanced picture of rural peripheries where social and spatial disadvantages do not necessarily accumulate and people do not inevitably see themselves as disadvantaged – either socially or spatially. Central to this is a high degree of agency, manifesting in a variety of coping strategies. The respondents apply these to meet daily challenges and to live more self-determined lives than the spatial structures of a rural periphery and the conditions of various forms of social disadvantage would initially suggest. [ABSTRACT FROM AUTHOR]

Cars are dominating urban traffic in cities around the world, even though daily trips in many cities are often realized with active modes of transportation or public transport. Urban transport planning processes need to adapt to this reality and the necessity of climate change mitigation. Against this background, the research project "Mobility Reporting", a joint undertaking of the district Pankow in Berlin and researchers from TU Berlin and TU Dresden, established a new, goal-driven, and participative planning process. The process identified local mobility as one of the central planning goals. The 15-min city (FMC) was thus adduced as a benchmark to analyze the district's current mobility system and development potential. We conducted extensive accessibility analyses to examine the status quo concerning the FMC. We calculated travel times to essential destinations in daily life by foot, public transport, and car. This analysis was accompanied by a mixed online and paper–pencil survey conducted to evaluate the perceived accessibility of people in Pankow. The survey results shed light on the question of which walking time thresholds constitute a "very good" or "good" accessibility. Further analyses included environmental and social variables, allowing us to check whether areas with different accessibility levels also differ regarding the socio-economic characteristics of their inhabitants. For example, do socially advantaged neighborhoods have better local accessibility? Is there a trade-off between exposure to environmental pollution and good accessibility? With this contribution, we shed light on what an FMC is and ought to be. Results from the survey support the normative and political vision of the FMC. Pankow generally offers the merits of a walkable city, showing the expected travel time differences between the dense inner city and the outskirts. Socially disadvantaged neighborhoods are not consistently less accessible. However, there seems to be a trade-off between good accessibility (especially PT accessibility) and correlated externalities of transport, namely air pollution and noise. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic and associated school closures may have constrained educational participation particularly for students in disadvantaged circumstances. We explore how 30 disadvantaged students in secondary school (14 mainstream/16 Flexible Learning Programme) from Queensland, New South Wales and Tasmania experienced home learning during the first wave of COVID‐19, teasing out nuances across two educational models. Drawing on semi‐structured interviews with these students, our analysis revealed three interconnected themes inflecting their learning: connection, connectivity and choice. Connection captures the desire for belonging and practices that facilitated meeting this desire during system‐wide disruptions to school routines and face‐to‐face learning. Connectivity captures the impact of digitally facilitated learning at home on students' ability to engage with curriculum content and with their learning community. Choice captures the availability of viable options to overcome barriers students encountered in their learning and possibilities to flexibly accommodate student preferences and learning needs. Students from Flexible Learning Programmes appeared generally better supported to exercise agency within the scope of their lived experience of home‐based learning. Findings indicate a need for strengthening student‐centred policy and practices aimed at leveraging the affordances of information technology, balancing self‐directed and structured learning and providing holistic support to enable meaningful student choice. [ABSTRACT FROM AUTHOR]

Background and Objectives The aim of this study is to contribute to the literature on variation in later-life outcomes by sexual identity. Drawing on the Iridescent Life Course framework, we examined differences in loneliness trajectories, and tested the roles of social connectedness and support, and socioeconomic and health statuses in explaining any observed disparities. Research Design and Methods Using growth models, we analyzed 19 years of data (2001–2019) from adults aged 50 years and older from the Household, Income and Labour Dynamics in Australia Survey (n = 5,500 individuals), where a question on sexual identity was asked twice in the study. Results One percent of our sample reported a change in their sexual identity, which we grouped with individuals who reported as bisexual. Our sample comprised of 45.3% heterosexual men, 52.2% heterosexual women, 0.6% gay men, 0.6% lesbian women, 0.6% bisexual-plus men, and 0.6% bisexual-plus women. We found bisexual-plus men were vulnerable to loneliness as they aged. This group had the highest levels of loneliness at age 50, and differences compared with heterosexual men persisted over time. Loneliness of bisexual-plus men increased steeply from age 70. Socioeconomic and health statuses did not explain the increased loneliness of older bisexual-plus men. Lower social support and connectedness partly accounted for these disparities. Discussion and Implications Findings are discussed with regards to existing research and theories on social disadvantage and resilience over the life course. We expand knowledge on factors explaining loneliness and how it varies in women and men by sexual identity. [ABSTRACT FROM AUTHOR]

How do personal networks evolve as individuals age? To what degree do social disadvantage and contextual factors matter for network dynamics in later life? This paper answers these two questions based on egocentric network data of older adults over a ten-year period. Specifically, I use longitudinal and nationally representative data on 1,168 older adults from the National Social Life, Health, and Aging Project. I use between-within models to separate the within- and between-individual effects of sociodemographic characteristics and contextual factors on three aspects of social connectedness in later life: network size, frequency of contact, and proportion of kin. Patterns of network change vary among people of different races and ethnicities as well as educational levels. Black and Hispanic respondents have a significantly smaller network size and a higher average frequency of contact with confidants. Moreover, Hispanic respondents have a higher proportion of kin in the network, compared to White respondents. Similarly, older adults with less education have a smaller network size, higher frequency of contact and higher proportion of kin in their confidant networks compared to those who attended college. Older adults who have better mental health are more likely to have a higher frequency of contact and higher proportion of kin. When an older adult starts to work for pay, their frequency of contact with confidants tends to increase. Older adults living in neighborhoods with stronger social ties are more likely to have a larger network size, higher frequency of contact, and lower proportion of kin in their confidant network. The above results show that disadvantaged backgrounds and contextual factors are associated with certain less favorable network characteristics, which helps to explain the concentration of social disadvantage on certain populations. [ABSTRACT FROM AUTHOR]

Background Populations willing to participate in randomized trials may not correspond well to policy-relevant target populations. Evidence of effectiveness that is complementary to randomized trials may be obtained by combining the 'target trial' causal inference framework with whole-of-population linked administrative data. Methods We demonstrate this approach in an evaluation of the South Australian Family Home Visiting Program, a nurse home visiting programme targeting socially disadvantaged families. Using de-identified data from 2004–10 in the ethics-approved Better Evidence Better Outcomes Linked Data (BEBOLD) platform, we characterized the policy-relevant population and emulated a trial evaluating effects on child developmental vulnerability at 5 years (n  = 4160) and academic achievement at 9 years (n  = 6370). Linkage to seven health, welfare and education data sources allowed adjustment for 29 confounders using Targeted Maximum Likelihood Estimation (TMLE) with SuperLearner. Sensitivity analyses assessed robustness to analytical choices. Results We demonstrated how the target trial framework may be used with linked administrative data to generate evidence for an intervention as it is delivered in practice in the community in the policy-relevant target population, and considering effects on outcomes years down the track. The target trial lens also aided in understanding and limiting the increased measurement, confounding and selection bias risks arising with such data. Substantively, we did not find robust evidence of a meaningful beneficial intervention effect. Conclusions This approach could be a valuable avenue for generating high-quality, policy-relevant evidence that is complementary to trials, particularly when the target populations are multiply disadvantaged and less likely to participate in trials. [ABSTRACT FROM AUTHOR]

This article explores how the sorting and separating of pupils into entangled categories of social/cultural disadvantage and disability in the 1960s through the 1980s created populations of concern. Even though the United States and Germany are typically contrasted in their approaches to inclusive education, a new scientisation of the "social" had similar effects in both countries. While inclusion is usually presumed as the opposite of segregation, we examine how distinct curricula – often administered in separate classrooms or schools – became deemed essential to prepare target populations for eventual inclusion. In the United States, demands for desegregation and mainstreaming were met in part with the design of curricula and instructional strategies for populations marked by categories of disability and/or cultural disadvantage. In West Germany, similar pedagogies appeared in materials designed for special and lower-track schools aimed at pupils classified as learning disabled and/or socio-culturally disadvantaged. Drawing on archival analysis of research journals, reports, and curricular materials from both countries, we examine how science pedagogies constituted social/cultural disadvantage and/or disability as a type of learner with limited experiences requiring compensation and emotional needs requiring affective calibration. Similar practices produced these populations of concern, enclosing them in a pre-scholastic intervention space and prescribing targeted strategies as necessary for their integration as healthy, responsible citizens. At stake is understanding how curricular differentiation directed to previously excluded groups can generate new subdivisions of the social – authorising separate (and unequally positioned) instruction in the name of inclusion. [ABSTRACT FROM AUTHOR]

This commentary describes a multi-national project which addresses gaps in the design and delivery of health and education services in Arabic-speaking countries in relation to early language development, with a focus on Egypt, Jordan, Lebanon and the Palestinian Territories. This includes: (1) co-production with early years professionals and NGOs of approaches to support early language development; (2) development and standardisation of tools to identify monolingual and multilingual Arabic-speaking children at risk of poor language development; and (3) examination of language development in refugee communities. The importance of inter-professional partnership and the inclusion of families in planning support for oral language development is highlighted. Arabic versions of the Communicative Development Inventory (CDI) Toddler were developed, and data collected from 1074 Egyptian, Jordanian and Palestinian monolingual infants aged 8–30 months. Data from 201 age-matched Palestinian infants in Lebanese refugee camps highlight inequalities resulting from limited maternal educational opportunities. Data from 230 multilingual Lebanese 2-year-olds enable the interpretation of CDI scores as a function of language exposure. This work contributes to the promotion of robust language development for all Arabic-speaking children. This commentary focusses on sustainable development goal (SDG) 3, SDG 4, SDG 10 and SDG 17. [ABSTRACT FROM AUTHOR]

This article emerges from a SCoTENS-funded research project, Contested Childhoods Across Borders and Boundaries (2019-2021), jointly conducted by Maynooth University and Stranmillis University College. It focuses on the origins, distinctiveness, and enduring relevance of the Arellian Nursery, the first nursery school in Ireland (North or South), which first opened its doors in 1928. Drawing on original sources and historical records, the article charts the establishment of Arellian as a philanthropic, privately sponsored venture in south Belfast, founded, from the outset, to address educational and social disadvantage and to promote outdoor learning, healthy lifestyles, pupil agency, and home-school links. Influenced by pioneers such as Grace Owen and Margaret McMillan, themselves disciples of Froebel, play, as a means of learning and development, was considered of great importance. While the founders and early superintendents of Arellian might have been seen as progressive, anti-establishment outliers, our contemporary context highlights the prescience and enduring relevance of the vision of Arellian almost a hundred years later. Active outdoor learning, healthy lifestyles, agentic learning, and home-school-community partnerships are becoming increasingly mainstream tenets throughout the Northern Irish education system. It is argued that, as we emerge from the COVID-19 pandemic, important lessons can be learned for educators and teacher educators from the example of Arellian, Ireland's very first nursery school. [ABSTRACT FROM AUTHOR]

The extent to which cumulative social disadvantage—defined as aggregate social risk resulting from multiple co-occurring adverse social determinants of health (SDOH)—affects the risk of all-cause mortality, independent of demographic and clinical risk factors, is not well understood. The objective of this study was to examine the association between cumulative social disadvantage, measured using a comprehensive 47-factor SDOH framework, and mortality in a nationally representative sample of adults in the United States. The authors conducted secondary analysis of pooled data for 63,540 adult participants of the 2013–2015 National Death Index-linked National Health Interview Survey. Age-adjusted mortality rates (AAMRs) were reported by quintiles of aggregate SDOH burden, with higher quintiles denoting greater social disadvantage. Cox proportional hazards models were used to examine the association between cumulative social disadvantage and risk of all-cause mortality. AAMR increased significantly with greater SDOH burden, ranging from 631 per 100,000 person-years (PYs) for participants in SDOH-Q1 to 1490 per 100,000 PYs for those in SDOH-Q5. In regression models adjusted for demographics, being in SDOH-Q5 was associated with 2.5-fold higher risk of mortality, relative to Q1 (adjusted hazard ratio [aHR] = 2.57 [95% confidence interval, CI = 1.94–3.41]); the observed association persisted after adjusting for comorbidities, with over 2-fold increased risk of mortality for SDOH-Q5 versus Q1 (aHR = 2.02 [95% CI = 1.52–2.67]). These findings indicate that cumulative social disadvantage is associated with increased risk of all-cause mortality, independent of demographic and clinical factors. Population level interventions focused on improving individuals' social, economic, and environmental conditions may help reduce the burden of mortality and mitigate persistent disparities. [ABSTRACT FROM AUTHOR]

Natural soundscapes experienced in parks are increasingly recognised as a valuable ecosystem service, yet urban parks soundscapes also commonly contain anthropogenic noise.While studies show bird calls can promote psychological restoration, the factors that might influence actual experiences of these sounds by individuals in urban parks are less clear. Equally, continual exposure to anthropogenic noise, such as vehicle traffic, is associated with negative health outcomes, but determinants influencing negative experiences of such sounds within a park soundscape are poorly understood.To address this gap we used an ex situ survey of over 4000 Australian residents and examined a range of spatial and social factors in influencing perceptions towards noticing and pleasantness of bird sounds and traffic noise within urban parks.The results indicate older age, recent park use, and valuing parks for uses such as exercising, socialising and to hear nature, were positively associated with pleasant bird sound experiences in parks. For traffic sounds, we found indicators of disadvantage, such as renting a home were associated with a higher likelihood of unpleasant experiences of traffic noise within parks. Notably, individuals using parks for social activities were still positively associated with pleasant bird sound experiences and less likely to perceive traffic sounds as unpleasant. Conversely, whilst those with greater nature‐relatedness had a strong positive association with pleasant bird sound experiences, they were more likely to perceive traffic as unpleasant.Overall, these findings suggest that whilst many types of park users can potentially experience the beneficial effects from bird sounds, the detrimental effects of traffic noise may constrain these benefits in certain social groups, particularly those of greater socio‐economic disadvantage. We discuss strategies to promote greater equity of therapeutic experiences of bird sounds in parks, whilst outlining traffic mitigation measures within urban parks. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Although the exact impact of the Covid‐19 pandemic on the inclusion of vulnerable children and young people—nationally and internationally—is unknown, historical failures to address the link between poverty and low educational outcomes have reversed any progress hitherto achieved. This thematic issue speaks to the challenges faced by, and promises of inclusion made to, children and young people in the most vulnerable circumstances: It brings together a set of articles that detail the challenges educators, educational institutions, and students faced during the pandemic, while also discussing innovative approaches to include pupils in mainstream education and help them make progress against the odds. The pandemic has been an opportunity for both learning and unlocking potentialities toward innovative solutions. Taking stock of these solutions is important in preparing and strengthening schools, educators, and students to face the post‐pandemic era that is dawning, for public education systems need not only be seen as sites of frustration and challenge, but also as sites of promise and possibility.

Abstract Socioeconomic disadvantage is associated with greater risk of dementia. This has been theorised to reflect inequalities in cognitive reserve, healthcare access, lifestyle, and other health factors which may contribute to the clinical manifestation of dementia. We aimed to assess whether area deprivation in the United Kingdom was associated with greater risk or severity of the specific neurodegenerative diseases which lead to dementia in a multi-centre cohort with autopsy assessment. Participants underwent clinical assessment prior to brain tissue donation post-mortem. Each then underwent detailed, standardised neuropathological assessment. National area deprivation statistics were derived for each participant’s neighbourhood, for use as a predictor in binary and ordinal logistic models assessing the respective presence and severity of staging of key neuropathological changes, adjusting for theorised confounders. Individuals from among the 20% most deprived neighbourhoods in the United Kingdom had significantly higher neurofibrillary tangle and neuritic plaque staging, and increased risk of cerebral amyloid angiopathy. These findings were not explained by a greater risk of diabetes or hypertension, APOE genotype, alcohol misuse or tobacco smoking, sex, or age differences. A sensitivity analysis conditioning on baseline cognitive impairment did not meaningfully change the observed association. Socioeconomic disadvantage may contribute to dementia incidence through a greater severity of specific neuropathological changes (neurofibrillary tangles, neuritic plaques, and cerebral amyloid angiopathy), independent of other indirect influences. Mechanisms through which deprivation is associated with these require further exploration.

The paper focuses on the issues of merit, explored in its complex polysemy, meritocracy, and skills, placing them in relation to those of – educational, social, economic, cultural – poverty and social disadvantage, which afflict, with considerable aggravation especially in the era of Sars-Cov-2 pandemic, even Italy. The essay consists of three paragraphs. In the first two, a reference framework is outlined, on the one hand relating to the polysemic concepts of merit, and meritocracy; on the other, to the situation of poverty and social inequalities in Italy. The third paragraph, which represents the heart of the paper, is linked to the abovementioned frameworks: it highlights the key role that a widespread, accessible, and high-quality Early Childhood Education and Care (ECEC) play, both in supporting children’s development, both promoting a democratic and inclusive society; a society characterized by effective “merit dynamics”, open to all, so as to promote skills development and, above all, social ascent and redemption.

Background: Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. Methods: A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007—March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13–19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. Results: Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. Conclusions: There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision. [ABSTRACT FROM AUTHOR]

Background: Food environments can contribute to excess weight gain among adults, but the evidence is mixed.Objectives: This longitudinal study investigates the association between changes in the food environment and changes in body mass index (BMI) in adults and whether changes in the food environment differentially impact various subgroups.Methods: At two time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in four New Jersey cities. The count of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences was collected at baseline and tracked until follow-up. A binary measure of social standing (social advantage, n = 219 vs social disadvantage, n = 298) was created through latent class analysis using social, economic, and demographic variables. Multivariable linear regression modelled the association between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of social standing and the food environment were examined.Results: Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (β = -1.0, 95% CI: -1.9, -0.1, P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (β = 0.1, 95% CI: 0.01, 0.2, P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between the food environment and change in BMI vary by social standing. For instance, the positive association between changes in fast-food restaurants and changes in BMI was only observed in the social disadvantage group (β = 0.1, 95% CI: 0.02, 0.2, P = 0.021).Conclusions: In a sample of adults living in New Jersey, changes in food environment had differential effect on individuals' BMI based on their social standing. [ABSTRACT FROM AUTHOR]

Early life adversity (social disadvantage and psychosocial stressors) is associated with altered microstructure in fronto-limbic pathways important for socioemotional development. Understanding when these associations begin to emerge may inform the timing and design of preventative interventions. In this longitudinal study, 399 mothers were oversampled for low income and completed social background measures during pregnancy. Measures were analyzed with structural equation analysis resulting in two latent factors: social disadvantage (education, insurance status, income-to-needs ratio [INR], neighborhood deprivation, and nutrition) and psychosocial stress (depression, stress, life events, and racial discrimination). At birth, 289 healthy term-born neonates underwent a diffusion MRI (dMRI) scan. Mean diffusivity (MD) and fractional anisotropy (FA) were measured for the dorsal and inferior cingulum bundle (CB), uncinate, and fornix using probabilistic tractography in FSL. Social disadvantage and psychosocial stress were fitted to dMRI parameters using regression models adjusted for infant postmenstrual age at scan and sex. Social disadvantage, but not psychosocial stress, was independently associated with lower MD in the bilateral inferior CB and left uncinate, right fornix, and lower MD and higher FA in the right dorsal CB. Results persisted after accounting for maternal medical morbidities and prenatal drug exposure. In moderation analysis, psychosocial stress was associated with lower MD in the left inferior CB among the lower-to-higher socioeconomic status (SES) (INR ≥ 200%) group, but not the extremely low SES (INR < 200%) group. Increasing access to social welfare programs that reduce the burden of social disadvantage and related psychosocial stressors may be an important target to protect fetal brain development in fronto-limbic pathways. [ABSTRACT FROM AUTHOR]

Background: In Australia, tobacco smoking rates have declined but inequalities remain with significantly higher smoking prevalence among low-socioeconomic populations. Clinical trial data suggest vaporized nicotine products (VNPs) aid smoking cessation. Most VNP trials have used refillable tank systems, but newer generation (pod) devices now comprise the largest market share yet have limited clinical trial evidence on safety and effectiveness. This study evaluates the effectiveness, safety and cost-effectiveness of VNPs (pod and tank device) compared with nicotine replacement therapy ([NRT]-gum or lozenge) for smoking cessation.Methods: This is a two-arm, open-label, superiority, parallel group, randomized controlled trial (RCT) with allocation concealment and blinded outcome assessment. The RCT is conducted at the National Drug and Alcohol Research Centre at the University of New South Wales, Sydney, Australia. Participants are people who smoke daily, are interested in quitting and receive a government pension or allowance (N = 1058). Participants will be randomized (1:1 ratio) to receive 8 weeks of free: VNPs, with pod (40 mg/mL nicotine salt) and tank device (18 mg/mL freebase nicotine) in mixed flavours; or NRT (gum or lozenge; 4 mg). All participants will receive daily text message behavioural support for 5 weeks. Assessments will be undertaken by telephone at baseline, with three follow-up calls (two check-in calls within the first month and final follow-up at 7 months post randomization) to ascertain smoking status, treatment adherence and adverse events. The primary outcome is 6-month continuous abstinence verified by carbon monoxide breath test of ≤5ppm at 7-month follow-up. Safety and cost-effectiveness of VNPs versus NRT will also be evaluated.Discussion: Further data are required to strengthen certainty of evidence for VNPs aiding smoking cessation, particularly for newer generation pod devices. To our knowledge, this trial is the first to offer choice of VNPs and no comparative effectiveness trial data exists for new pod devices. If effective, the findings can inform wider implementation of VNPs to aid smoking cessation in a priority group.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000076875. Registered on 29 January 2021.  https://www.anzctr.org.au. [ABSTRACT FROM AUTHOR]

This study uses situational action theory (SAT) to analyse the effects of socioeconomic disadvantages on criminality rates (namely, robbery) in Brazilian municipalities. To achieve this objective, the variation of robberies per thousand inhabitants was used as a proxy for criminality, estimating its determinants using a spatial panel data set. As a result, we identified social disadvantage greater effect (i.e. variation of the mean Education and Health Firjan indices) when compared to economic disadvantage on the criminality in Brazilian municipalities. This effect was more noticeable in regions with poorer social infrastructure. Moreover, the crime environment to which individuals are exposed has a positive association in the determination of illegal acts, confirming arguments made by SAT. [ABSTRACT FROM AUTHOR]

Background: Neighborhood-level adverse social determinants may be a risk factor for sleep health disparities. We examined the associations between neighborhood factors and insomnia and explored their spatial clustering in the city of Philadelphia, Pennsylvania., Methods: We conducted a cross-sectional analysis of data from Philadelphia residents who participated in online screening for insomnia-related research. Participants self-reported sex, age, body mass index, anxiety, post-traumatic stress disorder, depression, and insomnia symptoms. The sample was stratified as "No Insomnia" (≤7) and "Insomnia" (>7) based on the Insomnia Severity Index (range: 0-28). Neighborhood and participant data were merged using geospatial techniques. Multiple regression models and geospatial analysis were used to identify neighborhood variables that are associated with insomnia and their spatial distribution., Results: The sample (N = 350) was predominantly female (53%), middle-aged (40.8 ± 13.8), overweight (body mass index=26.1 ± 5.54), and 53.7% had insomnia. The insomnia group had significantly higher depression scores (14.6 ± 5.5), a large percentage had anxiety (64.4%) and post-traumatic stress disorder symptoms (31.9%), and largely resided in high crime (p < .001) and highly deprived neighborhoods (p = .034). Within the insomnia group, a 1-point increase in the number of spiritual centers in the neighborhood was associated with lower insomnia symptoms (b=-1.02, p = .002), while a 1-point increase in depression scores (b=0.44, p < .001) and residence in a highly deprived neighborhood (b=1.49, p = .021) was associated with greater insomnia., Conclusion: Disparities exist in the neighborhood determinants of insomnia and their spatial distribution in Philadelphia. Interventions targeting the spatial distribution of adverse social determinants may improve insomnia disparities., Competing Interests: Declaration of conflicts of interest None., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

How does stigma influence the extent to which the child protection services in Russia undertake preventative work with vulnerable families in order to avoid taking the child out the family? Based on an analysis of previous research and my own fieldwork from St. Petersburg and Moscow, I note the gap between expectations towards vulnerable families, and their actual living conditions and potential for meeting these expectations. This gap results in a stigmatising categorisation of families who find themselves marginalised as neblagopolutsjnye – socially disadvantaged. Although Russia’s officially ‘family-oriented’ child protection system is expected to base its work on objective methods, stigmatisation influences the decisions of social workers, making the system risk-oriented in practice. This is due to little or inadequate specialised education among social workers, resulting in the strong presence of the human factor: subjective, non-professional evaluations are made. With scant intersectional cooperation among state actors, there is little space to counteract or modify subjective evaluations. Thus, stigmatisation serves to limit the extent to which vulnerable families in Russia receive help, thus creating and upholding ‘social orphanhood’.

Socially disadvantaged groups have to deal with diverse negative circumstances. We can expect that high status groups often legitimate and justify these disadvantages. However, when the low status group itself shares this perspective, it is more threatening: How do disadvantaged groups deal with social injustice when the ingroup itself frames it as deserved and legitimate? Previous studies have shown that under this circumstance, those individuals who highly identify with the ingroup reject the legitimacy norm and challenge their views instead by perceiving them as able to overcome and contest the disadvantage by collective means. In this work, we study the effect of a boundary condition, specifically the reliability of the norm of legitimacy. In one experimental study (n = 73), we expect high identifiers to contest the ingroup—as they frame their own disadvantage as legitimate—only if the reliability of the ingroup norm is weak, namely when a small (vs. large) ingroup sample supports it, as the chances to gather support amongst other ingroup members are better. However, when a large ingroup sample endorses the norm, high identifiers will accept this view, as the chances for success are low. We confirmed these hypotheses hinting that although high identifiers are expected to preserve ingroup interests, they might only do that when they can rely on ingroup support. This implies that, even though minorities are crucial to lead social change, the majority ingroup support is necessary in order to approach real changes.

BackgroundThe prevalent, neuropsychiatric, deficit perspective on children and youth diagnosed with ADHD prohibits a multidimensional approach where socio-economic status, family stress and relationships within the families are relevant factors to examine. Assessments of ADHD through the use of rating scales and short-term interventions may lead not only to overdiagnosis but also to a reductionistic approach in the psychiatric field. This literature review aims to address research outside the prevailing discourse on ADHD as an organic brain dysfunction and broaden the perspectives on children's behavioral difficulties.MethodsThe articles included in this applied, mixed-method, systematic review includes 26 peer-reviewed articles, both English and French, with a search focus on ADHD in children and youth related to Attachment styles and relationships.ResultsIn the studies reported, researchers approached correlations between ADHD and attachment in different ways, and in most cases, there was a caution to address causality. The role of parents was found to be both buffering and aggravating for the appearance of ADHD. In the French case studies, the diagnosis was conceptualized as a relational phenomenon where the child's behavior was inseparable from family member's suffering.DiscussionThis review article illustrates how children's difficulties in terms of ADHD symptoms can be addressed through a paradigm where emotional and cognitive dysregulation is understood through psychosocial factors rather than as a neurological condition. In our view, to avoid an overly reductionistic and medicalized approach to children's behavioral difficulties, it is time to reiterate the value of the biopsychosocial perspective.ConclusionProfessionals and researchers need to acknowledge that becoming diagnosed with ADHD has a strong connection to economic disadvantage, social status, and familial care. The academic discourse of addressing brain dysfunctions might serve the unintended purpose of masking emotional stress and social disadvantage that manifests across generations. A biopsychosocial approach to ADHD including family, emotional history, and socio-economic issues could imply a lesser focus on medical treatment as a first choice.

Transition to school may be experienced as a critical event for both children and their families. Within an ecological framework of transition, the scope of the concept of school readiness in recent years has decentered from the child to the environment, including the readiness of (pre)school education to develop core skills in children. This study aims to understand the extent to which preschool teachers' completion of training in the Incredible Years®-Teacher Classroom Management program (IY-TCM) during children's last preschool year has an impact when children transition to primary school, and how this contributes to reducing differences between children with and without economic disadvantage. Forty-four teachers from classes with a high percentage of students in economic disadvantage completed questionnaires about 192 five/six-year-old children. Results from cross-sectional analyses showed that children whose preschool teachers attended the IY-TCM program, when compared to children whose teachers did not, were significantly higher in social skills, adaptation to school and school achievement at the end of the first term, and had parents more involved in education but with a lower bonding with the teachers (medium to large effect sizes). Although not statistically significant (p =.08, Hedge's g =.29), results of longitudinal analyses are trending in the expected direction, suggesting that the IY- TCM could help to reduce socio-economic disparity. Results are discussed bearing in mind the importance of a preschool education that addresses the development of self-regulation and social skills in children, and the value of both initial and continuous training for preschool teachers. [ABSTRACT FROM AUTHOR]

Background: The relationship between social disadvantage and alcohol use disorder (AUD) among Asian American and Pacific Islander (AAPI) people is poorly understood. The study explores the patterns of social disadvantage and their associations with the AUD criteria in this population.Methods: This study used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III on AAPI people's (N = 1801) social disadvantage, adverse childhood experiences (ACEs), racial discrimination, and AUD. A three-step latent class analysis (LCA) using the Bolck, Croon, and Hagenaars (BCH) method was conducted to examine the heterogeneity within response patterns to items that describe social disadvantage among AAPI people. In addition, the relationship between classes and the AUD criteria was examined.Results: Three classes were identified: Class 1, labeled "High Adversity" (8.2%); Class 2, labeled "High Discrimination" (9.7%); and Class 3, labeled "Low Disadvantage" (82.2%). Results from the analyses of a multiple regression model suggest that Class 1 (High Adversity; B = 1.049, SE = 0.27, p < 0.001) is more susceptible to AUD compared to Class 3 (Low Disadvantage).Conclusions: The average number of AUD criteria among AAPI people who had experienced high levels of adversity was 2.2. Latent class models demonstrate how social disadvantage is distributed across classes and illustrate its associations with the AUD criteria. Tailored interventions for AAPI people are required. Further studies are also necessary to more effectively understand social disadvantage in AAPI populations. [ABSTRACT FROM AUTHOR]

• Busy schedules of parents are major barriers to timely childhood immunizations. • Long distances, transportation issues, and clinic hours exacerbate access issues. • Concerns about vaccines also play a major role in parents' decision making. • Parents want better access to vaccinations and reliable information about vaccines. Under-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. Fourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. Busy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. Implementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents. [ABSTRACT FROM AUTHOR]

Background: Many environmental factors are known to hinder breastfeeding, yet the role of the family living environment in this regard is still poorly understood.Objectives: We used data from a large cohort to identify associations between neighborhood characteristics and breastfeeding behavior.Methods: Our observational study included 11,038 children (0-2 years) from the Southwest Finland Birth Cohort. Participant information was obtained from the Medical Birth Register and municipal follow-up clinics. Neighborhood socioeconomic disadvantage, greenness, and population density were measured for a period of 5 years prior to childbirth within the residential neighborhood on a 250 × 250-m grid. Any breastfeeding and breastfeeding at 6 months were the primary outcomes. Binary logistic regression models were adjusted for maternal health and socioeconomic factors.Results: Adjusted analyses suggest that mothers living in less populated areas were less likely to display any breastfeeding (OR: 0.46; 95% CI: 0.36, 0.59) and breastfeeding at 6 months (OR: 0.37; 95% CI: 0.34, 0.40). Mothers living in highly disadvantaged neighborhoods were less likely to display any breastfeeding if the neighborhood was less populated (OR: 0.54; 95% CI: 0.30, 0.95) but more likely to breastfeed at 6 months if the neighborhood was highly populated (OR: 3.74; 95% CI: 1.92, 7.29). Low greenness was associated with higher likelihood of any breastfeeding (OR: 3.82; 95% CI: 1.53, 9.55) and breastfeeding at 6 months (OR: 4.41; 95% CI: 3.44, 5).Conclusions: Our results suggest that neighborhood characteristics are associated with breastfeeding behavior in Finland. Unravelling breastfeeding decisions linked to the living environment could help identify interventions that will allow the appropriate support for all mothers and infants across different environmental challenges. [ABSTRACT FROM AUTHOR]

Background: In Brazil, there are 55 million people living in extreme poverty. People with disabilities are doubly impacted by low income and the presence of the disability. The Continuous Cash Benefit Program (BPC) is an aid granted by the Brazilian federal government to people who attest to the condition of disability as an impediment to a life on an equal basis with other individuals. Requests to BPC are made to the national competence body that carries out an expert medical and social assessment, by means of an instrument that determines the degree of the disability. Our objective was to analyse the standard of BPC concessions for children and young people with disabilities and to identify the prevalence of major diseases in the concessions. Methods: The exploratory, cross‐sectional and retrospective research used primary data collected from 332 expert medical assessments of children under 16 years old. The standard and determinants of the concessions were established through Cluster Analysis by Ward's criterion and Euclidean distance, specifying the homogeneous groups of dysfunction classes. The prevalence of major diseases was performed by frequency analysis according to the International Classification of Diseases (ICD). The socioeconomic profile of BPC requirements and the main causes of BPC rejection were analysed through descriptive analysis. Results: There was a predominance of male, preschoolers and illiterate individuals in the requirements and concessions. In the granting standard for impaired function class, problems related to congenital changes received benefits even in the absence of impairment, with childhood autism being the most prevalent diagnosis. Conclusions: The concessions seemed more dependent on the diagnosis itself and on the age of the beneficiaries than on the degree of dysfunction suffered, without exclusions, by the individuals. [ABSTRACT FROM AUTHOR]

Fear of crime among older people has been a frequent topic in ageing research, criminology and urban studies. The 'environmental docility hypothesis' assumes that older people are more vulnerable to adverse neighbourhood conditions than younger age groups. Yet, few studies have tested this influential hypothesis using samples of respondents covering the complete adult lifespan. Looking at fear of crime, we investigated the person–environment interaction of age and neighbourhood disadvantage, using two independent surveys comprising 12,620 respondents aged 25–90 years residing in 435 neighbourhoods in four cities in Germany and Australia. We used multi-level analysis and cross-level interactions to model age-differential effects of neighbourhood disadvantage on fear. Contrary to the hypothesis, we found a weakening of neighbourhood effects on fear with age. The strong effect of neighbourhood disadvantage on fear of crime dropped by around half from the youngest (25 years) to the oldest age (90 years) in both countries. Younger people were almost as fearful as older people in the most disadvantaged neighbourhoods, but older people were considerably more fearful than younger ages in better-off neighbourhoods. We found limited empirical support for the assumption that this diminished association between neighbourhood disadvantage and fear can be explained by the stronger neighbourhood attachment of older people. The limitations of the analysis and potential future directions of research are discussed. [ABSTRACT FROM AUTHOR]

A good school start for children coming from socially disadvantaged backgrounds has been the subject of theoretical and empirical analysis for many years. With reference to developments in the concept of “school readiness,” this review-reflection article seeks to point out the potential that early intervention, incorporating educational and preventive and, in special cases, therapeutic measures, can have for children from at-risk backgrounds, their families and society, if it is referenced in concepts that provide it with a certain theoretical framework. The purpose of this research is to present three exemplary programmes -Sentinel pre-K (HighScope-Perry Preschool Study) [Ypsilanti, Michigan], Abecedarian Project [Chapel Hill, North Carolina], Child-Parent Centers [Chicago, Illinois] – that support children from socially disadvantaged backgrounds in achieving school readiness. The presentation of the programmes takes into account the results of longitudinal studies on the functioning of the children participating in them. It can be concluded from them that early intervention and the continuation of the measures taken at the stage of early childhood education can be important not only for the continued progressive functioning of individuals but also for the development of policies to support children and their families in a school start situation. It should be emphasised that the results of this research can also open up perspectives and areas of research measures to support children from socially disadvantaged backgrounds in crossing the school threshold that are implemented in Poland. [ABSTRACT FROM AUTHOR]

Community disadvantage and a person's residential geographical location are believed to be risk factors for crime. This research aimed to go beyond examining individual-level risk factors for reincarceration and explored the impact of community disadvantage and residential geographical location on Australia's Indigenous and non-Indigenous peoples' risk of reincarceration post-release. Descriptive analyses, logistic regression and Cox proportional hazards models were conducted using survey and linked administrative data for 1238 prisoners. We found no relationship between residential geographical location and reincarceration for either Indigenous or non-Indigenous people. Moreover, no relationship between community disadvantage and reincarceration was found for non-Indigenous people, however, results indicated community disadvantage to be a protective factor for Indigenous people. Potential explanation. [ABSTRACT FROM AUTHOR]

The pilot study precedes a broader research aimed at identifying the effects on parenting and development of children between 0 and 3 years old (REC 2013/112 / EU), of an Italian policy against poverty. The goal is to describe the effects of introducing a specific parenting assessment tool (Roggman et al., 2013), in a participatory key, on socio-educational practices with vulnerable families with children aged 0 to 3. The results were obtained through semi-structured interviews with 19 professionals involved in a research-training-action experience. They indicate an improvement in observation skills and — the most significant — the creation of a new space for dialogue and reflection on parenting and children development. This latter reveals to be a scarcely addressed area in the context of policy interventions against poverty. Pedagogical, methodological and communicative challenges that emerge from the results are discussed.

Abstract Background Researching access to health services, and ways to improve equity, frequently requires researchers to recruit people facing social disadvantage. Recruitment can be challenging, and there is limited high quality evidence to guide researchers. This paper describes experiences of recruiting 1068 participants facing social disadvantage for a randomised controlled trial of prescription charges, and provides evidence on the advantages and disadvantages of recruitment methods. Methods Those living in areas of higher social deprivation, taking medicines for diabetes, taking anti-psychotic medicines, or with COPD were eligible to participate in the study. Several strategies were trialled to meet recruitment targets. We initially attempted to recruit participants in person, and then switched to a phone-based system, eventually utilising a market research company to deal with incoming calls. We used a range of strategies to publicise the study, including pamphlets in pharmacies and medical centres, media (especially local newspapers) and social media. Results Enrolling people on the phone was cheaper on average than recruiting in person, but as we refined our approach over time, the cost of the latter dropped significantly. In person recruitment had many advantages, such as enhancing our understanding of potential participants’ concerns. Forty-nine percent of our participants are Māori, which we attribute to having Māori researchers on the team, recruiting in areas of high Māori population, team members’ existing links with Māori health providers, and engaging and working with Māori providers. Conclusions Recruiting people facing social disadvantage requires careful planning and flexible recruitment strategies. Support from organisations trusted by potential participants is essential. Registration The Free Meds study is registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12618001486213 ).

PurposeEpilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population.MethodsThis prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods (“SI district” and “SI neighborhood”) of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles.ResultsBoth indicators of structural SES were independently linked to stigma (p = 0.002). For “SI district”, we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second (p < 0.001) or least deprived quartile (p = 0.009). Furthermore, more restrictions of daily life (p < 0.001), unfavorable income (p = 0.009) and seizure freedom in the past 6 months (p = 0.05) were related to increased stigma. A lower “SI neighborhood” was associated with higher stigma (p = 0.002).ConclusionStrategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.

The paper focuses on the issues of merit, explored in its complex polysemy, meritocracy, and skills, placing them in relation to those of – educational, social, economic, cultural – poverty and social disadvantage, which afflict, with considerable aggravation especially in the era of Sars-Cov-2 pandemic, even Italy. The essay consists of three paragraphs. In the first two, a reference framework is outlined, on the one hand relating to the polysemic concepts of merit, and meritocracy; on the other, to the situation of poverty and social inequalities in Italy. The third paragraph, which represents the heart of the paper, is linked to the abovementioned frameworks: it highlights the key role that a widespread, accessible, and high-quality Early Childhood Education and Care (ECEC) play, both in supporting children’s development, both promoting a democratic and inclusive society; a society characterized by effective “merit dynamics”, open to all, so as to promote skills development and, above all, social ascent and redemption.

Background: The COVID-19 pandemic has had mental health, social, and economic implications among communities with high levels of social disadvantage; this may have impacted community violence rates. The objective of this study was to characterize overall trends in assault and social disadvantage of patients experiencing assault before and during the COVID-19 pandemic. Methods: All trauma activations at a level one trauma center serving the entire southeast Louisiana region were included during March–August pre-COVID (2018–2019) and during COVID (2020). ICD-10 E-codes were used to identify trauma intent (assault vs. other). Assaults in this context are defined as physical injuries caused by an act of violence wherein the perpetrator was suspected or confirmed to have intended harm, injury, or death to the victim. Social disadvantage was assessed using the Area Deprivation Index (ADI). Change in the monthly rate of assault-trauma activations was assessed using negative binomial regression with adjustment for race, gender, and injury intent. The study was reviewed and approved by the Louisiana State University Health Sciences Institutional Review Board. Results: A total of 4,233 trauma activations were included. The majority of activations occurred among men. Assaults increased from 27.5% of all activations pre-Covid to 35.6% during the pandemic. Penetrating trauma similarly increased from 29.5% to 35.7% of all activations. Negative binomial regression demonstrated that in addition to this increase in proportion of assaults relative to all activations, the monthly assault rate also increased by 20% during the pandemic. These increases were driven primarily by increased assaults among Black men. ADI rank did not change between study periods. Conclusions: Health disparities in violence worsened during the pandemic: increased cases of assault occurred disproportionately among Black men, and assaults persisted in occurring primarily among low-ADI communities where burden had been high pre-pandemic. There is a critical need for resources and support to Black men, to mitigate violence and improve racial heath equity.

Introduction: Adverse childhood experiences (ACEs) can negatively affect children's current and future health. Objectives: This study aims to analyse the impact of ACE on the health of 12‐month‐old infants assessed by a Physical Health and Maternal Care Indicator (ISCM). Methods: We conducted a retrospective cohort including 170 infants born in two public services for high‐risk births in Brazil. ISCM gathers information that reflects maternal care and the child's health throughout the first year of life, such as vaccination, nutrition, growth, illnesses and accidents. The ACE impact on ISCM was analysed by multiple linear regression, and the d‐Cohen test estimated its effect size. Spearman's correlation was used to analyse the cumulative ACE effect, measured by a score reflecting events such as family dysfunction, maternal mental health, poverty and exposure to violence. Results: Most infants were born prematurely (71.7%), had low birthweight (64.7%) and were exposed to three ACEs on average. The ISCM was lower in children exposed to maternal depression (P < 0.001, d‐Cohen = 0.08), substance abuse by family members (P = 0.02, d‐Cohen = 0.6) and marital conflicts (P = 0.03, d‐Cohen = 0.7). The Spearman's correlation showed that the greater the exposure to ACEs, the lower the ISCM (r = −0.40, P < 0.0001). Conclusion: Exposure to ACE, especially in the family environment, had negative effect on maternal care and child health. The impact could be detected in the first year of life and had cumulative effect. Our findings indicate the need for a broader approach to child health to minimize ACE's impacts. [ABSTRACT FROM AUTHOR]