Examining the stability of emotional regulation and psychological distress for low-income individuals: A latent transition analysis.

Previous relationship education research has focused on investigating healthy relationships at the couple level, with limited research conducted on individual-oriented relationship education programs for economically disadvantaged individuals. More specifically, there is a lack of research on how individual-oriented relationship education programs contribute to changes in unique attributes of individuals who enroll in these programs and who would benefit most from relationship education programs. The primary aim of this study is to understand the stability of economically disadvantaged individuals' psychological distress and emotion regulation over two time points, comparing individuals randomly assigned to the relationship intervention using Prevention and Relationship Education's (PREP) Within My Reach (WMR) versus those assigned to a wait-list control. Using a sample of 1129 economically disadvantaged individuals enrolled in the study, results indicated that the three-class model for psychological distress and emotion regulation was the most appropriate for the latent transition analysis. Treatment group participants were more likely to transition to more adaptive models than their wait-list control counterparts, although a small percentage of participants did transition to a less adaptive model. Implications, future directions, and limitations are discussed.

Leveraging MOOCs for learners in economically disadvantaged regions.

While Massive Online Open Courses (MOOCs) have seen a surge in enrollments in higher education around the world especially during the Covid-19 pandemic, it is unclear if learners from the economically disadvantaged regions (EDR) are also able to capitalize on them. Specifically, challenges related to using MOOCs in these regions have been reported in the literature. Thus, the objective of this paper is to address the pedagogical challenge by investigating approaches to leverage MOOCs for learners in EDR. Drawing from the ARCS (i.e. Attention, Relevance, Confidence and Satisfaction) model, we proposed an embedded MOOCs approach where bite-sized MOOCs segments are integrated into in-class lectures under the guidance of the instructors. The effectiveness of the embedded MOOCs approach was evaluated and compared with other instructional methods. Results from randomized experiments showed that the embedded MOOCs approach had higher evaluations in terms of attention, relevance and satisfaction than face-to-face learning approach. In addition, the embedded MOOCs approach outperformed asynchronously blended MOOCs in enhancing students' relevance perception. Regression analysis further revealed that attention, confidence, and satisfaction perceptions were positively associated with students' intention to adopt the embedded MOOCs approach in their future studies. The findings shed light on how to utilize MOOCs and re-use content in MOOCs for global benefits and enable new pedagogical developments. The findings also underscore the importance of local social support and offline interactions to support the online learning materials.

Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies.

OBJECTIVE: To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme. DESIGN: A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health. SETTING: Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1). PARTICIPANTS: Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings. RESULTS: Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings. CONCLUSIONS: There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

A randomized trial of relationship education using Within Our Reach for economically vulnerable couples.

Couples relationship education is grounded in teaching couples' skills and strategies to form and sustain healthy relationships. The purpose of this investigation was to examine the impact of a relationship education intervention on emotion regulation, individual distress, dyadic coping, and relationship adjustment utilizing a randomized control trial for economically vulnerable couples. The analysis sample included 1418 couples (2836 individuals) who were randomly assigned to receive the 12-h Within Our Reach curriculum immediately, or to a wait-list control group. We estimated multilevel growth curve models over time among outcomes between treatment and wait-list control conditions. Treatment group couples demonstrated statistically significant improvements over the 6-month study period on emotional regulation and dyadic coping when compared to their wait-list group counterparts. Although models showed improvements in individual distress and relationship adjustments, these improvements did not amount to statistically significant group differences. Implications and limitations are also noted.

Clinical trial recruitment of adult African American smokers from economically disadvantaged urban communities.

This investigation evaluated the effectiveness and challenges of multiple recruitment methods, described as proactive, reactive, and combination methods, among adult African American smokers (N = 527) from economically disadvantaged urban communities enrolled to test progressively reduced nicotine content investigational cigarettes. The study evaluated success using descriptive statistics to measure the volume of phone calls and percentage of eligible participants per method. Reactive and combination strategies effectively prompted participants to call about the study. Combination methods yielded the highest eligibility rates. Findings demonstrate the unique recruitment successes within this population across a range of recruitment methods and may inform improved methods to recruit and engage African Americans in clinical trials.

Assessing the community-level impact of a decade of user fee policy shifts on health facility deliveries in Kenya, 2003-2014.

BACKGROUND: The long-term impact of user fee removal policies on health service utilization in low- and middle-income countries may vary depending on the context in which they are implemented, including whether there are policy actions to support implementation. We examined the community-level impact of a decade of user fee policy shifts on health facility delivery among poorest and rural women and compared the changes with those among the richest and urban women in Kenya using data from three rounds of nationally representative surveys. METHODS: Data are from births occurring in the 5 years preceding the survey to women aged 15-49 years who were interviewed in the 2003, 2008-2009 and 2014 Kenya Demographic and Health Surveys. A total of 5949, 6079 and 20,964 births were reported in respective surveys. We conducted interrupted time series analysis predicting changes in quarterly proportions of births occurring in public and private health facilities as well as at home before and after the 2004, 2007 and 2013 user fee policy shifts in Kenya. RESULTS: There were no statistically significant immediate changes in the proportion of births occurring in public facilities following the 2004, 2007 and 2013 user fee policy shifts among poor or rural women. There was, however, a statistically significant increase in home deliveries among all women and among those from the poorest households immediately following the 2004 policy. There was also a statistically significant increase in public facility deliveries among women from the two top quintiles, which was accompanied by a statistically decline in home deliveries immediately after the 2007 policy shift. Differences in trends in public facility deliveries between pre- and post-policy periods were not statistically significant for all sub-groups of women, indicating that even among the sub-group that experienced significant immediate increase after the 2007 policy shift, this pattern was not sustained over time. CONCLUSION: The findings of this paper provide empirical evidence that poorly implemented user fee removal policies benefit more well-off than poor women and in cases where there are significant immediate effects on uptake of facility delivery, this trend is not sustained over time.

Participants at Norwegian Healthy Life Centres: Who are they, why do they attend and how are they motivated? A cross-sectional study.

AIMS: We examine the characteristics of participants entering Norwegian Healthy Life Centres, their reasons for attending and whether socio-economic status, motivation, self-efficacy and social support relate to physical activity and sedentary behaviour. METHODS: This cross-sectional study is part of a randomised controlled trial. Inclusion criteria are that participants should be ≥ 18 years old and able to take part in a physical activity group intervention. Exclusion criteria are severe mental illness and general learning disability. We analysed data using simple and multiple linear regression analyses. RESULTS: We recruited 118 participants from eight Norwegian municipalities between June 2014 and September 2015. Of these, 77% were female, mean (standard deviation) age 48.6 (13.4) years, body mass index 34.0 (5.8) kg/m2 and mean gross family income €61,000. The proportion of participants with upper-secondary school or less as their highest level of education was 55%. The most frequent reasons given for attendance at Healthy Life Centres were being overweight, increasing physical activity, improving diet and having musculoskeletal health challenges. Participants had high levels of autonomous motivation and 79% achieved national recommendations for physical activity. Respect and appreciation in childhood, self-esteem and self-rated health were associated with self-efficacy and social support for physical activity. CONCLUSIONS: Participants were predominantly obese, physically active, female and motivated for change. A high proportion had low educational attainment and low incomes. The trial will reveal whether interventions succeed in increasing physical activity further, or in decreasing sedentary behaviour, and whether health inequalities narrow or widen across groups.

Dual trajectories of breakfast eating and fruit and vegetable intake over a 5-year follow-up period among economically disadvantaged children: Gender differences.

Breakfast eating (BE) seems to be cross-sectionally associated with fruit and vegetable intake (FVI). To date, gender differences in any codevelopment between BE and FVI, as well as their associated factors, have not been examined. The objectives of this study were (1) to identify dual trajectories of BE and FVI among economically disadvantaged boys and girls; and (2) to examine potential associated factors of identified dual trajectories by gender. Children from economically disadvantaged families were enrolled in this prospective multicity study of the Taiwan Database of Children and Youth in Poverty between July 6 and October 31, 2009 and followed up biannually (2009, 2011, and 2013). One thousand one children (50.2% girls, mean ages at each time point being 9.1, 11.2 and 13.1 years, respectively; 49.8% boys, 9.0, 11.0 and 13.0 years) who completed at least two of the three assessments were included. Dual trajectories of BE and FVI over a 5-year follow-up period were identified as the outcome variables of interest by using mainly group-based dual trajectory modeling. Nine potential associated factors were then examined using logistic regression models. Two distinct dual trajectories of BE and FVI were identified among the girls: longitudinally irregular (68.8%) and shift to irregular (31.2%). Two distinct dual trajectories of BE and FVI were identified among the boys: longitudinally irregular (90.2%) and consistently regular (9.8%). Age was the significantly associated factor for boys. The findings confirmed a heterogeneous codevelopment between BE and FVI that may indicate different underlying mechanisms. Most children with a longitudinally irregular BE pattern had a similar pattern of FVI. Future research should comprehensively explore the gender differences in the determinants of codevelopment between BE and FVI.

The effect of lower socioeconomic status insurance on outcomes after primary shoulder arthroplasty.

BACKGROUND: Patient-reported outcomes (PROs) are becoming increasingly important to define successful outcomes. With the potential transition toward quality-based reimbursement, identifying risk factors for poor surgical outcomes becomes increasingly important. This study compared functional and PROs of primary shoulder arthroplasty in patients aged younger than 65 years with lower socioeconomic insurance compared with those with private insurance. METHODS: A retrospective review of all primary shoulder arthroplasties in patients aged younger than 65 was performed at a single institution. Patients were stratified according to insurance type (private vs. Medicare/Medicaid) with 2-year minimum follow-up. Preoperative, postoperative, and improvements in range of motion, visual analog scale (VAS) pain, and PROs were compared. RESULTS: We evaluated 143 shoulders (64 Medicare/Medicaid, 79 private insurance). Age, race, diagnosis, and type of arthroplasty were similar between groups. Patients with Medicare/Medicaid insurance demonstrated worse PROs before and after surgery, despite similar range of motion at both assessments. Despite poorer PROs postoperatively, both groups demonstrated similar improvements after surgery. Complications and reoperation were more common in the socioeconomically disadvantaged group (14% vs. 9%, P = .3; 11% vs. 6%, P = .2, respectively). DISCUSSION: Medicaid and Medicare patients aged younger than 65 years undergoing shoulder arthroplasty demonstrate poorer preoperative and postoperative PRO measures compared with similar patients with private insurance. However, both groups demonstrate similar improvements in scores from baseline.

Total Joint Arthroplasty: A Granular Analysis of Outcomes in the Economically Disadvantaged Patient.

BACKGROUND: Poor patients experience more serious complications and worse outcomes after surgery than higher-income patients. Our objective was to study detailed patient sociodemographic characteristics and preoperative/postoperative patient-oriented outcomes in economically disadvantaged and non-economically disadvantaged primary total joint arthroplasty patients. METHODS: From a consecutive series, 213 economically disadvantaged patients and 1940 non-economically-disadvantaged patients were statistically analyzed. Baseline sociodemographic characteristics and pain visual analog scale, Quality of Well-Being Index 7, Short Form 36, and Western Ontario and McMaster Universities Arthritis Index scores recorded before and after surgery were compared between both groups controlling for baseline differences. Minimum follow-up was 1 year. RESULTS: Economically disadvantaged patients were significantly younger, more likely to be disabled, and had worse preoperative and postoperative scores. CONCLUSION: When compared with non-economically disadvantaged patients, economically disadvantaged patients consistently had lower function and worse quality of life before and after total joint arthroplasty.

Cancer diagnosed in the Emergency Department of a Regional Health Service.

OBJECTIVE: Patients diagnosed with cancer in the Emergency Department (ED) have more advanced disease at diagnosis and poorer outcomes. High rates of initial presentation to ED suggest potential problems with access to care. The aim of this project was to interpret findings in regional/rural Victoria and explore implications for practice. DESIGN: Cross-sectional study linking two independent data sets. SETTING: Regional city of Geelong and surrounding rural areas in south-west Victoria. PARTICIPANTS: All newly diagnosed cancer patients in 2009. MAIN OUTCOME MEASURES: Number of cancer patients diagnosed in the ED. RESULTS: One in five newly diagnosed cancer patients present to ED 6 months prior to cancer diagnosis. One in 10 is diagnosed as a result of their ED visit. Patients presenting to ED were older, more often men and from disadvantaged areas. Symptoms on presentation included chest complaints, bowel obstruction, abdominal pain, anaemia and generalised weakness. Cancer diagnosed in the ED is associated with advanced stage and shorter survival. CONCLUSION: Reasons for presentation to ED would be multifactorial and include complex cases with coexisting symptoms making diagnosis difficult. The general public appear to have a low level of awareness of alternative primary care services or difficulty accessing such information. Some of the changes towards reducing the number of patients presenting to ED will include patient education.

"It Really Takes a Village": A Socio-Ecological Model of Resilience for Prevention Among Economically Disadvantaged Ethnic Minority Youth.

Promoting resilience prevents maladaptation among economically disadvantaged ethnic minority (EDEM) youth. EDEM youth need access to a variety of assets and promotive factors (i.e., resources) in the family, school, and community system to counter risks and promote positive adaptation. However, the field lacks a socio-ecological model of resilience for prevention targeted towards EDEM youth. We aim to review assets and promotive factors in the family, school, and community systems to present a socio-ecological model of resilience for the prevention of negative educational and health outcomes among EDEM youth. We reorient the social ecologies of EDEM youth from "at risk" to "at promise" focusing on family and community-centered prevention models. We discuss implications for the design of prevention strategies as well as their implementation and methodological challenges.

Beliefs and Motivations Regarding Early Shared Reading of Parents From Low-Income Households: A Qualitative Study.

OBJECTIVE: Parent-child "shared" reading is a catalyst for development of language and other emergent literacy skills. The American Academy of Pediatrics recommends that parents initiate shared reading as soon as possible after birth. Persistent disparities exist in reading resources, routines, and subsequent literacy outcomes, disproportionately impacting low-income households. We sought to understand beliefs, motivations, and experiences regarding shared reading during early infancy among parents from low-income households. METHODS: In this qualitative exploratory study, parents of infants aged 0 to 9 months from low-income households who had initiated shared reading ("readers") and those who had not ("nonreaders") were purposefully recruited to participate in individual semistructured virtual interviews. These interviews were coded using inductive thematic analysis by a 3-member team with diverse backgrounds. RESULTS: A total of 21 parents participated (57% readers, 86% mothers). Infants were 86% African American/Black, with a mean age of 3 months. Barriers noted by readers and nonreaders were i) competing demands on time, ii) lack of resources, and iii) parental mental health. An additional barrier noted solely by nonreaders was iv) it's too early/baby is not ready. Two benefits of reading were noted by both groups: 1) parents as child's first teachers and 2) reading catalyzes the child's development. Benefits noted exclusively by readers included 3) reading begets more reading, 4) bonding, 5) "it works," and 6) "two-for-one" shared reading (other children involved). CONCLUSIONS: This study provided insights into barriers and benefits regarding shared reading by socioeconomically disadvantaged parents of infants and has the potential to inform reading-related guidance and interventions.

The Effect of Social Support on Depression among Economically Disadvantaged College Students: The Mediating Role of Psychological Resilience and the Moderating Role of Geography.

The study examined the influence of social support on depression, including the mediating role of psychological resilience and the moderating role of geography. Questionnaires were completed by 424 economically disadvantaged college students in two provinces, X, a coastal province, and Y, an inland province. The results indicated that (1) the social support of economically disadvantaged college students was positively correlated to psychological resilience (ß = 0.62, t = 11.22, p < 0.001); (2) the psychological resilience of economically disadvantaged college students was negatively correlated with depression (ß = -0.24, t = -10.3, p < 0.001); (3) the social support of economically disadvantaged college students was negatively correlated with depression (ß = -0.08, t = -2.85, p < 0.001); (4) the psychological resilience of economically disadvantaged college students played a partial mediating role between social support and depression; and (5) geography played a moderating role in the effect of social support on depression.

Promoting hope in minoritized and economically disadvantaged students.

Minoritized and economically disadvantaged (MED) students encounter a host of detrimental factors within the academic setting (e.g., racism, classism, low expectations). In order for them to be successful, ways must be found to help them achieve academically despite their disadvantageous academic environments. Recent research indicates that hope theory might provide a pathway for MED students to have a higher chance at success. In this review, how hope has the potential to take on a special significance for MED students as well as how it can be leveraged to increase their odd of academic and life success is discussed. In addition, recent research centered around promoting hope in MED students, both formally and informally, is reviewed. Altogether, this review has implications for cultivating hope in schools.

Children with uncontrolled asthma from economically disadvantaged neighborhoods: Needs assessment and the development of a school-based telehealth and electronic inhaler monitoring system.

BACKGROUND: Children from economically disadvantaged communities often encounter healthcare access barriers, increasing risk for poorly controlled asthma and subsequent healthcare utilization. This highlights the need to identify novel intervention strategies for these families. OBJECTIVE: To better understand the needs and treatment preferences for asthma management in children from economically disadvantaged communities and to develop a novel asthma management intervention based on an initial needs assessment and stakeholder feedback. METHODS: Semistructured interviews and focus groups were conducted with 19 children (10-17 years old) with uncontrolled asthma and their caregivers, 14 school nurses, 8 primary care physicians, and three school resource coordinators from economically disadvantaged communities. Interviews and focus groups were audio-taped and transcribed verbatim and then analyzed thematically to inform intervention development. Using stakeholder input, an intervention was developed for children with uncontrolled asthma and presented to participants for feedback to fully develop a novel intervention. RESULTS: The needs assessment resulted in five themes: (1) barriers to quality asthma care, (2) poor communication across care providers, (3) problems identifying and managing symptoms and triggers among families, (4) difficulties with adherence, and (5) stigma. A proposed video-based telehealth intervention was proposed to stakeholders who provided favorable and informative feedback for the final development of the intervention for children with uncontrolled asthma. CONCLUSIONS: Stakeholder input and feedback provided information critical to the development of a multicomponent (medical and behavioral) intervention in a school setting that uses technology to facilitate care, collaboration, and communication among key stakeholders to improve asthma management for children from economically disadvantaged neighborhoods.

Exposures to volatile organic compounds (VOCs) and associated health risks of socio-economically disadvantaged population in a "hot spot" in Camden, New Jersey.

To address disparities in health risks associated with ambient air pollution for racial/ethnic minority groups, this study characterized personal and ambient concentrations of volatile organic compounds (VOCs) in a suspected hot spot of air pollution - the Village of Waterfront South (WFS), and an urban reference community - the Copewood/Davis Streets (CDS) neighborhood in Camden, New Jersey. Both are minority-dominant, impoverished communities. We collected 24-h integrated personal air samples from 54 WFS residents and 53 CDS residents, with one sample on a weekday and one on a weekend day during the summer and winter seasons of 2004-2006. Ambient air samples from the center of each community were also collected simultaneously during personal air sampling. Toluene, ethylbenzene, and xylenes (TEX) presented higher (p < 0.05) ambient levels in WFS than in CDS, particularly during weekdays. A stronger association between personal and ambient concentrations of MTBE and TEX was found in WFS than in CDS. Fourteen to forty-two percent of the variation in personal MTBE, hexane, benzene, and TEX was explained by local outdoor air pollution. These observations indicated that local sources impacted the community air pollution and personal exposure in WFS. The estimated cancer risks resulting from two locally emitted VOCs, benzene and ethylbenzene, and non-cancer neurological and respiratory effects resulting from hexane, benzene, toluene, and xylenes exceeded the US EPA risk benchmarks in both communities. These findings emphasized the need to address disparity in health risks associated with ambient air pollution for the socio-economically disadvantaged groups. This study also demonstrated that air pollution hot spots similar to WFS can provide robust setting to investigate health effects of ambient air pollution.

Parental Attributions-Mothers' Voices in Economically and Socially Disadvantaged Contexts.

In the present study, the attributions of socially and economically disadvantaged mothers for their own negative parenting behavior and for their children's undesirable behaviors as perceived by parents-understood as misbehavior-were analyzed. To this end, an exploratory study with a qualitative design was developed, in which 24 socially and economically disadvantaged mothers were individually interviewed. The data were analyzed following a thematic analysis approach, using software suited to qualitative analysis, namely NVIVO 12. The children's undesirable behaviors as perceived by parents and some characteristics associated with parental performance (particularly the appraisal of the effectiveness of their negative practices) emerged respectively as external and internal factors, explaining mothers' inadaptive behaviors-difficulties in behavior regulation, physical coercion, psychological control and paraverbal hostility. The parental subsystem and school emerged as the main external factors, and the psychological characteristics as the most relevant internal factors, explaining the children's undesirable behaviors-challenge, immaturity, hostility, emotionally-based, school behavior/absenteeism and danger. The results also indicate weak self-critical reflexivity regarding some of the inadaptive behaviors. The comprehensive analysis of the results, based on the literature review, gave rise to an explanatory hypothesis on the dysfunctional circular process regarding the maintenance of inadaptive practices and children's undesirable behaviors, considering the role played by parental attributions and by insufficient parental reflexivity.

Thromboembolic Events in a Socio-Economically Disadvantaged Population with COVID-19 Admitted to a Medicalized Hotel in Madrid.

Background: The social determinants of health (SDOH) of patients with COVID-19-related thrombosis have been scarcely explored. Our objective was to investigate the cases of thrombosis in a group of socially disadvantaged populations with COVID-19. Methods: We investigated the thrombotic events that occurred in a cohort of migrant and Spanish patients with COVID-19 that were admitted to a medicalized hotel in Madrid. Demographic data, past medical history, and socio-economic backgrounds, such as monthly household income, level of education, and living conditions, were explored to determine the factors related to thrombosis. Results: A cohort of 383 subjects (mean age 55.4 ± 14.6 years old, 69% male), of which 58% were migrants, was studied. Fourteen (3.6%) cases of thrombosis were reported. Thrombosis was more frequent in Spanish than in migrant individuals (OR 5.3, 95%CI 1.4-19.5, p = 0.005). Neither a low monthly household income nor a low education level showed a statistical association with thrombosis (p ≥ 0.05). History of venous thromboembolism (OR 8.1, 95%CI 2.2-28.6) and being a current smoker (OR 4.7, 95%CI 1.3-16.0) were factors associated with thrombosis. Conclusions: The SDOH studied were not associated with thrombosis; however, further investigation must be performed to investigate the socio-economic conditions of subjects with COVID-19 with adverse outcomes such as thrombotic events.

Exploratory Mixed-Methods Study of a Primary Care-Based Intervention Promoting Shared Reading During Infancy.

Parent-child "shared" reading can be a rich source of language exposure. Clinic-based programs, notably Reach Out and Read (ROR), are intended to enhance this. However, ROR has been traditionally introduced at 6 months and only recently expanded to younger ages. This study explored efficacy of an intervention delivered during pediatric well visits promoting shared reading prior to 6 months old, in terms of home reading attitudes and routines. The intervention group received children's books and anticipatory guidance about benefits of shared reading, whereas the control group received general age-related anticipatory guidance. Surveys were administered at the child's newborn (pre-intervention) and 6-month (post-intervention) well visits. Significant findings at 6 months included more frequent shared reading (P = .03), greater comfort reading at this age (P = .01), and greater importance attributed to shared reading (P = .04) in the intervention group relative to controls. These support the expansion of early literacy interventions such as ROR into early infancy.