Perceived familial financial insecurity and obesity among Korean adolescents during the COVID-19 pandemic.

BACKGROUND: In high-income countries, socioeconomically disadvantaged adolescents experience a higher risk of obesity, which may have been further exacerbated during the early phase of the COVID-19 pandemic. This study aimed to investigate the association between obesity and familial financial insecurity, utilizing data on subjective household socioeconomic status (SES) and perceived family-level financial deterioration induced by COVID-19. METHODS: We utilized data from the Korea Youth Risk Behavior Survey, a nationally representative sample of Korean adolescents, in 2020 and 2021. The independent and joint associations of two primary exposures, subjective household SES and perceived family-level financial deterioration, with obesity were assessed using multivariable logistic regression models. RESULTS: Among 106,979 adolescents aged 12-18 years, 16.9% of boys and 9.0% of girls met the criteria for obesity. Notably, 70.5% reported experiencing COVID-19-related financial deterioration. Both subjective household SES and perceived family-level financial deterioration independently and synergistically increased the odds of obesity. A graded association was observed between obesity and lower SES and more severe financial deterioration, particularly among girls. Younger adolescents were more sensitive to household SES, whereas older adolescents were more sensitive to financial deterioration. CONCLUSIONS: While the COVID-19 pandemic presented a unique social context, our findings highlight that financially insecure adolescents were at an increased risk of obesity during the early phase of the pandemic. This underscores the need for obesity-prevention strategies in times of macroeconomic recession to address not only the persistent influence of household SES but also the direct and indirect effects of family-level financial deterioration.

Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study.

BACKGROUND: Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants. METHODS: An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice. RESULTS: Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data. CONCLUSIONS: This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.

Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya: A Longitudinal Qualitative Investigation.

Exclusive breastfeeding for the first 6 months and continued breastfeeding for 24 months or longer is recommended for all mothers world-wide, including women living with HIV (WLWH). Given evidence of suboptimal infant feeding and the need to understand context specific barriers, we explored experiences of perinatal WLWH in Kisumu, Kenya. We applied a longitudinal qualitative approach (4 in-depth interviews) with 30 women from pregnancy to 14-18 months postpartum. Cross-sectional profiling led to a narrative description of infant feeding across time. The majority of women breastfed exclusively for 6 months and weaned by 18 months. Severe financial and food insecurity were primary challenges as women worked through when/how to breastfeed or stop breastfeeding in the setting of multiple competing priorities/pressures across time. Financial and food support and increased support for breastfeeding beyond 18 months have the potential to reduce women's stress and uncertainty associated with infant feeding as well as optimize infant health and nutrition in this setting.

RESUMEN: Se recomienda la lactancia materna exclusiva durante los primeros 6 meses y la continuación de la lactancia durante 24 meses o más para todas las madres en todo el mundo, incluidas las mujeres que viven con el VIH (WLWH). Debido a la evidencia de alimentación infantil subóptima y la necesidad de comprender las barreras específicas del contexto, exploramos las experiencias de WLWH perinatal en Kisumu, Kenia. Aplicamos un enfoque cualitativo longitudinal (4 entrevistas en profundidad) con 30 mujeres desde el embarazo hasta los 14-18 meses posparto. El perfil transversal resultó en una descripción narrativa de la alimentación infantil a través del tiempo. La mayoría de las mujeres amamantaron exclusivamente durante 6 meses y dejó de amamantar a los 18 meses. La grave inseguridad financiera y alimentaria fueron los principales desafíos cuando las mujeres analizaban cuándo y cómo amamantar o dejar de amamantar en el contexto de múltiples prioridades y presiones en competencia a través del tiempo. El apoyo financiero y alimentario y un mayor apoyo para la lactancia más allá de los 18 meses tienen el potencial de reducir el estrés y la incertidumbre de las mujeres asociados con la alimentación infantil, así como optimizar la salud y la nutrición infantil en este entorno.

"'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting.

BACKGROUND: Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS: Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS: Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION: Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.

Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices.

OBJECTIVES: This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression. METHODS: Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples. RESULTS: Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders. CONCLUSION: This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.

Family Well-Being During the COVID-19 Pandemic: The Risks of Financial Insecurity and Coping.

During the COVID-19 pandemic, families have experienced unprecedented financial and social disruptions. We studied the impact of preexisting psychosocial factors and pandemic-related financial and social disruptions in relation to family well-being among N = 4091 adolescents and parents during early summer 2020, participating in the Adolescent Brain Cognitive DevelopmentSM Study. Poorer family well-being was linked to prepandemic psychosocial and financial adversity and was associated with pandemic-related material hardship and social disruptions to routines. Parental alcohol use increased risk for worsening of family relationships, while a greater endorsement of coping strategies was mainly associated with overall better family well-being. Financial and mental health support may be critical for family well-being during and after a widespread crisis, such as the COVID-19 pandemic.

Longitudinal associations between the quality of family interactions and school-age children's narrative abilities in the context of financial insecurity.

This longitudinal study investigates whether the quality of family interactions at 3-5 years of age predicts narrative abilities in 7-9-year-old children from socioeconomically disadvantaged families. The sample consists of 67 children and their parents receiving social welfare. Family interactions were filmed during mealtime at home and coded using the Mealtime Interaction Coding System. Children's narrative abilities were measured based on their capacity to coherently elaborate and resolve stories from the Attachment Story Completion Task. Results revealed that children exposed to family interactions of higher quality make their narratives more accessible and understandable and include more appropriate expression of affects in their stories 4 years later, even after accounting for maternal education and verbal abilities. The results of this study highlight the importance of considering family interactions in the context of financial insecurity when studying socioemotional competence in childhood.

"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV.

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Perinatal health care access, childbirth concerns, and birthing decision-making among pregnant people in California during COVID-19.

BACKGROUND: During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care. METHODS: We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a 'non-surge' wave (June 2020, n = 433), and (2) during a 'surge' in cases (December 2020, n = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities - including acute financial insecurity and racial/ethnic minoritization - are associated with access, concerns, and decision-making over these two waves. RESULTS: Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020-2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 'lull' in the summer of 2020. However, across 'surge' and 'non-surge' pandemic circumstances, marginalized pregnant people continued to fare worse - especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous. CONCLUSIONS: It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California.

COVID-19 restrictions and mental distress among American adults: evidence from Corona Impact Survey (W1 and W2).

BACKGROUND: The present study examines the impact of coronavirus-related restrictions on mental health among American adults, and how this relationship varies as a function of time and two measures of vulnerability (preexisting physical symptoms and job insecurity). METHODS: We draw on data from two waves of Corona Impact Survey, which were fielded in late April and early of May 2020. Multilevel models were used to analyze the hierarchically nested data. RESULTS: Experiencing coronavirus disease-2019 restrictions significantly raise mental distress. This association is stronger for individuals with preexisting health conditions and those who worry about job prospects. These findings hold with the inclusion of region-wave covariates (number of deaths, wave dummy and aggregate measure of restrictions). Finally, there is a cross-level interaction: the restriction-distress connection is more pronounced in the second wave of data. CONCLUSIONS: Our research indicates that people who are more physically and/or financially vulnerable suffer more from the imposed restrictions, i.e. 'social isolation'. The mental health impact of coronavirus pandemic is not constant but conditional on the level of vulnerability.

Worrying About Finances During COVID-19: Resiliency Enhances the Effect of Worrying on Both Proactive Behavior and Stress.

Amidst the COVID-19 pandemic and resulting economic instability, many people are contending with financial insecurity. Guided by Conservation of Resources Theory (Hobfoll, American Psychologist 44:513-524, 1989; Hobfoll et al., Annual Review of Organizational Psychology and Organizational Behavior 5:103-128, 2018), the current research explores the consequences of experiencing financial insecurity during a pandemic, with a focus on individuals who report relatively higher rates of financial insecurity, performance challenges, and stress during such experiences: working parents (American Psychological Association, 2022). This research also examines the role that personal resources, in the form of trait resiliency, play in the relationships between financial insecurity and behavioral and psychological outcomes including worrying, proactive behaviors, and stress. In a study of 636 working parents and their children, we find that financial insecurity heightens worrying, underscoring the threatening nature of the loss or anticipated loss of material resources. Worrying, in turn, promotes proactive behaviors at work-an effect that is more pronounced among high-resiliency individuals. However, worrying is also associated with elevated stress among high-resiliency individuals, providing support for a trait activation perspective (rather than buffering hypotheses) on ongoing, uncontrollable adversities. Taken together, our results help to (1) illuminate the impact of financial insecurity on work and well-being, (2) reveal a mechanism (i.e., worrying) that helps explain the links between financial insecurity and work and personal outcomes, and (3) expand our knowledge of the implications trait resiliency has for both psychological and behavioral reactions to ongoing crises.

Pandemic-Related Stress May Be Associated with Symptoms of Poor Mental Health Among African Americans.

The COVID-19 pandemic has disproportionately affected African Americans and has been a significant source of stress for this population due to increased economic hardship and social isolation. This study characterized the associations between COVID-19 vulnerability (e.g., contracting the illness or losing a loved one), pandemic-related stress, and symptoms of poor mental health among African Americans. The study sample included African Americans (N = 304) who responded to an online survey. Symptoms of poor mental health were assessed using the PHQ-4, which assessed symptoms of depression and anxiety. Vulnerability to COVID-19 was measured via self-report in three ways: (1) personal vulnerability, (2) family vulnerability, and (3) community vulnerability (i.e., friends, neighbors, and co-workers). Pandemic-related stress was measured by asking participants to rate how difficult it has been to access essential resources and services, manage finances, and plan or attend social events since March 13, 2020. Data were analyzed using multivariable logistic regression. Results showed that COVID-19 vulnerability was not associated with symptoms of depression or anxiety, but pandemic-related stress was consistently associated with symptoms of poor mental health. Study findings highlight the need to monitor and intervene on pandemic-related stress to prevent further psychological distress within this vulnerable and underserved population.

"It has changed my life": unconditional cash transfers and personalized infant feeding support- a feasibility intervention trial among women living with HIV in western Kenya.

BACKGROUND: The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress. METHODS: To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20-35 weeks pregnant-20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health. RESULTS: Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing. CONCLUSIONS: The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials. TRIAL REGISTRATION: Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022. CLINICALTRIALS: gov ID: NCT05219552 Protocol ID: K23MH116807.

Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action.

Advancements in cancer treatments over the past several decades have led to improved cancer survival in adolescents and young adults (AYAs, ages 15-39 years). However, AYA cancer survivors are at an increased risk for "late effects", including cardiovascular, pulmonary and bone diseases as well as fatigue, infertility and secondary cancers. The treatments for cancer may also alter taste, lead to nutritional deficiencies and increase financial burdens that, when taken together, may increase the risk of food and nutrition security in AYA cancer survivors. Furthermore, although AYAs are often merged together in cancer survivorship studies, adolescents and young adults have distinct developmental, psychosocial and pathophysiological differences that may modify their risk of nutritional challenges. In this narrative review and "Call to Action", rationale is provided for why there is a need to better understand nutritional challenges and food insecurity in AYA cancer survivors as a special population. Then, recommendations for next steps to advance knowledge and policy in this field are provided. In particular, integrating screening for food and nutrition insecurity and enhancing awareness of existing resources (e.g., the Supplemental Nutrition Assistance Program, SNAP) might help AYA cancer survivors combat nutritional deficiencies and reduce late effects while improving their overall survival and quality of life.

Health of Young Adults Experiencing Social Marginalization and Vulnerability: A Cross-National Longitudinal Study.

People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.

Changes in retirement plans in the English older population during the COVID-19 pandemic: The roles of health factors and financial insecurity.

Over the course of 2020 and 2021, the COVID-19 pandemic disrupted lives globally. In the UK, unemployment rate continued to increase during and post-lockdown periods, and job security and financial wellbeing deteriorated. It is important to understand whether individual decisions related to retirement plans have changed systematically as a result of the pandemic, especially among older adults who experienced greater rates of pandemic unemployment. Using the English Longitudinal Study of Ageing, this article examines changes in retirement plans of older adults during the COVID-19 pandemic and estimates the impact of health and financial circumstances on these changes. In June/July 2020, 5% of 2095 participants reported planning earlier retirement, while 9% reported planning later retirement. We found that poor self-rated health and financial insecurity were associated with intentions to postpone retirement. Additional risk of later retirement associated with poor health was detected among those experiencing financial insecurity. In November/December 2020, 7% of 1845 participants reported planning earlier retirement, while 12% reported planning later retirement. We found that poor health was predictive of a lower relative risk of later retirement, while depressive symptomology and financial insecurity predicted a higher relative risk of later retirement. The findings imply a contextual role of health factors in, and a persistent influence of financial insecurity on, retirement planning in the older population.

Dying at home for people experiencing financial hardship and deprivation: How health and social care professionals recognise and reflect on patients' circumstances.

Background: International palliative care policy often views home as the most desirable location for end-of-life care. However, people living in more deprived areas can worry about dying in poor material circumstances and report more benefits from hospital admission at the end of life. There is increasing recognition of inequities in the experience of palliative care, particularly for people living in more deprived areas. Promoting an equity agenda in palliative care means building healthcare professionals' capacity to respond to the social determinants of health when working with patients near the end of their life. Objectives: The purpose of this article is to present data which reveal how some health and social care professionals view home dying for people experiencing financial hardship and deprivation. Design: This work was framed by social constructionist epistemology. Methods: Semi-structured qualitative interviews (n = 12) were conducted with health and social care professionals who support people at the end of life. Participants were recruited from one rural and one urban health board area in Scotland, UK. Data collection occurred between February and October 2021. Analysis: Thematic analysis was used to analyse the interview data. Discussion: Our findings suggest that healthcare staff relied on physical clues in the home environment to identify if people were experiencing financial hardship, found discussions around poverty challenging and lacked awareness of how inequities intersect at the end of life. Health professionals undertook 'placing' work to try and make the home environment a suitable space for dying, but some barriers were seen as insurmountable. There was recognition that increased partnership working and education could improve patient experiences. We argue further research is needed to capture the perspectives of individuals with direct lived experience of end-of-life care and financial hardship.

Be Good to Your Mother (Earth): The Relationship between Anthropomorphising Nature, Financial Insecurity, and Support for Pro-environmental Policies in the Context of the Coronavirus Pandemic.

Anthropomorphism of nature is known to be related to pro-environmental outcomes; however, little is known about these variables in the context of the coronavirus pandemic. The economic impact of the prolonged lockdowns may disrupt the historical relationship between these variables, as financial insecurity may compete with environmental concerns for consideration. This study examined the relationship between anthropomorphism of nature the context of COVID-19, and pro-environmental support, and the potential moderating role of financial insecurity in this relationship. It was hypothesised that anthropomorphism of nature in the context of COVID-19 would have a lesser effect on pro-environmental support for individuals who experienced financial insecurity during the pandemic. Participants (N=615; M age=48.71, SD age=17.50; 70% female) completed self-report measures of anthropomorphism of nature, anthropomorphism of nature in the context of COVID-19, financial insecurity, and a measure of support for pro-environmental policies in the economic recovery from COVID-19. Results demonstrated that, after controlling for general anthropomorphism of nature, anthropomorphism of nature in the context of COVID-19 predicted pro-environmental support (R 2 = .05, F(4, 610) = 8.36, p < .001). However, contrary to expectation, pro-environmental support was higher in those experiencing financial insecurity compared to those who were financially secure (B = -2.65, BootSE= .93, p = .004, 95% BootCI [-4.47, -.83]). Financial insecurity also did not moderate the relationship between anthropomorphism of nature in the COVID-19 context and pro-environmental support. Furthermore, the general tendency to anthropomorphise nature was not a significant predictor of support for pro-environmental policies. These findings have important implications for understandings of anthropomorphism, financial insecurity, and environmental protection as well as for public policy on economic recovery in response to the coronavirus pandemic.

Multiple social risk factors are adversely associated with diabetes management and psychosocial outcomes among adults with diabetes.

Adults from structurally marginalized populations have disproportionately higher rates of diabetes, highlighting the importance of addressing social risk factors in diabetes prevention and management. This study examined the correlations among multiple social risk factors and their respective burden on diabetes management and psychosocial health outcomes among adults with diabetes. Data came from the baseline assessment of an ongoing randomized controlled trial evaluating approaches to addressing unmet social needs among 579 adults with diabetes. Four social risks (food insecurity, financial insecurity, housing insecurity, and utility insecurity) were assessed, dichotomized and summed to create a score of cumulative social risk factors. The outcomes of interest were: hemoglobin A1c, cost-related non-adherence for diabetes, diabetes distress, and anxiety or depression. Multivariate regression models were used to examine the associations between cumulative social risk factors and health outcomes, adjusting for sociodemographic characteristics and diabetes duration. Approximately 18% of study participants reported one social risk, 18% reported two social risks, and 23% reported three or four social risks. After multivariate adjustment, adults with three or four social risk factors had a greater likelihood of cost-related non-adherence (OR 2.81, 95% CI 1.95, 4.06), diabetes distress (OR 3.03, 95% CI 2.13, 4.31), and anxiety or depression (OR 5.36, 95% CI 3.39, 8.47), compared to adults with no social risk factors. Significant dose-response relationships were observed with greater social risk factors and poorer diabetes-related outcomes. These findings support efforts to address systemic contributors to diabetes management and care to better promote individual and population health.