Having less and wanting more: an investigation of socioeconomic status and reinforcement pathology

Abstract Background In the United states obesity and socioeconomic status (SES), or one’s standing in society based on income, education, and/or occupation, are strongly associated. The mechanisms for this relationship may include having high levels of motivation to get food (reinforcing value of food; RRV) and low levels of inhibitory control (delay discounting; DD) which, when combined, is referred to as reinforcement pathology (RP). We sought to examine the relationships among multiple measures of household SES, RP, and age-adjusted body mass index (zBMI) among adolescents. Methods These data were collected as part of ongoing longitudinal study of risk factors for obesity in 244 adolescents. The adolescents and one parent/guardian had height and weight measured and completed surveys. The adolescents completed an adjusting amount DD task and a computer-based RRV task. Analyses consisted of correlations among measures of SES and RRV, DD, and BMI z-scores. In the case of significant associations, multiple regression models were created with theoretically informed covariates. Results Household income, parent/guardian education, parent/guardian occupation, and food insecurity status were all related to one another. Among the adolescents, a significant portion of the variance in RRV was accounted for by household income after controlling for covariates. For DD, it was parent/guardian education that was most associated after controlling for covariates. Conclusion When low income and low parent/guardian education occur together, there may be an increased risk of RP. Separately, food insecurity was predictive of higher parent/guardian BMI. Future research should continue to explore the effects of low income and parent/guardian education on RP among youth by examining them over time.

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Spatiotemporal patterns of urban mosquitoes are modulated by socioeconomic status and environmental traits in the United States

10.1101/2021.10.30.466623 ◽

2021 ◽

Author(s):

Senay Yitbarek ◽

Kelvin Chen ◽

Modeline Celestin ◽

Matthew McCary

Keyword(s):

United States ◽

Socioeconomic Status ◽

Low Income ◽

Household Income ◽

Meta Analysis ◽

Spatial Regression ◽

The United States ◽

Urban Environments ◽

Urban Landscapes ◽

Lower Income

The distribution of mosquitoes and associated vector diseases (e.g., West Nile, dengue, and Zika viruses) is likely a function of environmental conditions in the landscape. Urban environments are highly heterogeneous in the amount of vegetation, standing water, and concrete structures covering the land at a given time, each having the capacity to influence mosquito abundance and disease transmission. Previous research suggests that socioeconomic status is correlated with the ecology of the landscape, with lower-income neighborhoods generally having more concrete structures and standing water via residential abandonment, garbage dumps, and inadequate sewage. Whether these socio-ecological factors affect mosquito distributions across urban environments in the United States (US) remains unclear. Here, we present a meta-analysis of 22 paired observations from 15 articles testing how socioeconomic status relates to overall mosquito burden in urban landscapes in the United States. We then analyzed a comprehensive dataset from a socioeconomic gradient in Baltimore, Maryland to model spatiotemporal patterns of Aedes albopictus using a spatial regression model with socio-ecological covariates. The meta-analysis revealed that lower-income neighborhoods (regions making less than $50,000 per year on average) are exposed to 151% greater mosquito densities and mosquito-borne illnesses compared to higher-income neighborhoods (≥$50,000 per year). Two species of mosquito (Ae. albopictus and Aedes aegypti) showed the strongest relationship with socioeconomic status, with Ae. albopictus and Ae. aegypti being 62% and 22% higher in low-income neighborhoods, respectively. In the spatial regression analysis in Baltimore, we found that Ae. albopictus spatial spread of 1.2 km per year was significantly associated with median household income, vegetation cover, tree density, and abandoned buildings. Specifically, Ae. albopictus abundance was negatively correlated with median household income, vegetation cover, and tree density. Ae. albopictus abundance and the cover of abandoned buildings were positively correlated. Together, these results indicate that socio-ecological interactions can lead to disproportionate impacts of mosquitoes on humans in urban landscapes. Thus, concerted efforts to manage mosquito populations in low-income urban neighborhoods are required to reduce mosquito burden for the communities most vulnerable to human disease.

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Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176037 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6037

Author(s):

Emily DeWitt ◽

Rachel Gillespie ◽

Heather Norman-Burgdolf ◽

Kathryn M. Cardarelli ◽

Stacey Slone ◽

...

Keyword(s):

Rural Communities ◽

Food Insecurity ◽

Low Income ◽

Rural Areas ◽

Household Income ◽

Vegetable Consumption ◽

The United States ◽

Dietary Intakes ◽

Annual Household Income ◽

Health Promoting

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.

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Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

American Journal of Perinatology ◽

10.1055/s-0041-1740194 ◽

2021 ◽

Author(s):

Helen Gomez ◽

Julia D. DiTosto ◽

Charlotte M. Niznik ◽

Lynn M. Yee

Keyword(s):

Diabetes Mellitus ◽

Food Security ◽

Food Insecurity ◽

Low Income ◽

Adult Population ◽

Clinical Work ◽

The United States ◽

Social Determinant ◽

Future Research ◽

The Impact

Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation. Key Points

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Does Participation in Food Benefit Programs Reduce the Risk for Depressive Symptoms?

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390320983904 ◽

2021 ◽

pp. 107839032098390

Author(s):

Harry Adynski ◽

Todd A. Schwartz ◽

Hudson P Santos

Keyword(s):

Depressive Symptoms ◽

Food Insecurity ◽

Low Income ◽

The United States ◽

Elevated Risk ◽

Physical And Mental Health ◽

Cross Sectional ◽

Assistance Program ◽

Sociodemographic Variables ◽

Increased Risk

BACKGROUND: Food insecurity affects 15 million households in the United States and is associated with negative physical and mental health outcomes including Major Depressive Disorder. Governmental public assistance or food benefit programs including the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) are social intervention services that attempt to minimize food insecurity for low-income households. There is little consensus regarding the effects of food benefit participation on reducing risk of depressive symptoms. OBJECTIVE: This study aims to explore the association between household food insecurity and food benefit participation (SNAP or WIC) on risk for depressive symptoms using nationally representative samples from the Center for Disease and Control and Prevention Nutritional Health and Nutrition Examination Survey 2013-2014 and 2015-2016 cohorts. We hypothesize that food insecurity is associated with increased risk of depressive symptoms and food benefit participation with reduced risk. METHOD: Cross-sectional analyses were conducted using survey-weighted logistic regression to explore the relationship between food insecurity, food benefit participation, and the risk of depressive symptoms controlling for relevant income and sociodemographic variables. RESULTS: When controlling for sociodemographic variables, food benefit participation did not reduce the risk of depressive symptoms, while high levels of food insecurity were associated with elevated risk. CONCLUSIONS: High levels of food insecurity are associated with elevated risk of depressive symptoms. Nurses and public health professionals can address food security needs through increased knowledge of referral and eligibility requirements. Implications on clinical practice, policy, and future directions for research are discussed.

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A Silenced Population

Crisis ◽

10.1027/0227-5910/a000470 ◽

2017 ◽

Vol 38 (6) ◽

pp. 433-442 ◽

Cited By ~ 1

Author(s):

Kim Gryglewicz ◽

Melanie Bozzay ◽

Brittany Arthur-Jordon ◽

Gabriela D. Romero ◽

Melissa Witmeier ◽

...

Keyword(s):

At Risk ◽

Depressive Symptomatology ◽

The United States ◽

Future Research ◽

At Risk Youth ◽

Peer Relationship ◽

Student Records ◽

Cross Sectional ◽

Increased Risk ◽

Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

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662 PAP Therapy: A Review of Resources for the Uninsured during COVID-19

SLEEP ◽

10.1093/sleep/zsab072.660 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A259-A259

Author(s):

Melissa Malinky ◽

Abigail Oberla ◽

Meena Khan ◽

M Melanie Lyons

Keyword(s):

Low Income ◽

Web Search ◽

Low Cost ◽

Wait Time ◽

The United States ◽

Fixed Cost ◽

United States Census ◽

Lower Socioeconomic ◽

Increased Risk ◽

Available Resources

Abstract Introduction In 2019, the United States Census estimated 8% (26.1 million) people were without health insurance. Further, an estimated 3.5 million people became/remained uninsured from COVID-19-related job losses. Patients with OSA that belong to a lower socioeconomic status (SES) are less likely to have access to healthcare and may be under or uninsured. Untreated OSA can lead to increased risk of symptoms and associated co-morbidities. Resources to help the uninsured to obtain PAP therapy were available pre-COVID, including two main sources, American Sleep Apnea Association (ASAA) and our local branch serving central Ohio, The Breathing Association. However, the COVID pandemic limited access or closed these programs. Our Sleep Medicine clinics saw 148 uninsured OSA patients between March-December, 2020. Given these difficulties, we re-evaluated available resources for the uninsured. Methods We conducted a search for current low cost ($100 or less) PAP therapy options for the uninsured, March 15, 2020-December 3, 2020, by: (1) contacting pre-COVID-19 resources, including Durable Medical Equipment (DME) providers, (2) consulting social work, and (3) completing a librarian assisted web-search not limited to PubMed, Embase, CINAHL for academic related articles and electronic searches using a combination of English complete word and common keywords: OSA, PAP, uninsured, no insurance, cheap, medically uninsured, resources, self-pay, low-income, financial assistance, US. Resources such as private sellers were not investigated. Results During COVID-19, assistance for PAP machines/supplies have closed or required a protracted wait-time. Options including refurbished items range from low, one-time fixed cost or income-based discounts from: one local charity (Joint Organization for Inner-City Needs) and DME (Dasco), and four national entities (ASAA, Second Wind CPAP, Reggie White Foundation, CPAP Liquidators). An Electronic Health Record-based tool was developed and distributed to increase provider awareness of pandemic available resources. Conclusion Untreated OSA is associated with increased risk of cardiovascular co-morbidities. Access and cost may limit treatment in OSA patients from a lower SES. The COVID-19 pandemic has shuttered programs providing discount PAP and supplies, leaving fewer resources for these patients, thus further widening this health care disparity. Alternatives are needed and current resources are not easily accessible for providers and patients. Support (if any):

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Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis

JDR Clinical & Translational Research ◽

10.1177/23800844211035669 ◽

2021 ◽

pp. 238008442110356

Author(s):

D.J. Gaskin ◽

H. Zare ◽

R. McCleary ◽

O. Kanwar ◽

A.L. Davis

Keyword(s):

Socioeconomic Status ◽

Oral Health ◽

Low Socioeconomic Status ◽

Low Income ◽

The United States ◽

Permanent Teeth ◽

Dental Visit ◽

Low Socioeconomic ◽

The Past ◽

Dental Needs

Objective: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. Method: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. Results: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. Conclusion: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. Knowledge Transfer Statement: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

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Abstract 033: Does Persistent Poverty Elevate Risk for Obesity More Than Occasional Poverty in Youth? Evidence From a Quebec Birth Cohort

Circulation ◽

10.1161/circ.125.suppl_10.a033 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Lisa Kakinami ◽

Marie Lambert ◽

Lise Gauvin ◽

Louise Séguin ◽

Béatrice Nikiéma ◽

...

Keyword(s):

Birth Cohort ◽

Low Income ◽

Weight Status ◽

Latent Class ◽

Group Analysis ◽

Latency Period ◽

High Exposure ◽

Increased Risk ◽

Z Scores ◽

Statistics Canada

Background: Childhood poverty heightens the risk of obesity in adulthood, but its effect during childhood is poorly understood. We analyzed the relationship between poverty trajectories across the ages of 6, 8, 10, and 12 years with BMI Z-scores and the risk of being overweight in a birth cohort of children. Methods: Data were from 703 participants in the 1998-2010 ″Quebec Longitudinal Study of Child Development″ (n=2,120) birth cohort. Household income was measured annually with poverty defined as income below the low-income thresholds established by Statistics Canada adjusted for household size and geographic region. Children’s height and weight at ages 6, 8, 10, and 12 years were measured by trained study staff. Body mass index (BMI) was converted to age- and sex- standardized BMI Z-scores and percentiles and were classified as overweight or obese (BMI percentile > 85th) based on CDC growth curves. Trajectories of poverty across the ages of 6, 8, 10, and 12 years were characterized with a latent class group analysis using maximum likelihood in a semiparametric mixture model. Multivariable linear regressions predicted BMI Z-scores at different ages, and logistic regression predicted the risk of being overweight or obese based on poverty trajectories after adjusting for sex. Because all children at ages 6 and 8 years were pre-pubertal, and all children at age 12 were in puberty, only the model for BMI at age 10 adjusted for puberty. Results: Poverty trajectories were fairly stable across time and fell into 1 lower exposure category (consistently low exposure (approximately 70%, n=487)) and 3 higher exposure categories (increasing: 8%, n=55; decreasing: 10%, n=70; or consistently high exposure: 13%, n=91)). After adjusting for covariates, compared to children experiencing lower exposure to poverty, BMI Z-scores of children with consistently high exposure to poverty were 0.05 (p=NS), 0.12 (p=NS), 0.37 (p=0.02), and 0.42 (p=0.003) higher at ages 6, 8, 10, and 12 years, respectively. After adjustment, children experiencing consistently high exposure to poverty were at a significantly increased risk for being overweight or obese at age 8 (OR: 2.0, 95% CI: 1.2-3.3, p=0.01), age 10 (OR: 2.1, CI: 1.2-3.5, p=0.005), and at age 12 years (OR: 2.8, CI: 1.7-4.7, p<0.001) compared to children experiencing lower exposure to poverty. Children experiencing decreasing exposure to poverty at all ages, or increasing exposure at age 10 and 12 years were at an increased risk for being overweight or obese, but the results were not statistically significant. Conclusion: Findings suggest that there is a latency period for the detrimental effects of poverty on weight, but that previous exposure can still impact future weight even at a young age. Whether the disparity in weight status according to poverty trajectories widens as the children continue to age should be investigated.

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Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa151 ◽

2020 ◽

Author(s):

Emi Minejima ◽

Annie Wong-Beringer

Keyword(s):

Socioeconomic Status ◽

Low Income ◽

Formal Education ◽

Geographic Location ◽

The United States ◽

Risk Scores ◽

Low Ses ◽

The Relationship ◽

Poor Health Literacy ◽

Hispanic White

Abstract Background Socioeconomic status (SES) is a complex variable that is derived primarily from an individual’s education, income, and occupation and has been found to be inversely related to outcomes of health conditions. Sepsis is the sixth most common admitting diagnosis and one of the most costly conditions for in-hospital spending in the United States. The objective of this review is to report on the relationship between SES and sepsis incidence and associated outcomes. Content Sepsis epidemiology varies when explored by race, education, geographic location, income, and insurance status. Sepsis incidence was significantly increased in individuals of Black race compared with non-Hispanic white race; in persons who have less formal education, who lack insurance, and who have low income; and in certain US regions. People with low SES are likely to have onset of sepsis significantly earlier in life and to have poorly controlled comorbidities compared with those with higher SES. Sepsis mortality and hospital readmission is increased in individuals who lack insurance, who reside in low-income or medically underserved areas, who live far from healthcare, and who lack higher level education; however, a person’s race was not consistently found to increase mortality. Summary Interventions to minimize healthcare disparity for individuals with low SES should target sepsis prevention with increasing measures for preventive care for chronic conditions. Significant barriers described for access to care by people with low SES include cost, transportation, poor health literacy, and lack of a social network. Future studies should include polysocial risk scores that are consistently defined to allow for meaningful comparison across studies.

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Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

American Journal of Nephrology ◽

10.1159/000507725 ◽

2020 ◽

Vol 51 (6) ◽

pp. 424-432 ◽

Cited By ~ 1

Author(s):

Salina P. Waddy ◽

Adan Z. Becerra ◽

Julia B. Ward ◽

Kevin E. Chan ◽

Chyng-Wen Fwu ◽

...

Keyword(s):

The United States ◽

Future Research ◽

Dialysis Patients ◽

Mortality And Morbidity ◽

Medication Prescription ◽

Risk Of Death ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage ◽

Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

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