Parenting During a Pandemic: Predictors of Parental Burnout

The global pandemic, COVID-19, has resulted in significant changes in many aspects of our lives. For parents, the impact has been great as they combine work, family, and homeschooling while maintaining the wellbeing of themselves and their family. COVID-19 has brought about challenges that many parents have not faced before, putting them at risk for parental burnout. The goal of this study was to investigate risk and protective factors that predict parental burnout during COVID-19. Eighty-six parents (75 mothers; M age = 40.73; SD = 7.88) living in New Zealand during COVID-19 lockdown participated in the survey. Results showed parental violence, parental constellation, unemployment, major decreases in finances, and living in a disadvantaged neighborhood were the strongest predictors of parental burnout. Child independence and parental emotional regulation were the strongest protective predictors of parental burnout. COVID-19 restrictions did not predict parental burnout. Findings highlight that promoting protective factors may support parental equilibrium during future crises.

Association between Neighborhood Disadvantage and Health Status/Healthcare Utilization in Survivors of Blood or Marrow Transplantation (BMT) - a BMTSS Report

Background: Living in a disadvantaged neighborhood (reflecting neighborhood-level social determinants of health) is associated with poor health outcomes. BMT survivors remain at a high risk of long-term and late-occurring chronic health conditions that require anticipatory management. We hypothesized that neighborhood disadvantage would be associated with poor health status as reported by the BMT survivors, as well as poor utilization of the healthcare system. Methods: We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals who survived ≥2y following BMT performed at three institutions between 1974 and 2014. Participants in this analysis underwent a single BMT and completed the BMTSS survey, which captures sociodemographic characteristics and chronic health conditions. We graded chronic health conditions using CTCAE v5.0, and calculated a summative index that takes into account the number and grades of the conditions, where a higher score indicates more/worse conditions. The survey also captured self-reported health status ("In general would you say your health is: excellent, very good, good, fair or poor?") and healthcare utilization ("When was your most recent routine check-up? <1y ago, 1-2y ago, 2-5y ago, ≥5y ago, never"). Neighborhood disadvantage was measured using the Area Deprivation Index (ADI), a validated composite indicator based on 17 US Census measures and percentiled as 0 (least deprived) to 100 (most deprived). BMT survivors were linked to ADI via census block group using home address at survey completion. Using multivariable ordered logit regression, we modeled the association between ADI and the odds of worse self-reported health or a longer time since a routine healthcare visit. Models were adjusted for available clinical factors (primary cancer diagnosis, donor source, conditioning intensity, chronic health conditions, chronic graft vs. host disease (GvHD), time from BMT) and individual-level sociodemographic characteristics (age at survey, sex, payor, race/ethnicity, education, income, marital status). Results: The cohort included 2,893 BMT survivors; median age at BMT was 47y (IQR: 30-58); median follow-up time was 9y (IQR: 5-16). Table 1 summarizes patient characteristics. Median ADI ranged from 14.0 in patients rating their health as excellent to 28.5 in those rating their health as poor, and from 21.0 in patients with visits <1y ago to 34.0 in patients reporting no visits [Fig 1]. In multivariable analyses, the odds of reporting worse health were higher for patients residing in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.005, p=0.003). Thus, for our cohort, a patient living in the most disadvantaged neighborhood (ADI=100) had 1.65 times the odds of reporting poor health compared to a patient living in the least disadvantaged neighborhood (ADI=1). Further, the odds of a longer time since the last routine physician visit were higher for patients living in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.007, p<0.001). Thus, a patient living in the most disadvantaged neighborhood had twice the odds (OR=2.06) of reporting no visits compared to a patient living in the least disadvantaged neighborhood. Conclusions: Conditional on surviving 2 or more years after BMT, living in a disadvantaged neighborhood was associated with poorer self-reported health and a longer time interval since a routine healthcare visit, after adjusting for self-reported individual socioeconomic indicators and chronic health conditions. The significant association between area deprivation and poorer self-reported health persisted after controlling for prior health care utilization. Our findings suggest that health status and access to healthcare are associated with characteristics of the built and social environment and deserve detailed examination in order to inform multi-level interventions that include policy. Figure 1 Figure 1. Disclosures Arora: Syndax: Research Funding; Kadmom: Research Funding; Pharmacyclics: Research Funding.

The cultural policies of a popular music venue: the case of Strasbourg's Espace Django

PurposeThis article discusses local cultural policies addressing popular music, and the values they imply, through a case study of Strasbourg's Espace Django, a publicly financed concert venue located in a disadvantaged neighborhood.Design/methodology/approachEspace Django's structural organization and overall cultural “philosophy” are described on the basis of field interviews and several documents related to the venue; they are then discussed in relation to literature on urban cultural policies and French policies concerning popular music.FindingsEspace Django's activities embody a will to improve social interactions within local communities. The venue does not fit in either the “music city” or the “creative cluster” theoretical model. However, its policies belong to the French institutional tradition of Développement Culturel, and they express a tendency toward eventification and the experience economy.Originality/valueIn France, the public sector plays an important role in cultural practices, mostly through funding and policymaking. The example of Espace Django adds a distinct French perspective to a research field mainly centered on Anglo-Saxon countries and more liberal economies. Also, the appendix on Espace Django's response to the coronavirus disease 2019 (COVID-19) health crisis adds interesting elements for understanding what are the successful choices in the current cultural scenario.

Abstract 16195: Socioeconomic Disadvantage is Associated With Higher Long-Term Cardiovascular Mortality Following Myocardial Infarction: The YOUNG-MI Registry

Introduction: Living in a disadvantaged neighborhood is associated with developing cardiovascular disease and poor health outcomes. We hypothesized that socioeconomic disadvantage - as measured by neighborhood level factors - is associated with cardiovascular (CV) mortality for patients who experienced a myocardial infarction (MI) at a young age. Methods: Retrospective cohort study of patients with a first MI at age <50 years treated at two medical centers from 2000 - 2016. Each patient’s home address was mapped to their census block group (CBG), a geographically compact region containing ~ 600 to 3000 people. For each CBG, we obtained the Neighborhood Stress Score (NSS) - a standardized score based on 7 census variables that Massachusetts Medicaid uses to measure socioeconomic stress. Patients were assigned an NSS score based on their CBG and stratified into tertiles of risk. Higher scores indicate greater socioeconomic disadvantage. We used Cox proportional hazards modeling to evaluate the association of NSS with CV mortality. Results: Of 2097 patients (median age 44; 19% female), addresses were available for 96%. The median NSS score was -0.31, with scores ranging from -1.11 to 5.33. Higher NSS scores were associated with public insurance, hypertension, diabetes, smoking cigarettes, and illicit drug use. Over a median follow-up of 11 years, 12.7% of individuals in the top tertile died versus 7.5% in the bottom tertile, p=0.002. After adjusting for age, sex, race, diabetes, hypertension, dyslipidemia, creatinine, tobacco smoking, use of alcohol or illicit drugs, cardiac catheterization, and statin or aspirin at discharge, each 1-point increase in NSS was associated with a 25% increase in CV mortality (adjusted HR = 1.25, [95% CI 1.01 - 1.55], p=0.045). Conclusion: Among patients experiencing an MI at a young age, socioeconomic disadvantage was associated with higher CV mortality. Our data suggest that neighborhood factors have an important effect on post-MI survival.

Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

Background Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as ‘neighborhood’ socioeconomic disadvantage, on a CDI patient’s health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient’s ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. Methods In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. Results From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). Conclusions Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.

Toxic Neighborhoods: The Joint Effects of Concentrated Poverty and Environmental Lead Contamination on Cognitive Development during Early Childhood

Although socioeconomic disparities in cognitive ability emerge early in the life course, most research on the developmental consequences of living in a disadvantaged neighborhood focuses on school-age children or adolescents. In this study, we outline and test a theoretical model of neighborhood effects on cognitive development during early childhood that highlights the mediating role of environmental health hazards, and in particular, exposure to neurotoxic lead. To evaluate this model, we follow a cohort of 1,266 children in the Project on Human Development in Chicago Neighborhoods from birth through the time of school entry, matching them at each survey wave with information on neighborhood composition and the areal risk of lead exposure. With these data, we then estimate the joint effects of neighborhood poverty and environmental lead contamination on receptive vocabulary ability. We find that sustained exposure to disadvantaged neighborhoods substantially reduces vocabulary ability during early childhood and that nearly all of this effect may operate through a causal mechanism involving lead contamination. These findings are robust to unobserved confounding and to the use of several alternative estimation strategies, which suggests that living in a disadvantaged neighborhood impedes early childhood development because it increases exposure to environmental toxins like lead.

Processes of co-producing a complex community based intervention in a disadvantaged neighborhood

Background Empowerment-based community interventions which may include co-production in local decision-making have become more and more common to address health and social inequalities. However knowledge concerning how best to develop and implement such interventions in a disadvantaged neighborhood is sparse. The purpose of this study is to look into the processes and potentials of co-producing a community restaurant in the socially disadvantaged neighborhood Tingbjerg in Copenhagen. The study is part of the initiative Tingbjerg Changing Diabetes which is based on the Supersetting approach involving multiple stakeholders in Tingbjerg. The purpose of the Restaurant is to engage residents and building capacity through participation in cooking workshop, social dining and co-production processes. Methods The study is based on Community Action Research (CAR). It mixes in depth ethnographic fieldwork and participation in the processes of developing the restaurant with participatory methods engaging residents in the development process, interviews with stakeholders and residents and using program theory to guide the process. The study is still ongoing, but data from five months participant observation and interviews with 5 stakeholders has been gathered to date with participatory methods planned. Preliminary findings Findings show that processes of co-producing and implementing a community restaurant in Tingbjerg through a Supersetting approach are characterized by agility, context sensitivity, adaptability and trust building, and that these have the potential to ensure resident participation, capacity building and sustainability. Conclusions Adaptability, context sensitivity and engaging multiple stakeholders in a long term commitment are imperative when working to build community capacity. In addition, participation and co-production are concepts that have to be carefully considered and applied stepwise and over a long period of time when working with vulnerable groups. Key messages Sustainable and effective community interventions in disadvantaged neighborhoods rely on strong and long term commitments by multiple partners, adaptability and context sensitivity. Co-production with vulnerable groups has the potential of being empowering, but only when applied contextually and stepwise.

Parental Perspectives and Experiences in Relation to Lifestyle-Related Practices in the First Two Years of a Child’s Life: A Qualitative Study in a Disadvantaged Neighborhood in The Netherlands

The first two years of a child’s life are a critical period in preventing several lifestyle-related health problems. A qualitative study was conducted to explore parental experiences and perspectives in relation to lifestyle-related child-rearing practices in order to minimize risk factors at an early stage. Data were collected through interviews (n = 25) and focus groups (n = 4) with parents of children aged 0–2 years, in a disadvantaged neighborhood in Amsterdam, the Netherlands. Results showed that parents were often uncertain about a number of lifestyle-related practices. Ambiguity also appeared regarding the parents’ intentions to engage in certain practices and what they were able to achieve in everyday life. In addition, parents experienced strong sociocultural influences from their family, which interfered with their ability to make their own decisions on lifestyle-related practices. Parents also expressed a need for peer-support and confirmation of their practices. Future studies should focus on supporting parents in their parental practices during the first two years of their child’s life. Any such study should take into account the specific sociocultural context accompanying lifestyle-related parental practices.