Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study

Background Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known. Methods We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population. Results Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90th and 10th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties. Conclusions County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level.

Applying Systems Thinking Approaches to Address Preventive Health Factors through Public Parks and Recreation Agencies

Within the United States parks and recreation agencies (P&R) manage public facilities, spaces, lands, and recreation programs. Public health (PH) evidence has increasingly pointed to local public P&R agencies as critical for promoting preventive health. Programs and strategies are available, but most P&R agencies have limited resources and lack local knowledge on which to base actions. However, the research base is growing. The global research question has shifted from asking IF P&R agencies can positively affect PH factors, to HOW they can best do so with limited resources.This research adapted a systems theory approach to how local public P&R agencies are addressing health factors. Methods included a literature review along with iterative exploration through a three-stage Delphi panel study with 17 P&R agency Expert Panelists in the U.S and Canada. Panelists were identified through a waterfall selection process. Each had at least three years of senior administration experience with interest in addressing PH factors.The study explored which preventive factors appear to be most modifiable by P&R. Results indicated increased physical activity, improved nutrition, enhanced safety or perception of safety, increased social and parental engagement, improved transportation and access to locations (especially nature), and cessation or reduced overconsumption of tobacco and alcohol. However, the priority of factors varies by community, and the continuing challenge is determining the priority of the factors for agencies and their partners to address. Community-specific data are not typically readily available to P&R agencies. Programs, strategies, internal methods, policies, and documents utilized by agencies were collected. Thirty-one related national initiatives (programs) were identified and ranked by the panelists.Key common strategies for P&R were identified. Results indicated a need to focus strategies on leadership and adequate funding to create a strong organizational culture of systematic assessment for addressing PH through allocation of P&R staff and financial resources. Systems thinking analysis and strategies can improve outcomes for cultural ethics of inclusion and equity, equitable access to assets and programs, collaboration with other partners, utilization of crime prevention and environmental design strategies, increased health promotions and education, and centralized tracking and evaluation of feasible measures.Implications for research include needs for additional validation and dissemination of research, evidence-based tools, and proven methods. There continues to be a strong need to help address gaps in knowledge transfer between research and practice realms. Management implications suggest methods for practice to enhance systems-thinking approaches for better preventive health outcomes through P&R in communities.

Religion and Death in the United States: A Meta-Regression Comparative Assessment of Between-County Mortality Heterogeneity in the United States

Religion can have a favorable impact on individual-level health. The influence of religion on population health, however, remains less clear. This study investigated the association between religion and mortality at the population-level. Using county data, a meta-regression was performed to examine between-county mortality heterogeneity. The percent heterogeneity associated with religion variables were compared to demographics (i.e., place, race, language, age, and gender) and health factors (i.e., individual behaviors, clinical care, social and economic, and physical environment) as predictors of mortality. Religion was measured in terms of adherence (i.e., prevalence attending/belonging to a congregation), congregation density, and the diversity of adherents and congregation by denominations. Results showed counties with lower mortality were associated with higher proportions of religion adherents and a greater diversity of adherents and congregations. Counties with higher mortality were associated with higher religion congregation density. Religion, as a parsimonious multivariate model with all demographic and health factor predictors, had less added value when controlled for individual variables or constructs. The direction of association between religion and mortality was consistent, even when controlling for demographics and health factors, and thus merits further consideration as a population health determinant, as it may play a critical role in understanding other population health outcomes.

Identification of Environmental-Based Health Problems in the Coastal Area of Banyuasih Village, Pandeglang Regency, Indonesia

Sanitation is still a problem for most Indonesians who have below average welfare status, especially in coastal areas where the fishing profession is dominant. The purpose of this study is to identify environmental-based health problems in the coastal area of Banyuasih Village, Pandeglang Regency, Indonesia. The method used is cross-sectional, with the unit of analysis being the household. A sample of 157 respondents was the head of the family which was taken by simple random sampling. The results of the study indicate that environmental health factors have not met good sanitation standards. These factors are garbage disposal sites, clean water sources, family latrines, and houses to live in. The conclusion of this study is that the majority of people in this coastal area still have poor sanitation knowledge and behavior.

Combined Body Mass Index and Waist-to-Height Ratio and Its Association with Lifestyle and Health Factors among Spanish Children: The PASOS Study

Background and Aims: The World Health Organization recommended simultaneous measurement of body mass index (BMI) and waist circumference (WC) and suggested joint use to predict disease risks. The aim of this study was to assess the prevalence of BMI and waist-to-height ratio (WHtR) categories among Spanish children and adolescents, as well as their associations with several lifestyle factors. Methods: Cross-sectional analysis of 8–16-year-old children and adolescents (n = 3772) were included in the PASOS nationwide representative study. Children/adolescents and their mothers/female caregivers answered a questionnaire on lifestyle and health factors. Child/adolescent anthropometrics were measured. Four combined BMI-WHtR disease risk categories were built. Results: A third of participants showed combined BMI-WHtR categories with high disease risk (12.3% ‘increased risk’, 9.7% ‘high risk’, 14.3% ‘very high risk’). Participants in the ‘very high risk’ group were less likely to be females (odds ratio 0.63; 95% CI: 0.52–0.76) and adolescents (0.60; 95% CI: 0.49–0.72), to practice ≥60 min/day of moderate-vigorous physical activity (MVPA) (0.73; 95% CI: 0.57–0.93), and to watch <120 min/day of total screen time on weekdays (0.61; 95% CI: 0.49–0.76). Mothers of participants in the ‘very high risk’ group were less likely to have a high educational level, be in the overweight or normal range, have never smoked or were former smokers, and watch <120 min/day of total screen time on weekends. Participants in the ‘increased’ and ‘high risk’ categories had mothers with normal weight and ≥60 min/day of MVPA. Participants in the ’high risk’ group did not achieve ≥60 min/day of MVPA and showed lower adherence to the Mediterranean diet. Conclusions: Adherence to a healthy lifestyle in children and adolescents, but also in their mothers/female caregivers during offspring’s childhood and adolescence, is associated with low BMI-WHtR disease risk.

Koettu työkyky ja hyvinvointitekijät Lapin 40–59-vuotiaassa väestössä

Heikentyneeseen työkykyyn yhteydessä olevien tekijöiden selvittäminen on tärkeää pyrittäessä ehkäisemään työelämästä syrjäytymistä ja parantamaan kuntoutuksen suuntaamista. Työkyvyn muutokset ovat 40 vuotta täyttäneillä yleisempiä kuin nuoremmissa ikäryhmissä. Tutkimuksen tavoitteena oli selvittää sosiaalisten resurssien ja psyykkiseen hyvinvointiin liittyvien tekijöiden yhteyttä työkyvyn heikentymiseen Lapissa asuvilla 40–59-vuotiailla henkilöillä. Tiedonkeruu toteutettiin Lapin sairaanhoitopiirissä syksyllä 2012. Postikyselyn otos oli 8200 henkilöä ja vastausprosentti 33. Ikäryhmään 40–59 vuotta kuului vastanneista 959 (vastausprosentti 32). Heikentynyt työkyky määriteltiin työkykypistemäärän avulla (arvo 0–7 asteikolla 0–10). Analyysimenetelmänä oli logistinen regressioanalyysi. Terveys ja työkyky olivat työssä olevilla paremmat ja eläkeläisillä heikommat kuin työttömillä. Psyykkisen hyvinvoinnin ongelmia oli työttömillä ja eläkeläisillä yhtä paljon. Pääasiallinen toiminta, sosiaalinen tuki, psyykkinen roolitoiminta, depressio ja terveydentila olivat tilastollisesti merkitsevästi yhteydessä heikentyneeseen työkykyyn kokonaismallissa, joka sisälsi myös sosiodemografiset taustamuuttujat. Tietoja työkykyä selittävistä tekijöistä voidaan käyttää hyväksi pohdittaessa työkykyä ylläpitävän toiminnan ja kuntoutuksen mahdollisuuksia. Abstract Perceived work ability and related factors with middle-aged people living in Lapland Perceived work ability predicts continuing at work or withdrawal to disability pension. The aim of the study was to investigate the associations of social, psychological and health factors with work ability in persons aged 40-59 years, living in Lapland. The total sample of the study was 8200 persons and the response rate 33. The number of persons aged 40–59 was 959 (response rate 32). A single-item work ability measure (work ability compared with the life time best) was used. With the unemployed, health and work ability were weaker than with those at work and better than with those at pension. Logistic regression analysis was used in determining the associations of social, psychological and health factors with work ability. In the total model, life situation, social support, psychological role functioning, depression and state of health were statistically significant predictors among all respondents, whereas health was the most important predictor among those at work. Information of factors associated with work ability is needed when developing strategies for rehabilitation and maintaining work ability.

Public transport analysis in the Petroșani Basin in the context of the need for sustainable mobility

Sustainable public transport requires finding a balance between economic and social objectives, ensuring the need for mobility without damaging environmental and health factors. At the level of the Petroșani Basin, the aim is to ensure the mobility of passengers as quickly as possible from one city to another (from east to west - Petrila, Petroșani, Aninoasa, Vulcan, Lupeni, Uricani) or from one part of the city to another, as the case may be. The study of population fluctuations by hours, on working or non-working days, per season allows the realization of a public transport that ensures the movement of people as quickly and safely as possible. The purpose of this paper is to study the way in which public transport is carried out in the Petroșani Basin, the means of transport used and the possibilities to improve this activity. In the context of sustainable mobility, the paper includes necessary aspects (transport demand, influencing factors, infrastructure) in order to conclude on the future of public transport in the Petroșani Basin.

Indigenous Rights

This chapter focuses on the mental health factors that impact student success for Indigenous youth within the higher education landscape in the Commonwealth of the Northern Mariana Islands (CNMI). It emphasizes the need to address these mental health factors by strengthening cultural identity to support the success of students in higher education. The authors explain how Indigenous rights can be used to address legacies of genocidal colonialism and how implementing Indigenous-based curriculum for effective student learning may provide pathways to improve academic and mental health outcomes. Several programs in Saipan that underscore the significance of reinforcing cultural identity to help mitigate and alleviate these negative outcomes are discussed. The authors conclude by providing examples of how cultural identity can be strengthened through the implementation of Indigenous rights-based legislation, thereby simultaneously safeguarding mental health and academic success for Indigenous youth in the CNMI.

Frailty and sociodemographic and health factors, and social support network in the brazilian elderly: A longitudinal study

ABSTRACT Objective: To identify and analyze the sociodemographic and health factors and the social support network of the elderly associated with frailty in the assessments carried out between 2007/2008 and 2018. Methods: This is a longitudinal study with elderly people aged ≥65 years living in the community. The instruments used were those for Demographic Profile, the Mini Mental State Examination, the Functional Independence Measure, Lawton and Brody Scale, Geriatric Depression Scale, Minimum Relationship Map for the Elderly, and Edmonton Frail Scale. Descriptive analysis and linear regression were used, all tests with p < 0.05. Results: Of the 189 elderly in the study period (2007/2008–2018), most were 80 years old and over, with an average of 82.31 years old; they were women, with no partner, who lived with other family members and were retired. In the final analysis, regardless of age and sex, a decrease in functional independence, an increase in depressive symptoms, an increase in the number of self-reported illnesses, and an increase in the frailty score were observed. Conclusion: The factors that were associated with the increase in frailty of the elderly during the study period were age, female sex, and no partner. The health team, which includes nurses, shall be aware of changes and develop care plans to prevent or avoid their progression.