Background: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (−2.31%), Amazonas (−1.57%), Puno (−1.54%), Huanuco (−1.52%), and Ancash (−1.44). Those with the lowest reduction were Ica (−0.67%), Ucayali (−0.64%), Tumbes (−0.45%), Lima (−0.37%), and Tacna (−0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition. / Revisión por pares

Poverty it is said to have harsh outcomes on one's antisocial or even delinquent behavior. Other factors as well lead an individual to antisocial behavior those are the environment that they are living, and their genes that have passed from one generation to the other one. Parents, poverty, environment, genes and social determinants affect one's involvement in a crime and also affect the health in distinct ways. The focus of this essay is on the African American population within the American society and the health disparities that exist in this situation. We try to understand and answer if these health disparities were created after their birth, or pre-existed and were carried through the generations. One of the main issues is the examination of how much is the prison or incarceration in charge for these health disparities, or how much did these disparities previously exist, out of other reasons. These issues are put on a life-course perspective, and there is shown how much these morbidities affect one's life from the beginning till incarceration. A certain policy implication is made to eliminate those disparities by improving maternal, child and family health status.

Contexte et objectifs : Le taux d’activité des femmes a augmenté régulièrement depuis les années 1970 et les femmes sont de plus en plus souvent en emploi au moment où elles vont avoir une grossesse. Ce travail a pour principal objectif de décrire et comprendre les liens entre l’activité professionnelle et la grossesse. Tout d’abord, en comparant les taux d’activité professionnelle selon que les femmes sont enceintes ou appartiennent à la population féminine générale. Dans un second temps, en observant comment le groupe professionnel et le statut de l’emploi occupé influencent le moment de l’arrêt de travail pendant la grossesse. Enfin la troisième partie analyse l’impact de la position sociale, définie d’abord par le statut d’emploi des femmes et prenant en compte leur situation de couple et l’emploi du partenaire, sur la surveillance pendant la grossesse et les issues périnatales.Méthodes et population : Les données ont été extraites des Enquêtes Périnatales Nationales (ENP) en 1972, 1981, 1995, 1998, 2003, 2010 et 2016 et des données du recensement Une comparaison de l’activité professionnelle des femmes enceintes et de la population générale des femmes en France métropolitaine en fonction de l’âge et du niveau d’études, a été effectuée. Une modélisation de l’activité professionnelle pendant la grossesse en fonction des caractéristiques sociodémographiques, de la période entre 1972 et 2016 et de la génération de naissance, a été réalisée. Une analyse des femmes qui travaillaient pendant la grossesse en 2010 et en 2016 a été menée pour déterminer les moments de l’arrêt de l’activité professionnelle au cours de la grossesse, selon la situation médicale et la position sociale des femmes, en s’intéressant à l’arrêt précoce, avant 24 semaines d’aménorrhée (SA), et à l’arrêt tardif, après 36 SA révolues. Une analyse entre 1995 et 2016 a permis de décrire la surveillance prénatale et les issues périnatales en fonction du statut d'emploi des femmes et de leur partenaire pendant la grossesse.Résultats : Comme dans la population générale, le taux d’emploi des femmes enceintes a augmenté régulièrement entre 1972 et 2016, de 53 à 74 %. En 2016, 32 % des femmes qui travaillent pendant la grossesse se sont arrêtées avant 24 SA, et 2 % après 37 SA. Il existe des inégalités sociales autour des arrêts de l’activité professionnelle: les femmes ayant les situations sociales les plus défavorables s’arrêtent précocement pendant leur grossesse, alors que les femmes qui s’arrêtent tardivement ont des situations socioprofessionnelles plus favorisées, quelle que soit leur situation médicale. Entre 1995 et 2016, les différences selon la position sociale des femmes enceintes observées pour la surveillance prénatale et les issues périnatales se réduisent mais persistent.Conclusion : Les transformations majeures du rapport à l’emploi des femmes au cours des dernières décennies peuvent modifier les pratiques des soignants prenant en charge les femmes enceintes. La majorité des femmes enceintes sont des femmes en emploi rémunéré et la discussion de l’arrêt de l’activité professionnelle au cours de la grossesse doit s’évaluer au regard de la situation médicale mais aussi de la situation sociale et professionnelle. Une attention particulière doit être portée aux femmes plus défavorisées, soit au chômage ou sans activité professionnelle déclarée, soit ayant une situation précaire dans l’emploi, car ces femmes ont une initiation des soins plus tardive et des issues périnatales plus défavorables que les femmes qui travaillent avec une position sociale plus favorisée. / Background and objectives: The occupational activity rate of women is steadily increasing since the 1970s, and women are more and more often in employment when they are in childbearing age. The main purpose of this work is to describe and understand the links between occupational activity and pregnancy. First, by comparing employment rates according to whether women are pregnant or belong to the female general population. In a second step, by observing how their occupational group and status is linked to the timing of prenatal leave. Finally, the third part analyzes the impact of the social position, defined by the employment status of women and taking into account their couple status and the employment of the partner, on the antenatal care and perinatal outcomes.Methods and population: The data were extracted from the French National Perinatal Surveys of 1972, 1981, 1995, 1998, 2003, 2010 and 2016 and the Census. A comparison of the employment rate of pregnant women and the general population of women in continental France, by age and level of education, was carried out. A modelization of the employment rate of women during pregnancy was realized according to the socio-demographic characteristics, the survey period from 1972 to 2016, and the birth generation. An analysis of women working during pregnancy in 2010 and 2016 was conducted to determine the time of prenatal leave, according to the medical situation and the social position of women, focused on early leave, before 24 weeks of gestation (WG), and late leave, after 36 WG. For the period 1995 to 2016, prenatal care and perinatal outcomes were analyzed according to the employment status of women, taking into account their couple situation and partner’s employment.Results: As in the general population, rate of occupational activity of pregnant women shown a steadily increasing, between 1972 and 2016, from 53% to 74%. In 2016, 32% of women working during pregnancy leave their job before 24 WG, and 2% after 37 WG. Social inequalities exists around maternity leave: women with the most unfavorable social situations stop early, while self-employed women and those with more favorable social and occupational situations leave late, even after stratification for the medical situation. From 1995 to 2016, the differences in antenatal care and perinatal outcomes according to the social position of pregnant women are always observed despite a reduction.Conclusion: The major changes in the relationship to women's occupational activity in recent decades may change the practices of caregivers for pregnant women. A majority of pregnant women had a paid job and the date of prenatal leave should be discussed in relation to the medical situation but also considering the social and occupational status. Special attention should be given to the most disadvantaged women, either unemployed or without a legal job, or having a precarious occupational situation, since these women have a later initiation of care and more unfavorable perinatal outcomes.

Ongoing research indicates that the burden of infection and mortality from the coronavirus disease 2019 (COVID-19) has been disproportionately borne by Latinx populations in the United States (U.S.). While Latinx people account for 18.4% of the U.S. population, they make up 23.1% of total COVID-19 cases and almost 38% of all COVID-19-related-deaths in the U.S. Latinx people face systemic socioeconomic and political challenges that adversely impact their risk of exposure to and recovery from COVID-19. This investigation will discuss the health disparities experienced by the U.S. Latinx population that have been exacerbated by the COVID-19 pandemic, with a particular focus on the social determinants of health (SDOH) and the unmet social needs for this population.

Thesis advisor: Rebekah L. Coley / Recent decades have witnessed the increasing spatial concentration of poverty and affluence in the United States (Biscoff & Reardon, 2013). Given well-documented links between neighborhood economic contexts and wellbeing (Chow et al., 2005), this has the potential to exacerbate disparities in health, particularly for people with limited neighborhood choice. However, limited research has systematically examined the neighborhood features underlying these links. A more nuanced understanding of why neighborhood poverty matters is essential for promoting equitable neighborhood development. Using rigorous analytic techniques that account for the dynamic nature of neighborhoods and help adjust for selection bias, I considered two complementary questions: 1) do observed neighborhood resources and stressors mediate associations between neighborhood poverty and wellbeing within and between individuals; and 2) how do observed versus perceived changes in neighborhood features mediate links between neighborhood poverty and wellbeing? I combined individual-level longitudinal data from the Post-Katrina Study of Resilience and Recovery with administrative neighborhood data drawn from the Census Bureau, FBI, and EPA. Analyses focused on a sample of 606 participants – primarily young Black mothers with low levels of income – who were affected by Hurricane Katrina, most of whom experienced some period of forced relocation. Participants were surveyed once before (2003/04) and twice after (2006/07; 2009) the hurricane. Results paint a complex picture. Contrasting with prior research, total effects of neighborhood poverty on wellbeing were limited. However, changes in neighborhood poverty were linked to wellbeing indirectly through intermediary neighborhood features, with results pointing to benefits and detriments of rising neighborhood poverty. Results were driven by those who changed neighborhoods over the course of the study. For participants that lived in the same New Orleans neighborhood across waves, changes in neighborhood poverty proved less consequential. Overall, results suggest that rather than treating neighborhood poverty as uniformly problematic for wellbeing, efforts to promote health equity should identify and build upon existing assets of neighborhoods, like affordability and amenity access, while also reducing stressors. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

This thesis investigates the impact of social determinants on life expectancy in 16 transition economies from 1995 to 2012 by a panel data regression analysis. The regression result suggests that, air quality, coverage for tertiary education, spending in health care have statistically positive associations with life expectancy. To be specific, 1 microgram per cubic meter reduction in PM 2.5 air pollution(mean annual exposure) is associated with a gain of 2.16 months of life expectancy at birth. 100 dollars increase in health expenditure per capita is associated with a gain of 2.4 months of life expectancy at birth. 10% points increase in the gross enrolment ratio for tertiary school is associated with a gain of 3.6 months of life expectancy. But the proxy variable of democracy(Unified Democracy Sores), Economic Freedom and out-of-pocket health expenditure are not significant factors of life expectancy.

Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers. Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in ruralareas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration. Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / The emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.

Background: Gender inequality is widespread throughout Latin America, in large part due to a ‘machista’ culture in which women tend to be regarded as inferior to men. In Colombia, especially in low-income areas, women and girls are consistently excluded and marginalized. As a result of this, adolescent girls are susceptible to gang recruitment, teen pregnancy, and substance abuse. In similar settings globally, sport has been shown to be an effective tool for development and for the socialization and inclusion of youth. Few studies have taken place in Latin America, however, and hardly any of them have focused specifically on marginalized girls. This study aims to address this gap in literature by exploring how sport can break down barriers of exclusion and promote inclusion of marginalized, adolescent girls in Colombia. Methods: This qualitative, multi-methods study involved the analysis of data collected from semi-structured and key informant interviews, as well as participant observation sessions. All data collection was conducted in Cazucá, Colombia with participants from local NGO Tiempo de Juego (TDJ). Semi-structured interviews were conducted with adolescent girls between the ages of 11-18 who were participating in at least 1 sport at TDJ. Key informant interviews were conducted with TDJ staff and a guardian of several girls who participate in TDJ. Interview transcripts and participant observation memos and reflections were reviewed and coded to identify themes through thematic analysis. Results: All participants interviewed indicated that sport had a positive impact on their day to day lives. Three main themes and two sub-themes were identified during data analysis: 1) ‘Machismo’ in Colombia with sub-themes: i) Gender Roles and ii) Gender Norms, 2) Exclusion and marginalization, and 3) Empowerment through sport. Most participants spoke about the prevalence of machismo in Colombian society and how gender roles and norms limit the types of opportunities that are available to them. Participants expressed how, although they are marginalized based on where they live, sport provided them with a healthy activity to engage in as an alternative to the negative behaviours that they are susceptible to in their neighbourhoods. Sport provided them with an outlet to escape from their daily problems, and they felt that through sport, they were able to realize their self-worth and gain confidence in themselves. Conclusion: These findings suggest that sport can become a useful tool for promoting the inclusion of marginalized girls through empowerment. While sport was shown to break down some barriers of exclusion, further work must be done to explore its potential role in breaking down gender stereotypes that remain prevalent in Colombian culture. These results highlight the need for more sport programs that focus on marginalized girls in Latin American countries where women and girls remain a neglected population.