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Quality of residential area, or neighborhood, is one determinant of overall quality of life and associated with health and health behavior. Ensuring that urban and suburban neighborhoods remain liveable and comfortable to reside in is a challenge amidst growing urbanization. Neighborhood quality has been associated with socio-demographic, dwelling-related, and subjective and objective neighborhood factors. However, only a few studies have additionally included participation in neighborhood decision-making and examined whether these associations are stronger among residents who are more settled in the neighborhood. We examined whether subjectively and objectively measured environmental factors and participation are associated with perception of neighborhood liveability and possible effect moderators. We analyzed survey data collected in 2021 among adults (aged 18–97) living in suburbs and urban centers in five Finnish cities ( n  = 2057; response rate 34%) with logistic regression models. Almost 80% of the respondents perceived their neighborhood as liveable or very liveable. The following factors were most strongly associated with perceiving the neighborhood as liveable: low area-level socioeconomic deprivation; central urban zone; green view from home; satisfaction with neighborhood safety, green areas, blue areas, and maintenance of traffic routes; and good or very good possibilities to influence decisions regarding the neighborhood. Only a few interactions between indicators of being more settled in the neighborhood (e.g., age group and dwelling ownership) modified these associations. In all, our study suggests that to maintain liveability, urban or community planning should consider local residents’ favorable perceptions of safety, recreational areas, and engagement in decision-making.

The coronavirus disease 2019 (COVID-19) has had a rapid and sustained negative impact on sleep and mental health in the United States with disproportionate morbidity and mortality among socioeconomically deprived populations. We used multivariable and logistic regression to evaluate the associations among sleep duration, mental health, and socioeconomic deprivation (social deprivation index) in 14,676 Ohio residents from 1101 zip code tabulation areas from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey. Higher socioeconomic deprivation was associated with shorter sleep and poorer mental health after adjusting for covariates (age, sex, race, education, income, and body mass index) in the multivariable linear regression models. Those in the highest socioeconomically deprived areas had 1.6 and 1.5 times higher odds of short sleep (duration < 6 h) and poor mental health (>14 poor mental health days), respectively, in the logistic regression models. Previous researchers have focused on limited socio-environmental factors such as crowding and income. We examined the role of a composite area based measure of socioeconomic deprivation in sleep duration and mental health during the first year of COVID-19. Our results suggest the need for a broader framework to understand the associations among socioeconomic deprivation, sleep duration, and mental health during a catastrophic event.

This study analysed the evolution of the association of socioeconomic deprivation (SED) with SARS-CoV-2 infection and COVID-19 outcomes in urban Italy during the vaccine rollout in 2021. We conducted a retrospective cohort analysis between January and November 2021, comprising of 16,044,530 individuals aged ≥ 20 years, by linking national COVID-19 surveillance system data to the Italian SED index calculated at census block level. We estimated incidence rate ratios (IRRs) of infection and severe COVID-19 outcomes by SED tercile relative to the least deprived tercile, over three periods defined as low (0–10%); intermediate (> 10–60%) and high (> 60–74%) vaccination coverage. We found patterns of increasing relative socioeconomic inequalities in infection, hospitalisation and death as COVID-19 vaccination coverage increased. Between the low and high coverage periods, IRRs for the most deprived areas increased from 1.09 (95%CI 1.03–1.15) to 1.28 (95%CI 1.21–1.37) for infection; 1.48 (95%CI 1.36–1.61) to 2.02 (95%CI 1.82–2.25) for hospitalisation and 1.57 (95%CI 1.36–1.80) to 1.89 (95%CI 1.53–2.34) for death. Deprived populations in urban Italy should be considered as vulnerable groups in future pandemic preparedness plans to respond to COVID-19 in particular during mass vaccination roll out phases with gradual lifting of social distancing measures.

Traumatic brain injury (TBI) is a leading cause of death and disability, primarily caused by falls and motor vehicle collisions (MVC). However, understanding the spatial distribution of TBI risk and their correlation with area-based deprivation remains limited. This study addresses this gap by employing a Bayesian spatial modeling approach to analyze the spatial patterns of fall and MVC-related TBI and their associations with area-based deprivation. Data on TBI cases from 2003 to 2019 in the Halifax Regional Municipality were sourced from the Nova Scotia Trauma Registry. Patients' residential postal codes were geocoded to dissemination areas (DAs), and area-based deprivation status from the national census data was linked to DAs. Bayesian spatial models were utilized to analyze TBI incidence rates resulting from falls and MVCs across DAs. The analysis revealed a substantial spatial disparity in TBI risk, illustrated through maps showing both the relative risk and posterior exceedance probability. Furthermore, area-based deprivation emerged as a significant factor associated with TBI risk. Specifically, areas within the most economically deprived quintile increased the risk of fall related TBI nearly threefold (RR = 2.7, 95%CI 1.98–3.66) compared to those in the least deprived quintile. The most residentially unstable quintile had a 35% greater risk of fall-related TBI than the least deprived quintile (RR = 1.35, 95%CI = 1.01–1.80). The risk of MVC-related TBI increased by 71% among areas in the second most deprived quintile (RR = 1.71; 95% CI 1.18–2.49), highlighting situational vulnerability as a significant risk factor. Deprivation was mapped within a social determinants of health framework to understand the downstream effects of residential instability, economic dependency, and situational vulnerability. This study reveals the unique spatial risk patterns of TBI resulting from falls and MVCs and demonstrates the impact of areal-level deprivation on injury risk. By identifying high-risk areas and understanding the pathways through which deprivation acts on the physical environment and community behavior, public health interventions can be developed to mitigate injury risk.

Background Increasingly, evidence has shown that different aspects of neighborhood context play a significant role in self-rated health, one of the key health indicators in advanced age. Nevertheless, very old adults are often under represented or excluded from such research. Therefore, the first aim of this study was to examine whether social, socioeconomic, and physical neighborhood context is associated with self-rated health in the very old population of Germany. The second objective was to explore whether the link of socioeconomic and physical neighborhood context with self-rated health is moderated by availability of social resources in neighborhoods. Methods Data from the representative survey, “Old Age in Germany” (D80+) were employed. In total, the study sample of D80+ included 10,578 individuals aged 80 years and over. Additionally, the D80+ data were matched with the freely accessible regional dataset of the Federal Institute for Research on Building, Urban Affairs, and Spatial Development. Two self-rated items (place attachment and social cohesion) were used to assess social neighborhood context. Socioeconomic context of neighborhoods was operationalized by German index of socioeconomic deprivation. To evaluate physical context, perceived measures of building conditions and walkability were included. Using the maximum likelihood estimator with robust standard errors, logistic regression models were estimated to analyze the relationship between neighborhood context (social, socioeconomic, and physical context, as well as their interactions) and self-rated health. Results Including 8,066 participants in the analysis, the findings showed that better condition of residential building, higher walkability, being closely attached to outdoor places, and higher social cohesion were associated with higher chance to report good self-rated health of very old adults. In the adjusted models, the German socioeconomic deprivation index was not related to self-rated health. The effect of socioeconomic and physical neighborhood context on self-rated health did not differ according available neighborhood social resources. Conclusions The results indicate that especially more favorable conditions in social and physical neighborhood context are associated with good self-rated health in the very old population of Germany. Further studies should consider multiple aspects of neighborhood context as well as their interplay when examining the neighborhood impact on self-rated health in older populations.

Background The number of people living with diabetes is rising worldwide and a higher prevalence of diabetes has been linked to those experiencing socioeconomic deprivation. Self‐management strategies are vital and known to reduce the risks of long‐term complications amongst people living with diabetes. Lack of knowledge about self‐care activity required to manage diabetes is a key barrier to successful self‐management. Self‐management interventions can be less effective in socioeconomically deprived populations which can increase the risk of exacerbating health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self‐management of diabetes amongst people who are socioeconomically disadvantaged. Methods MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self‐management of multiple long‐term conditions amongst socioeconomically disadvantaged populations. Relevant papers which focused on diabetes were identified. Data were coded and thematically synthesised using NVivo. Findings From the search results, 79 qualitative studies were identified after full‐text screening and 26 studies were included in the final thematic analysis. Two overarching analytical themes were identified alongside a set of subthemes: (1) Socioeconomic barriers to diabetes self‐management; healthcare costs, financial costs of healthy eating, cultural influences, living in areas of deprivation, competing priorities and time constraints, health literacy, (2) facilitators of diabetes self‐management; lifestyle and having goals, support from healthcare providers, informal support. Discussion Self‐management of diabetes is challenging for people experiencing socioeconomic deprivation due to barriers associated with living in areas of deprivation and financial barriers surrounding healthcare, medication and healthy food. Support from healthcare providers can facilitate self‐management, and it is important that people with diabetes have access to interventions that are designed to be inclusive from a cultural perspective as well as affordable. Patient or Public Contribution A patient advisory group contributed to the research questions and interpretation of the qualitative findings by reflecting on the themes developed.

Background Informal carers compose approximately 7% of the UK population and, through their unpaid care, they make important contributions to society and the health care industry. Being an informal carer is higher in people experiencing socioeconomic deprivation; however, no qualitative research has explored the impact of this on the ability to provide care for those with long‐term conditions. Aim To explore the experiences and challenges of being a carer whilst experiencing socioeconomic deprivation. Methods Semi‐structured one‐to‐one interviews with adults experiencing socioeconomic deprivation (n = 12) living in London and Sheffield, United Kingdom. Participants were recruited through social media and community channels. Data were managed in NVivo and analysed using reflexive thematic analysis. Results Three analytical themes were developed: (1) Economic insecurity including insecure housing and challenges with financial welfare leading to sacrificing the necessities such as healthy food, water and heating; (2) social and structural barriers such as a lack of opportunities for social mobility due to care impacting employment and educational attainment, as well as area‐based barriers and feeling unheard by professionals; (3) the emotional challenges and rewards of being a carer such as managing people with poor mental well‐being exacerbated by their socioeconomic situation, whilst finding their caring role meaningful. Conclusion Carers experiencing socioeconomic deprivation face additional challenges and barriers in their ability to provide care such as more emotional work, making sacrifices of necessities due to financial constraints and feeling unheard. Policy changes are needed to better support this population financially and to enable social mobility, as well as development of interventions and support resources for carers to use to feel empowered and to maintain good well‐being.

The standard measures of relative socio-economic deprivation within New Zealand are the NZDEP studies and the NZ IMD. Although both sets of studies are extremely rigorous, high quality research outputs they are only able to provide a snapshot of the national distribution of relative socio-economic deprivation at fixed points in time. The inability to express deprivation levels as an extended and current time series means that not only are policy analysts and researchers working with outdated information, but also that it is often unfeasible to associate changes in deprivation levels to specific events or policy implementations. The Dynamic Deprivation Index (DDI) assigns a deprivation score and deprivation index to each area unit in New Zealand on a monthly basis. In this paper we look to describe the methodology behind the construction of the DDI and to validate the results therein. We argue that if public bodies were to make the data they hold more easily accessible, then there is no reason why New Zealand should not be able to benefit from a measure of socio-economic deprivation that combines the sophistication of the NZDEP studies or IMD with the contemporaneousness of the DDI.

Background Globally, it is estimated that one in three adults live with two or more long‐term conditions (multiple long‐term conditions, MLTCs), that require self‐management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient‐healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self‐managing MLTCs, amongst people who experience socioeconomic deprivation. Methods Semistructured one‐to‐one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Findings Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self‐management, including social isolation, area‐based and economic exclusion, and health‐related stigma and (4) adapting self‐management strategies, including cost‐effective, and culturally/lifestyle appropriate strategies. Conclusions Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self‐management of MLTCs are of great importance. Patient or Public Contribution A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.

In many high‐income countries such as the United Kingdom, inequalities in breastfeeding initiation and continuation rates exist, whereby socio‐economically advantaged mothers are most likely to breastfeed. Breastfeeding peer support interventions are recommended to address this inequality, with non‐profit breastfeeding organisations providing such support in areas of deprivation. As these organisations' roots and membership are often formed of relatively highly resourced women who have different backgrounds and experiences to those living in areas of deprivation, it is important to understand their practices in this context. In order to explore how UK non‐profit organisations practice breastfeeding peer support in areas of socio‐economic deprivation, a systematic review and meta‐ethnography of published and grey literature was undertaken. Sixteen texts were included, and three core themes constructed: (1) ‘changing communities’ reveals practices designed to generate community level change, and (2) ‘enabling one to one support’, explains how proactive working practices enabled individual mothers' access to supportive environments. (3) ‘forging partnerships with health professionals’, describes how embedding peer support within local health services facilitated peer supporters' access to mothers. While few breastfeeding peer support practices were directly linked to the context of socio‐economic deprivation, those described sought to influence community and individual level change. They illuminate the importance of interprofessional working. Further work to consolidate the peer‐professional interface to ensure needs‐led care is required.