A person-reported cumulative social risk measure does not show bias by income and education.

BACKGROUND: Social risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing. METHODS: We conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model. RESULTS: Analyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible. CONCLUSIONS: Results suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.

How Do Households Fare Economically When Mothers Become Their Primary Financial Support?

The economic circumstances in which children grow up have garnered much scholarly attention due to their close associations with well-being over the life course. While it has been well-documented that children are increasingly growing up in households where their primary financial support comes from their mother, regardless of whether she is partnered or single, the consequences for household economic well-being are unclear. We use the 2014 Survey of Income and Program Participation to quantify how a mother's transition into primary earner status affects the economic well-being of her household and if the effects differ based on her relationship status. On average, household income declines and more households are unable to meet their economic needs once the mother becomes the primary earner. However, these declines in income are concentrated among partnered-mother households and mothers who transition from partnered to single during the year. At the same time, although many single mothers see an increase in household income, the majority of these households are still unable to meet their economic needs. These findings suggest that the shift to a welfare system that requires employment coupled with structural changes in the labor market have created financial hardship for most families.

Financial hardship after cancer: revision of a conceptual model and development of patient-reported outcome measures.

Aim: This qualitative study refined a conceptual model of financial hardship and developed measures corresponding to model constructs. Methods: Eighteen women with breast cancer recruited through a comprehensive cancer center completed interviews. A qualitative framework analysis was conducted of the interviews. Results: Participants experienced varying levels of financial hardship. Protective factors included good health insurance, work accommodations and social support. Participants worried about cancer care costs and employment. Programs for alleviating financial hardship had high administrative burdens. Four preliminary financial hardship measures were developed: coping, impacts, depression and worry. Conclusion: Reducing administrative barriers to benefits could reduce financial hardship after cancer. More research is needed on the effects of out-of-network/formulary care and denials of coverage and to validate the measures.

Financial hardship is common after cancer diagnosis. This study interviewed women with breast cancer about financial hardship. Financial hardship included how participants coped with healthcare costs and reduced income. Worry and depression were also aspects of financial hardship. Administrative burdens led to financial hardship. Administrative burdens were actions patients had to take to access financial support. This study also created surveys to measure financial hardship in cancer.

This study revised a conceptual model of financial burden after cancer. Measures were developed for each financial burden dimension from the model. Reducing administrative hurdles for work accommodations and insurance could prevent burden.

Preclinical Dementia and Economic Well-Being Trajectories of Racially Diverse Older Adults.

ObjectivesThis study examined the magnitude, changes, and racial/ethnic disparities in the economic costs of the 16-year preclinical phase of dementia-a period of cognitive decline without significant impact on daily activities. Methods: The study utilized two dementia algorithms to classify individuals with incident dementia in the Health and Retirement Study. These cases were compared to matched controls in terms of poverty status, labor force participation, and unsecured debts. Results: Older adults classified with dementia were more likely to drop out of the labor force and become poor than similar older adults without dementia. Racial/ethnic disparities in poverty persisted during the preclinical period, with non-Hispanic Black older adults more likely to leave the labor force and Hispanic older adults more likely to have unsecured debt. Discussion: Findings highlight the economic costs during prodromal phase of dementia, emphasizing need for early interventions to reduce financial strain across diverse older adults.

A comprehensive analysis of well-being frameworks applied in Australia and their suitability for Indigenous peoples.

PURPOSE: Well-being is a complex, multi-dimensional, dynamic, and evolving concept, covering social, economic, health, cultural and spiritual dimensions of human living, and often used synonymously with happiness, life satisfaction, prosperity, and quality of life. We review the existing key wellbeing frameworks applied in Australia both for the wider public and Indigenous peoples. The aim is to provide a comprehensive overview of various applied frameworks, along with a critical analysis of domains or dimensions comprising those frameworks, and to analyse the role of nature in those frameworks. METHODOLOGY: We conducted a critical analysis of the main frameworks applied in Australia to date to measure the well-being of the mainstream (mainly non-Indigenous) and Indigenous populations. This study is particularly timely given the Australian Government's interest in revising the well-being frameworks as mentioned in the Government "Measuring What Matters" statement. RESULTS: The existing well-being frameworks in Australia either overlook or hardly consider the role of nature and its services which are important to support human well-being. Likewise, for Indigenous peoples "Country" (Indigenous clan land) is vital for their well-being as their living is imbued with "Country". The role of nature/"Country" needs to be considered in revising the well-being frameworks, indicators and measures to inform and develop appropriate policies and programs in Australia. CONCLUSION: To develop appropriate welfare policies and programs for achieving socio-economic and other wellbeing outcomes, it is essential to evolve and conceptualize wellbeing frameworks (and related indicators and measures) in line with people's contemporary values, particularly considering the role of nature and its services.

Disparities in the impact of economic well-being on self-esteem in adulthood: Race and ethnicity.

BACKGROUND: Most studies have defined economic well-being as socioeconomic status, with little attention given to whether other indicators influence self-esteem. Little is known about racial/ethnic disparities in the relationship between economic well-being and self-esteem during adulthood. AIM: To explore the impact of economic well-being on self-esteem in adulthood and differences in the association across race/ethnicity. METHODS: The current study used data from the National Longitudinal Survey of Youth 1979. The final sample consisted of 2267 African Americans, 1425 Hispanics, and 3678 non-Hispanic Whites. Ordinary linear regression analyses and logistic regression analyses were conducted. RESULTS: African Americans and Hispanics were more likely to be in poverty in comparison with non-Hispanic Whites. More African Americans were unemployed than Whites. Those who received fringe benefits, were more satisfied with jobs, and were employed were more likely to have higher levels of self-esteem. Poverty was negatively associated with self-esteem. Interaction effects were found between African Americans and job satisfaction predicting self-esteem. CONCLUSION: The role of employers is important in cultivating employees' self-esteem. Satisfactory outcomes or feelings of happiness from the workplace may be more important to non-Hispanic Whites compared to African Americans and Hispanics.

The association between material-psychological-behavioral framework of financial hardship and markers of inflammation: a cross-sectional study of the Midlife in the United States (MIDUS) Refresher cohort.

BACKGROUND: Measures of financial hardship have been suggested to supplement traditional indicators of socioeconomic status (SES) to elucidate household economic well-being. This study formally tested the construct validity of financial hardship and examined its association with markers of inflammation. METHODS: This study utilized data from the Midlife Development in the United States Refresher Study (MIDUS-R; Age = 23-76, 53.7% female, 71% white). Participants were divided into exploratory factor analysis (EFA; completed SAQs only; N = 2,243) and confirmatory factor analysis sample (CFA; completed SAQs and biomarker assessment; N = 863). Analysis was divided into three steps. First, exploratory factor analysis (EFA) is used to examine if the three-domain factor (material, psychological, and behavioral) is the best fitting model for financial hardship measures. Second, we conducted CFA to test the hypothesized three-factor measurement model of financial hardship. Third, we tested the association between domains and the general latent factor of financial hardship and inflammation (interleukin 6/IL6, c-reactive protein/CRP, and fibrinogen). RESULTS: Results from EFA supported the three-domain model of financial hardship. The hypothesized three-domain measurement model fits well in a different sample within MIDUS-R. In the models adjusted for age and sex, higher material hardship was associated with elevated IL6, CRP, and fibrinogen, while higher behavioral hardship was associated with higher CRP. The association between the material domain and IL6 remained significant after adding body mass index, education, and race as additional covariates. The second-order financial hardship measurement model was associated with IL6, CRP, and fibrinogen, adjusted for age, sex, BMI, education, and race. CONCLUSION: Explicating the socioeconomic environment to include indicators of financial hardship can help researchers better understand the pathway between SES and the inflammation process, which may help elucidate pathways between SES and age-related chronic diseases associated with inflammation.

Influence of Parenting Guilt on the Mental Health among Single-Parent Women: Multiple Additive Moderating Effect of Economic Well-Being and Level of Education.

This study explored how the core problems (e.g., parenting, economy, and education level) of single-parent women affect their mental health. Although parenting guilt, economic well-being, and level of education are important variables that affect the mental health of single parents, there is no study that examines the interaction effect between them together. Therefore, this study examined the moderating effects of economic well-being and level of education on the relationship between parenting guilt and mental health in 419 single-parent women. In addition, it was verified whether there was a multiple additive modulation effect when they were put in at the same time. As a result, the higher the parenting guilt and the lower the economic well-being, the higher the level of mental health pain, but the level of education had no statistical significance. However, the interaction term between parenting guilt and education level had statistical significance, while the interaction term between parenting guilt and economic well-being did not produce significant results. These findings suggest the importance of education for single-parent women's mental health as well as the need to establish policies that allow them to have sufficient time and room for child rearing.

Maternal Diet Quality and Prenatal Depressive Symptoms: The Moderating Role of Economic Well-Being.

Prenatal depression is prevalent and adversely impacts maternal and infant health. This study addresses a critical literature gap and investigates the association between maternal diet quality and prenatal depressive symptoms, as well as the moderating effect of economic well-being on this link. A cross-sectional design was used, including 43 healthy pregnant women in the second trimester aggregated from two research projects. Prenatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Dietary quality was evaluated using two non-consecutive 24 h dietary recalls, from which the Adapted Dietary Inflammatory Index (ADII) and the Healthy Eating Index (HEI)-2015 were derived. Economic well-being was indicated by the income-to-poverty ratio. A higher HEI-2015 (adherence to dietary guidelines; ß = -0.53, p = 0.01) and negative ADII (anti-inflammatory diet; ß = 0.40, p = 0.06) were associated with fewer prenatal depressive symp-toms. Among pregnant women with worse economic well-being, a pro-inflammatory diet was as-sociated with more prenatal depressive symptoms (b = 1.69, p = 0.004), but among those with better economic well-being, the association was not significant (b = 0.51, p = 0.09). Dietary interventions aimed at reducing dietary inflammation might hold some promise for improving mental health among pregnant women who are economically vulnerable.

Whose Future, Whose Security?: Unconventional Oil and Gas Extraction and the Economic Vulnerability and Forced Participation of Small-scale Property Owners.

Since the 'shale revolution' of the late 2000s, unconventional oil and gas extraction (UOGE) has been hailed by many as a boon for local and regional economies, workers, and property owners. While energy social science has documented many realities that counter this narrative - natural resource dependent economies, 'boom and bust' cycles of the energy industry, and 'resource curse'- there is less research examining economic impacts of UOGE for small-scale property owners. While some large-scale property owners lease their land, minerals, or water rights to oil and gas companies in exchange for royalties, other property owners are not able or do not wish to do so. Yet, nearby UOGE may negatively impact property values and thus threaten people's sense of economic stability. Several legal mechanisms - forced pooling, split estate, and rule of capture - significantly restrict the rights of many property owners while privileging other property rights. While property ownership represents a privileged status, it is the largest investment many Americans will make and is relied upon for retirement planning, financial stability, and transfer of generational wealth. Yet, despite the importance of property ownership, particularly home ownership, little is known about how proximity to oil and gas development impacts small-scale property owners. This paper analyzes how UOGE impacts property owners' sense of economic precarity. We conducted surveys of hundreds of affected households and interviews with 66 property owners in two Colorado towns that have experienced heavy UOGE. We find that the current regulatory regimes disempower small-scale property owners, create economic vulnerability, and ultimately privilege property rights of mineral owners and operators over others - creating uncompensated losses for small-scale property owners. We explore important implications, including the need for more responsive and community-based governance processes.

Effects of Economic Well-Being on Outcomes at One Year after Volar Plate Fixation of Distal Radius Fractures.

Background: The objective of this study was to determine whether economic well-being is associated with patient-reported functional outcomes and range of motion 1 year following volar plate fixation of distal radius fracture. Methods: A retrospective study was performed on 200 patients with distal radius fractures treated with volar plate fixation at two Level 1 trauma centres from 2006 to 2017 with 1-year clinical follow-up using a previously published cohort. The economic well-being of patients was assessed using the Distressed Communities Index (DCI). Our outcome variables were patient-reported functional outcomes assessed by QuickDASH score and wrist and forearm range of motion 1 year after surgery. The analysis of variance (ANOVA) test was used to compare outcome variables across pre-established tiers of economic well-being. Results: The mean QuickDASH score at 1 year following distal radius fracture volar plate fixation was 10.8 and ranged from 7.3 to 12.2 across tiers of economic well-being. QuickDASH score and wrist range of motion were not significantly different across all tiers of economic well-being. However, wrist flexion-extension arc at 1 year following surgery was significantly decreased in the economically at-risk group compared with the remaining cohort. Conclusions: Patient-reported functional outcomes 1 year after volar plate fixation of distal radius fracture are similar across tiers of economic well-being. Economically disadvantaged patients are at risk for poorer wrist motion following distal radius fracture surgery, though it is not clear if this difference is clinically significant. Level of Evidence: Level II (Prognostic).

Time cannot heal all wounds: Wealth trajectories of divorcees and the married.

Objective: To explore disparities in wealth trajectories between divorcees and continuously married individuals including moderation effects of remarriage and gender. Background: Amid concerns of long-term economic consequences of divorce, research illustrated that ever-divorced individuals hold less wealth than the married preretirement. However, it remains unclear whether this is a direct result of immediate, lasting divorce-related wealth penalties or whether divorce also leads to long-term wealth accumulation disparities. Method: Using personal-level, longitudinal wealth data from the Socio-Economic Panel Study, I applied propensity score and exact matching with random-effects growth models to compare wealth trajectories of divorcees and the married. The matching allowed (1) married controls to be assigned a theoretical divorce date for ease of comparability to the treatment group (i.e., divorcees) and (2) the account of a wide range of baseline differences. Results: Wealth differences between ever-divorce and continuously married individuals stem from lasting disadvantage-particularly for housing wealth-generated immediately around divorce rather than a scarring of divorcees' wealth accumulation. Remarriage but particularly gender is relevant moderators. Whereas remarriage moderates net wealth trajectories through housing wealth, gender moderates trajectories through financial wealth. Conclusion: Divorce importantly contributes to wealth stratification. Mitigation of divorce-related wealth penalties for both men and women needs to focus on immediate, but lasting costs of divorce particularly regarding homeownership.

Divergent trajectories: three dimensions of child poverty during the Great Recession in Ireland.

While research has investigated the effects of the Great Recession on the Irish economy using economic indicators or cross-sectional household-level data, this research note applies group-based multitrajectory modelling to provide a more nuanced approach. Using nationally representative, longitudinal data from the Growing Up in Ireland study, we analyse patterns in three common measures of economic well-being (financial strain; disposable income; material deprivation) across Irish households in the period leading up to, during and after the Great Recession, and subsequently, break down the characteristics for each group of trajectories. We identify six distinct trajectory clusters, which all indicate declining income and increasing financial strain from the start to the height of the economic depression. However, trajectory groupings show that experiences were far from uniform, with previous economic well-being and demographic characteristics shaping the household experience. Implications for future research are discussed.

Improving preparedness for next pandemics: Max level of COVID-19 vaccinations without social impositions to design effective health policy and avoid flawed democracies.

In the presence of pandemic threats, such as Coronavirus Disease 2019 (COVID-19) crisis, vaccination is one of the fundamental strategies to cope with negative effects of new viral agents in society. The rollout of vast vaccination campaigns also generates the main issue of hesitancy and resistance to vaccines in a share of people. Many studies have investigated how to reduce the social resistance to vaccinations, however the maximum level of vaccinable people against COVID-19 (and in general against pandemic diseases), without coercion in countries, is unknown. The goal of this study is to solve the problem here by developing an empirical analysis, based on global data, to estimate the max share of people vaccinable in relation to socioeconomic wellbeing of nations. Results, based on 150 countries, reveal that vaccinations increase with the income per capita, achieving the maximum share of about 70% of total population, without coercion. This information can provide new knowledge to establish the appropriate goal of vaccination campaigns and in general of health policies to cope with next pandemic impacts, without restrictions that create socioeconomic problems. Overall, then, nations have a natural level of max vaccinable people (70% of population), but strict policies and mandates to achieve 90% of vaccinated population can reduce the quality of democracy and generate socioeconomic issues higher than (pandemic) crisis.

Association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID-19 pandemic.

OBJECTIVE: The aim of this study is to explore the association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID-19 pandemic. DESIGN: A cross-sectional study via SurveyMonkey was conducted in Australia between August 2020 and October 2020. Descriptive and inferential statistics were used to analyze the data. RESULTS: A total of 1211 individuals responded to the survey. Income loss was significantly associated with those from low socioeconomic status (OR = 1.65; 95% CI 1.01-2.68). Access of superannuation was significantly associated with those in outer regional (OR = 3.61; 95% CI 0.81-16.03) and low socioeconomic status (OR = 2.72; 95% CI 1.34-5.53). Financial inability to pay for services was significantly associated with living in remote areas (OR = 2.26; 95% CI 0.88-5.80). CONCLUSIONS: The economic wellbeing of people who identify as Aboriginal and Torres Strait Islander, live in regional or remote areas, and reside in low socioeconomic areas have been substantially impacted during the pandemic. Findings call for policies to address the underlying social determinants of health.

Maternal depression and economic well-being: A quasi-experimental approach.

Maternal depression is associated with adverse impacts on the health of women and their children. However, further evidence is needed on the extent to which maternal depression influences women's economic well-being and how unmeasured confounders affect estimates of this relationship. In this study, we aimed to measure the association between maternal depression and economic outcomes (income, employment, and material hardship) over a 15-year time horizon. We conducted longitudinal analyses using the Fragile Families and Child Wellbeing Study, an urban birth cohort study in the United States. We assessed the potential contribution of time-invariant unmeasured confounders using a quasi-experimental approach and also investigated the role of persistent versus transient depressive symptoms on economic outcomes up to 15 years after childbirth. In models that adjusted for time-invariant unmeasured confounders, maternal depression was associated with not being employed (an adjusted risk difference of 3 percentage points (95% CI 0.01 to 0.05)) and experiencing any material hardship (an adjusted risk difference of 14 percentage points (95% CI 0.12 to 0.16)), as well as with reductions in the ratio of household income to poverty by 0.10 units (95% CI -0.16 to -0.04) and annual household income by $2114 (95% CI -$3379 to -$850). Impacts at year 15 were strongest for those who experienced persistent depression. Results of our study strengthen the case for viewing mental health support services as interventions that may also foster economic well-being, and highlight the importance of including economic impacts in assessments of the cost-effectiveness of mental health interventions.

Association of Economic Well-Being With Comorbid Conditions in Patients Undergoing Carpal Tunnel Release.

PURPOSE: Medical comorbidities have been associated with the development of carpal tunnel syndrome (CTS), severity at the time of presentation, and outcomes of carpal tunnel release (CTR). Socioeconomic factors have also been associated with worse function in patients with CTS at presentation and after surgery. However, the effects of economic well-being on the prevalence of medical comorbidities in patients with CTS have not been well-described. The objective of this study was to determine whether economic well-being is associated with medical comorbidities in a cohort of patients undergoing CTR. METHODS: Patients (n = 1,297) who underwent CTR at a single tertiary care referral center over a 5-year period from July 2008 to June 2013 were retrospectively identified. The exclusion criteria were acute trauma or infection, revision surgery, incomplete medical records, and neoplasm excision. Additionally, patients were excluded if they lacked documented confirmatory or normal electrodiagnostic study findings prior to CTR. Finally, this study comprised a cohort of 892 patients with electrodiagnostic study-confirmed CTS who underwent CTR. The economic well-being of patients was assessed using the Distressed Communities Index. The comorbidities of diabetes mellitus, chronic kidney disease, hypertension, hypothyroidism, cervical radiculopathy, tobacco use, and body mass index were assessed. Bivariate comparisons were used to determine the associations between the tiers of economic well-being and comorbidities. RESULTS: Lower economic well-being was associated with body mass index, diabetes mellitus, chronic kidney disease, and tobacco use in these patients. Although hypertension, hypothyroidism, and cervical radiculopathy were not associated with economic well-being, their comparisons were underpowered. CONCLUSIONS: Patients experiencing economic distress have a higher comorbidity burden, and as such, may be at an increased risk of complications or poorer outcomes. The association between economic well-being and comorbidities in this population suggests the need for a multidisciplinary care model that addresses both compressive neuropathy and the associated economic factors. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Environmental Performance in EU Countries from the Perspective of Its Relation to Human and Economic Wellbeing.

The actual development challenges impose new criteria of national performance evaluation, the concept of wellbeing tending to be measured not just in terms of economic and social dimensions, but also vs. the environment. Accordingly, considering the national environmental performance among the EU countries in 2006-2019 period, we grouped them and concentrated on the clusters registering the highest and lowest levels, analyzing how the components of the human and economic dimensions influence it. Applying panel data models, our main results emphasized that, firstly, for the countries with a better environmental performance, sufficient drinking water, safe sanitation, education, gender equality, and good governance were significant; in the countries with the lowest levels of environmental wellbeing, sufficient food, sufficient to drink, education, and income distribution were insignificant, while the remaining components were relevant. Secondly, in both groups of countries, organic farming and public debt were significant; nevertheless, differences were observed for genuine savings and employment, for which the peculiarities of economic activities seemed to be materialized as different influences upon environmental wellbeing. Our study draws alarm signals regarding the development patterns applied in the EU, seeming to have results that strengthen the sustainable goals, but not sufficient for exceeding the traditional growth-oriented model.