Browsing by Subject "Socioeconomic"

Now showing 1 - 6 of 6
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    Dreamchasers: Examining the Organizational Structure of Social Institutions Across Communities & the Inevitable Cultural Influences which Comprise One’s American Dream
    (2023-09) Hibbert, Karl Roy; Parrish-Sprowl, John; Karnick, Kristine; White-Mills, Kim
    In a nation indoctrinated with the notion that civil liberties are an expected set of rights, along with policies, presumably made to ensure the equality of all citizens; the idea of egalitarianism, (the belief that all people are equal and deserve equal rights and opportunities) it is critical to pose the question: how equally accessible is the American Dream for all Americans? Our predisposed congenital qualities such as gender and ethnicity, along with socioeconomic status, all contribute to the ‘societal blueprint’ which dictates one’s social reputation, educational rank, and financial reach in this American nation. More specifically, we find that the journey to achieve the American Dream varies by community and major obstacles that impede on the access to key developmental resources. Often minorities and those who do not fit into the static image of ‘The American Dream’ exhaust most of their time trying to bridge the gap, rather than focusing solely on community advancement. In other words, those who live in communities lacking proper infrastructure essential to modern growth and development are forced to play the hand their dealt, while still being expected to attain the heights of their privileged counterparts. The organizational structure of a community’s social institutions will inevitably influence the resources, motivations, and competence of its members. With this, viewing all American’s as having the same access to the ‘American Dream’ is unreasonable. Through comparing the background and livelihoods of characters from four different movies, I examine the depiction and actuality which media uses to highlight the American Dream; and how the challenges inhibit in the journey looks different across cultures.
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    Exploring for Municipality-Level Socioeconomic Variables Related to Zika Virus Incidence in Colombia
    (MDPI, 2021-02-13) Kellemen, Marie; Ye, Jun; Moreno-Madriñan, Max J.; Global Health, School of Public Health
    Colombia experienced an outbreak of Zika virus infection during September 2015 until July 2016. This study aimed to identify the socioeconomic factors that at the municipality level correlate with this outbreak and therefore could have influenced its incidence. An analysis of publicly available, municipality-aggregated data related to eight potential explanatory socioeconomic variables was conducted. These variables are school dropout, low energy strata, social security system, savings capacity, tax, resources, investment, and debt. The response variable of interest in this study is the number of reported cases of Zika virus infection per people (projected) per square kilometer. Binomial regression models were performed. Results show that the best predictor variables of Zika virus occurrence, assuming an expected inverse relationship with socioeconomic status, are “school”, “energy”, and “savings”. Contrary to expectations, proxies of socioeconomic status such as “investment”, “tax”, and “resources” were associated with an increase in the occurrence of Zika virus infection, while no association was detected for “social security” and “debt”. Energy stratification, school dropout rate, and the percentage of the municipality’s income that is saved conformed to the hypothesized inverse relationship between socioeconomic standing and Zika occurrence. As such, this study suggests these factors should be considered in Zika risk modeling.
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    Insurance coverage and respiratory morbidities in bronchopulmonary dysplasia
    (Wiley, 2022) Collaco, Joseph M.; Tracy, Michael C.; Sheils, Catherine A.; Rice, Jessica L.; Rhein, Lawrence M.; Nelin, Leif D.; Moore, Paul E.; Manimtim, Winston M.; Levin, Jonathan C.; Lai, Khanh; Hayden, Lystra P.; Fierro, Julie L.; Austin, Eric D.; Alexiou, Stamatia; Agarwal, Amit; Villafranco, Natalie; Siddaiah, Roopa; Popova, Antonia P.; Cristea, Ioana A.; Baker, Christopher D.; Bansal, Manvi; McGrath‐Morrow, Sharon A.; Pediatrics, School of Medicine
    Introduction: Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge. Methods: Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart review. Surveys for clinical outcomes were administered to caregivers. Results: Of the 470 subjects included in this study, 249 (53.0%) received employer-based insurance coverage and 221 (47.0%) received Medicaid as sole coverage at least once between 0 and 3 years of age. The Medicaid group was twice as likely to have sick visits (adjusted odd ratio [OR]: 2.06; p = 0.009) and emergency department visits (aOR: 2.09; p = 0.028), and three times more likely to be admitted for respiratory reasons (aOR: 3.04; p = 0.001) than those in the employer-based group. Additionally, those in the Medicaid group were more likely to have nighttime respiratory symptoms (aOR: 2.62; p = 0.004). Conclusions: Children with BPD who received Medicaid coverage were more likely to utilize acute care and have nighttime respiratory symptoms during the first 3 years of life. More comprehensive studies are needed to determine whether the use of Medicaid represents a barrier to accessing care, lower socioeconomic status, and/or a proxy for detrimental environmental exposures.
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    Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status
    (BioMed Central, 2017-02-01) Baptiste, Dadrie F.; MacGeorge, Erina L.; Venetis, Maria K.; Mouton, Ashton; Friley, L. Brooke; Pastor, Rebekah; Hatten, Kristen; Lagoo, Janaka; Clare, Susan E.; Bowling, Monet W.; Department of Surgery, IU School of Medicine
    BACKGROUND: Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations. METHODS: Patients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments. RESULTS: Across demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments. CONCLUSIONS: Reducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations.
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    Racial disparities in staging, treatment, and mortality in non-small cell lung cancer
    (AME, 2024) Duncan, Francesca C.; Al Nasrallah, Nawar; Nephew, Lauren; Han, Yan; Killion, Andrew; Liu, Hao; Al-Hader, Ahmad; Sears, Catherine R.; Medicine, School of Medicine
    Background: Black race is associated with advanced stage at diagnosis and increased mortality in non-small cell lung cancer (NSCLC). Most studies focus on race alone, without accounting for social determinants of health (SDOH). We explored the hypothesis that racial disparities in stage at diagnosis and outcomes are associated with SDOH and influence treatment decisions by patients and providers. Methods: Patients with NSCLC newly diagnosed at Indiana University Simon Comprehensive Cancer Center (IUSCCC) from January 1, 2000 to May 31, 2015 were studied. Multivariable regression analyses were conducted to examine the impact of SDOH (race, gender, insurance status, and marital status) on diagnosis stage, time to treatment, receipt of and reasons for not receiving guideline concordant treatment, and 5-year overall survival (OS) based on Kaplan-Meier curves. Results: A total of 3,349 subjects were included in the study, 12.2% of Black race. Those diagnosed with advanced-stage NSCLC had a significantly higher odds of being male, uninsured, and Black. Five-year OS was lower in those of Black race, male, single, uninsured, Medicare/Medicaid insurance, and advanced stage. Adjusted for multiple variables, individuals with Medicare, Medicare/Medicaid, uninsured, widowed, and advanced stage at diagnosis, were associated with significantly lower OS time. Black, single, widowed, and uninsured individuals were less likely to receive stage appropriate treatment for advanced disease. Those uninsured [odds ratio (OR): 3.876, P<0.001], Medicaid insurance (OR: 3.039, P=0.0017), and of Black race (OR: 1.779, P=0.0377) were less likely to receive curative-intent surgery for early-stage NSCLC because it was not a recommended treatment. Conclusions: We found racial, gender, and socioeconomic disparities in NSCLC diagnosis stage, receipt of stage-appropriate treatment, and reasons for guideline discordance in receipt of curative intent surgery for early-stage NSCLC. While insurance type and marital status were associated with worse OS, race alone was not. This suggests racial differences in outcomes may not be associated with race alone, but rather worse SDOH disproportionately affecting Black individuals. Efforts to understand advanced diagnosis and reasons for failure to receive stage-appropriate treatment by vulnerable populations is needed to ensure equitable NSCLC care.
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    Unequal access: Tobacco Retail in the Indianapolis Metro Area
    (The Polis Center, Indiana University at Indianapolis, 2017-07) Comer, Karen; Davila, Kelly; Hollon, Deb; Nowlin, Matt
    Retail access to various smoking products is an important consideration when discussing community action to improve a community’s health. Studies show that tobacco outlet density and proximity are linked to tobacco use–particularly in poor areas. We used socioeconomic data culled from the SAVI community information system to examine the density and proximity of tobacco outlets relative to vulnerable communities in Marion County. The report serves as a companion piece to the IU Richard M. Fairbanks School of Public Health’s September 2016 Report on the Tobacco Epidemic in Marion County and Indiana.