Alcohol and illicit drugs:prevalence of alcohol and illicit drug use and their predictors in young people from Argentina,Bulgaria,Chile and Romania

Background:Alcohol and illicit drugs(AID)continue to be a major global health concern.Although preventable,AID is linked to millions of deaths annually worldwide.The situation is particularly grave for young people,with AID being a major direct risk factor for disability-adjusted youth life-years lost and death.It further contributes to assaults,road crashes,accidental poisoning,and suicide,leading to long-term issues and public health concerns.Objective:This study aimed at disclosing current AID prevalence data for Argentinian,Bulgarian,Chilean and Romanian youth.It shed light on the predictors of AID in young people from those countries.Method:The study used an online survey to gather data from people aged 18 to 25(n=1,297).The survey was underpinned by the theory of planned behaviour(TPB).Predictors were investigated separately for drinking alcohol and using illicit drugs.Results:Our data revealed that across the four target countries,49%to 90%of the participants drank alcohol,and 8%to 35%used illicit drugs in the past three months.Between 20%and 91%of them intended to drink,and between 8%and 31%intended to use illicit drugs in the following three months.Our TPB model predicted statistically significant(P<0.001)amounts of variance in drinking alcohol(between 61%and 72%)and using illicit drugs(between 20.3%and 74.4%).Intention was consistent in significantly predicting both behaviours.Evidence around the predictive validity of self-efficacy,age and gender was mixed across the investigated countries.Conclusion:This research provided an update on the scarce AID epidemiological data.It also supplied evidence about what theoretically-informed measures might be useful targets of interventions in the case of Argentina,Bulgaria,Chile and Romania.This new knowledge of understanding substance abuse determinants and prevalence may help researchers and practitioners better meet young people's health prevention needs.

The Relationship between Mental Health Literacy and Subjective Well-Being of Young and Middle-Aged Residents: Perceived the Mediating Role of Social Support and Its Urban-Rural Differences

This study investigates mental health literacy among young and middle-aged urban and rural residents and the differences in mental health literacy,perceived social support and subjective well-being.From January to February 2022,620 participants(320 rural and 300 urban residents)from three provinces of China were selected by con-venience sampling.A general data questionnaire,mental health literacy scale,perceived social support scale and subjective well-being scale were administered.The mental health literacy scores of urban residents were 3.34±0.57 and those of rural residents were 2.73±0.79.The results of multiple regression analysis showed that the mental health literacy scores of rural residents were more significant than those of urban residents in terms of sex and age,while urban residents’mental health literacy scores were more significant than those of rural resi-dents in terms of monthly income.Mental health literacy,perceived social support and subjective well-being of young and middle-aged urban and rural residents were all positively correlated(P<0.01).While the level of mental health literacy is better among urban residents than rural residents,perceived social support plays a partial mediating role between mental health literacy and subjective well-being of both urban and rural residents,and should be the focus of researchers seeking to improve the level of well-being of residents.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China,2002–2019,and Predictions to 2030

Objective This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.Methods Data were obtained from the China national vital registration system.Significant changes in mortality were assessed by Joinpoint regression.Age-period-cohort analysis was used to explain the reasons for the changes.Future mortality and counts were predicted by the Bayesian age-period-cohort model.Results Between 2002 and 2019,a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded.The age-adjusted mortality rates(AAMRs)of women showed a downward trend.The annual percent changes(APC)were-3.5%(-5.2%,-1.7%)for urban women and-2.8%(-3.7%,-1.9%)for rural women.By contrast,the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46.The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64years did not change significantly.Between 2020 and 2030,the projected stroke deaths are 1,423,584 in men and 401,712 in women.Conclusion Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China.Targeted health policy measures are needed to address the burden of stroke in the young generation,especially for rural men,with a focus on the prevention and management of high risk factors.

Association of Vitamin D Deficiency with Diabetic Retinopathy in Young People with Type 1 Diabetes Mellitus

Background: Diabetic retinopathy is among the most common diabetic complications, and is one of the leading causes of blindness in the world. Recent studies have linked vitamin D to the pathogenesis of diabetes and there is growing evidence that vitamin D can interfere with the mechanisms involved in diabetes and its complications. Despite improvements in treatment, diabetic retinopathy remains a significant complication of type 1 diabetes mellitus. Identification of early treatable predictors of diabetic retinopathy such as vitamin D deficiency, may allow more aggressive management of those at high risk. Purpose: To assess the association of vitamin D deficiency with diabetic retinopathy in young people with type 1 diabetes mellitus. Design: Observational study with case control design. Method: 60 young people with type 1 diabetes aged between 11 to 24 years were included in this study. Among them, 30-young people have diabetic retinopathy and 30-young people do not have diabetic retinopathy. Purposive sampling technique was applied as per inclusion criteria. Statistical analysis of the results was done by using computer-based software, SPSS version 26. P value of less than 0.05 was considered as statistically significant. Results: Vitamin D deficiency was present in 83% of the young people with diabetic retinopathy and in 53% without diabetic retinopathy. The mean vitamin D level in young people with and without diabetic retinopathy was 17.38 ± 3.77 ng/ml and 20.15 ± 5.06 ng/ml respectively and the difference was statistically significant (p = 0.019). Vitamin D deficiency was increased with the severity of diabetic retinopathy. Univariate and multivariate logistic regression showed vitamin D deficiency was independently associated with diabetic retinopathy with a crude odds ratio of 5.69 with a p value of 0.008 and adjusted odds ratio of 16.08 with a p value of 0.002 respectively. Conclusion: Result of the study revealed that vitamin D deficiency was strongly associated with diabetic retinopathy in young people with type 1 diabetes mellitus.

Influencing factors of fatigue in young and middle-aged patients with coronary heart disease:a cross-sectional study

Objective:To examine the present state of fatigue in young and middle-aged patients with coronary heart disease(CHD)and to identify the elements that may be affecting it.Methods:From December 2020 to June 2021,240 young and middle-aged patients with CHD who were being treated in the cardiology department of a tertiary care hospital in Suzhou were chosen using a convenience sampling method in order to gather data on the patients’sociodemographic status,fatigue,social support,and stress.Results:Of the 240 disseminated questionnaires,220 valid responses were returned,resulting in an effective recovery rate of 91.67%.The frequency of exhaustion was 51.8%,and the fatigue score was(5.27±2.77).The stress score was(11.15±3.36),while the overall social support score was(39.13±4.72).Binary logistic regression analysis indicated that age,exercise,staying up late,stress,social support,high-sensitivity troponin T,high-density lipoprotein,and ejection fraction were independent risk factors for fatigue in young and middle-aged patients with CHD(P<0.05).Conclusions:Fatigue is more prevalent in young and middle-aged patients with CHD.Clinical nurses can create a unique management plan for patients based on their lifestyle and behavioral patterns,stress levels,social support,and clinical signs to reduce fatigue.

Association of fatigue with short-term prognosis in young and middle-aged patients with coronary heart disease

Background:To investigate the effect of fatigue on the short-term prognosis of young and middle-aged patients with coronary heart disease(CHD).Methods:A cross-sectional,observational survey was distributed at a tertiary hospital in Suzhou,China.Patients were assessed for fatigue and their prognosis was assessed at 3 and 6 months after discharge.General Information Questionnaire,Fatigue Scale and Seattle Angina Questionnaire(SAQ)were used for the survey.The Cox proportional hazard model was used to analyze the impact of fatigue on the occurrence of major adverse cardiac events(MACEs)at 3 and 6 months after discharge.Multiple linear regression models were used to analyze the effect of fatigue on health-related quality of life(HRQoL)at 3 and 6 months after discharge.Results:199 patients were followed up with in the end.43 patients(21.6%)with MACE three months after discharge had a total SAQ score of(399.76±39.61).The overall SAQ score was(425.14±22.66)and 52 patients(26.1%)experienced MACE six months after discharge.Fatigue was identified as a risk factor for MACE 6 months after discharge by the Cox proportional hazard model(HR=2.939,95%CI:0.177~0.655,P=0.001)and as an independent risk factor for quality of life 3 and 6 months after discharge by multiple linear regression(P<0.001).Conclusions:In individuals who are young or middle-aged and have coronary heart disease,fatigue is a risk factor for the short-term prognosis.It is advised that clinical professionals prioritize patient fatigue assessment and improve management of fatigue symptoms.

Public Square Dancing Intervention on Subjective Well-Being of Middle-Aged and Elderly People:A Meta-Analysis

Objective:To understand the influence of public square dancing on the subjective well-being of middle-aged and elderly people.Methods:According to the principle of Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines,we search Chinese databases,such as CNKI,Wanfang Data,and VIP,and English databases,such as Proquest,Web of Science,Pubmed,Cochrane,and ScienceDirect,and collect relevant articles at home and abroad from 2006 to December 2019 for meta-analysis in January 2020.Result:A total of 10 articles were included.The meta-analysis results showed that the well-being of middle-aged and elderly people in the public square dancing intervention group was significantly higher than that of the other exercise group and control group(both P<0.01).The results of the subgroup analysis showed the following:Different durations of intervention significantly influence the intervention effect(P<0.01).No difference was found between the effect of the mixed-gender intervention and the individual female intervention(P>0.05).No significant difference was found between the groups with weekly intervention frequency(P>0.05).Conclusion:Public square dancing intervention is effective for middle-aged and elderly people’s subjective well-being.Neither mixed intervention nor the times of weekly intervention have an impact on the intervention effect.However,the length of duration of intervention influences the intervention effect.

Relationship between Waist Circumference, Waist-Height Ratio, Body Fat Percentage, Visceral Fat and Bone Mineral Density in Middle-Aged and Elderly Zhuang of China

Objective: To understand the correlation between different degrees of obesity and bone mineral density (BMD). Methods: 772 cases (300 men and 472 females) of Zhuang over 40 years old were randomly selected. The BMD and T score were calculated by measuring the right heel bone using a quantitative-ultrasound densitometer. Body composition index of body weight, waist circumference (WC), waist height ratio (WtHR), body fat percentage (BFP) and visceral fat (VF) were measured using a bioelectrical impedance method. Results: The BMI, WC, and WtHR of the male osteoporosis group were lower than those of the normal bone mass (NBM) group (P Conclusion: BMI is positively correlated with BMD in Zhuang. BFP has a greater correlation with female BMD, and a small reduction in BFP can result in a significant decrease in BMD. BMD of male was positively correlated with abdominal obesity indicators (WC, WtHR, VF). However, abdominal obesity has no obvious effect on the promotion of BMD in women, and increased WtHR can lead to a decrease in BMD. Zhuang can appropriately increase the amount of fat within the normal weight range. At the same time, reasonable exercise and balanced nutrition to avoid excessive obesity or low body weight can reduce the incidence of osteoporosis and osteoporosis fractures.

Evaluation of a School-Based Health Education Program for Urban Indigenous Young People in Australia

The aim of this study was to investigate the effectiveness of a school-based health promotion and education program in improving knowledge, attitudes, self-efficacy and behaviours of urban Indigenous young people regarding chronic disease and associated risk factors. A mixed methods approach was adopted for this evaluation;however, this paper will focus on the quantitative aspect of the study. The Deadly Choices? health education program was delivered weekly at six education facilities in Brisbane, Australia to participants from years seven to 12 over seven weeks. One school that received the Deadly Choices program the following term acted as the control group. Questionnaire data was collected immediately pre and post intervention to assess program impact. As self-reported by participants there were mostly significant improvements over time for questions relating to knowledge, attitudes and self-efficacy regarding leadership, chronic disease and risk factors within the intervention group. There were also significant changes within the intervention group regarding breakfast frequency (P = 0.002), physical activity frequency (P ≤ 0.001), fruit (P = 0.004) and vegetable (P ≤ 0.001) intake. Overall, there were few significant differences between the control and intervention groups regarding health attitudes and behaviours;however, there were considerably more improvements relating to self-efficacy and knowledge of chronic disease and associated risk factors between groups. The program also facilitated 30 Aboriginal and Torres Strait Islander health checks for participants. Deadly Choices is an innovative and comprehensive school-based program which has great potential to improve the health outcomes of Indigenous young people in urban areas by providing education in leadership and chronic disease prevention;engaging students in physical activity participation;and collaborating with health services to facilitate health checks.

Marijuana Use and Depressive Symptoms among Young People: Examining Unidirectional and Bidirectional Effects

Research suggests that the prevalence of marijuana use and depression are increasing in the United States. Although it is not entirely clear what accounts for these coincident trends, several studies have shown that these two health concerns are associated among young people. This study assessed four hypotheses regarding the association between marijuana use and depression: 1) whether marijuana use affects subsequent symptoms of depression;2) whether depressive symptoms affect subsequent marijuana use;3) whether they are associated in a bidirectional (reciprocal) manner;and 4) whether the association between the two is confounded by stressful life events. Using eight years of longitudinal data from the Family Wellness and Health Study, a fixed-effects regression model provided empirical support for the first hypothesis only, but not for the others. Future research should explore in greater detail why marijuana use may have a causal impact on experiences with depression among young people.

Young People’s Conceptualization of Their Wellbeing: Culturally Situated Understandings in the Context of Kazakhstan

Little is known about the wellbeing of young people living in post-Soviet nation contexts such as Kazakhstan. The qualitative data reported represents the views of 309 Kazakhstani young people on their conceptualizations of wellbeing that fell broadly into three major thematic categories: external factors from one’s surroundings;relationships with others;and internal aspects of the self. The direct consequence of inadequate physical environment on health and the environment’s impact on psychological wellbeing through leisure, lifestyle, education, and employment opportunities were emphasized. Affirmative connections with others were associated with increased levels of emotional wellbeing. The importance of making independent choices as well as being actively involved in leisure, volunteering and extracurricular school activities for achieving optimal levels of wellbeing was highlighted.

Factors associated with financial support in old age for young and middle-aged rural residents in China

This study examined the factors associated with financial support in old age from three primary mechanisms-personal savings,family support,and social insurance-to explore the implications for the future development of China's rural social welfare system.Cross-sectional surveys of 1392 young and middle-aged rural residents were conducted in July and August2012.The results showed that while social insurance was increasingly acceptable,personal savings and family support still had fundamental value.Combining the three mechanisms,the rural old-age welfare system presented nontraditional features.China's new rural endowment insurance is discussed as a means to address the need for financial support among the rural aging population.

Knowledge, Attitude and Practice of Sexuality and Modern Contraceptive Methods among the Young People at Cotonou (Benin)

Introduction: Youth is the period of life when one usually experiences sexual relations for the first time. Lack of preparation and inexperience lead to unwanted pregnancies and sexually transmitted infections. The aim was to study the knowledge, attitudes and practices of sexuality and modern contraceptive methods among young people in Cotonou. Method: This was a descriptive and prospective study that was conducted from August to September 2017 among young people living in Cotonou. Results: We had questioned 500 young people. The sex ratio was 0.6 with 267 girls (61.1%). 27.9% of young people surveyed do not know the fertility period. 76.2% of young people are sexually active and 39.8% have at least 2 sexual partners. Most of these young people had early sexual intercourse at an average age of 16.73 ± 2.85 years. Half of the boys have sex for pleasure and half of the girls have sex for love. 100% of young people know at least one STI, especially HIV/AIDS. Of the 15.10% of cases of reported pregnancy, 49.2% resulted in an abortion. 99% are aware of modern contraceptive methods for the prevention of pregnancy. But 53.7% are unaware that modern contraceptive methods prevent STIs. The main sources of information on contraception are the media and teachers. The main modern contraceptive method used is the condom in 73%. Young people surveyed do not use modern contraceptive methods in 57.5%. Conclusion: The practices of sexuality and modern contraceptive methods remain quite limited among young people. It is important to intensify information and awareness activities.

Relationship between Sexual Risk Behaviors and HIV Counseling and Testing (HCT) Uptake among Young People in Nigeria

This study examined the relationship between sexual risk behavior and HIV counselling and testing uptake among young people in Nigeria. Probability sampling technique was used to obtain a sample of 10,091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192;urban = 10,351) using structured and semi-structured questionnaires. The data were summed using descriptive statistics. Frequencies and percentages;measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that sexual risk behaviors comprised three variables: sex with multiple partners, intergenerational sex (sex with partners 10 years older), and transactional sex. The results of the chi-square test of association between sex with multiple partners and HCT uptake showed that there was no statistically significant relationship between sex with multiple partners and HCT uptake among young people ages 15 to 24 years in Nigeria. It was among others recommended that sexually active young people in Nigeria should use protection against HIV infection.

Hypertension (Htn) among Young People of 18 to 35 Years Old in Cardiology Department of Gabriel Toure University Teaching Hospital

Few studies have been conducted on hypertension among youth in Mali?hence the interest of our study aimed to clarify certain aspects what are not taken account yet in previous studies.?Objective: Determine the clinical and para-clinical characteristics of hypertension among 18 to 35 years old young people.?Methods:?This cross-sectional and retrospective study of 24 months from January 1st, 2009 to December 31st, 2010?in the cardiology department of the Gabriel Touré UTH.?Results:?We identified 132 cases during the study period out of 2146 cases of hypertension with a prevalence of 6.1%. The female gender represented 81.8%, with a sex ratio of 45.59, 1% of patients had an unknown family history of hypertension. The age group of 31 to 35 years accounted for 43.9%. The circumstances of discovery were dominated by exertional dyspnea (37.9%). Body mass index was normal in 45.5% of patients. The higher BMI was more common in female patients with 39.39% (p?= 0.045). In the sample,53% of patients had a systolic blood pressure between 140?and 159 mmHg and 38.6% had diastolic blood pressure ≥ 110 mmHg with no significant difference (p?> 0.5). The high creatinine level was found in 18.18% of our patients. The ECG?found?84.6%?of left ventricular hypertrophy among cavitary hypertrophies. The echocardiography has found cavitary?dilatation in 40.04% of cases;it concerned the left ventricle in 25.71%. Also 18.57% of our patients had impaired left ventricular systolic function. Among the complications found in our patients, kidney failure led with 56%.?Conclusion:?Hypertension is not a rare event among young population even with a normal body mass index. It is often discovered during complications that can be dreadful.

Sexual Identity, Preference and Prevalence of Forced Sexual Intercourse among Young People in an Urban Community in Ovia North East Local Government Area, Edo State, Nigeria

Background: Young people are at risk of being victims or perpetrators ofcoerced or forced sexual sex. In predominantly low- and middle-income countries, this contributes significantly to their risk for HIV infection, unwanted pregnancy, and sexually transmitted diseases. Current trends show that young people sexual identity and preferences affect their sexual and reproductive health. Objective: This study aims to determine prevalence of coerced or forced sexual intercourse, sexual identity and sexual preferences of young people in Oluku Community, Ovia North East, Local Government, Edo State, South Nigeria. Methods: A descriptive cross-sectional study conducted in June, 2013 using multi-stage sampling method. Results: A total of 400 young people participated in this study. The mean age was 17.8 ± 3.9 years. A higher proportion of respondents were of the Bini ethnic group 145 (36.3%). Most respondents were Christians 346 (86.5%) while 33 (8.2%) were Moslems. Majority of the respondents had secondary education 271 (67.8%), most were single 363 (90.8%) and were from families with a monogamous setting 289 (72.3%). The prevalence of forced sex was 12.9%, similarly, condom use during forced sex was 27.8%. More females (15.3%) than males (9.6%) had experienced forced sex;forced sex was common among young people from older age group, monogamous homes, and those living in a flat or self contained. Majority (95.3%) of adolescent’s sexual preference was vaginal, only a few preferred oral (3.3%) and anal sex (1.5%). Religion was associated with sexual preference and identity. The sexual identity of most (98.0%) young person’s was heterosexual (or different sex), while 0.5% were homosexual (or same sex) and 1.5% bisexual (or both). Conclusion and Recommendations: Legislation against forced and coerced sex, rape and other forms of sexual violence should be formulated and implemented.

Factors related to compliance with the COVID-19 health regulations among young people

The coronavirus pandemic has affected all facets of our lives and all ages and social strata worldwide.Measures have been taken to protect against the spread of the virus,such as more rigorous hand hygiene,the use of face masks and social distancing.However,the focus has often been on young people,who have been seen as a group lacking sufficient respect for government-imposed measures.This review outlines the preventive measures that have been taken in different countries and discusses their specific impact on young people and adolescents,taking into account the developmental stage and concrete needs of this age group.It summarizes those studies that have provided information on compliance with preventive measures by young people and adolescents,concluding that although compliance levels among this age group are lower than among older adults,the general view of youths as non-compliant is not consistent with real,objective data.The review also summarizes different views regarding the possible reasons for this lower level of compliance,taking into account both social(gender and age)and personal factors(personality,empathy,prosociality,self-control,cognitive styles and motivations),and discusses the practical implications of these findings for the future.

Psychosocial Adaptation Level and Work Participation Rate of Young and Middle-aged Patients with Coronary Heart Disease after PCI

[Objectives]The research aimed to understand the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI and their participation situation in work.[Methods]210 young and middle-aged patients aged 18-59 years with coronary heart disease treated by PCI in a tertiary hospital of Suzhou from July of 2020 to November of 2022 were selected,and general information of patients in three days after operation was registered.Self-report psychosocial adjustment to illness scale(PAIS-SR)was used to investigate the psychosocial adjustment to illness of patients in 1,3 and 6 months after operation and the participation rate of work.[Results]The psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI was different in gender,age,education level,marital status,hypertension,diabetes,postoperative cardiac color Doppler ultrasound results(left ventricular ejection fraction)and the number of stents(P<0.05).[Conclusions]The psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI needs to be improved.The psychosocial adjustment to illness of men is higher than that of women.The older the age is,the lower the psychosocial adjustment to illness is.The psychosocial adjustment to illness of patients with high educational background is higher than those with low educational background,while the psychosocial adjustment to illness of married people is higher than unmarried people.The psychosocial adjustment to illness of patients with hypertension and/or diabetes is lower.

Sidelights of the Chinese Speaking Contest for International Young People

Editor's Note:Listen to the understanding of young people on"a Community with a Shared Future for Mankind"and tell the story of China s rapid development from an international perspective.This is the original intention of the Chinese speaking contest for international young people,themed"The Pursuit of a Community with a Shared Future for Mankind".

Relationship between HIV Counseling and Testing (HCT) Awareness and HCT Uptake among Young People in Nigeria: Implications for Social Change

This study examined the relationship between HIV counselling and testing (HCT) awareness and HCT uptake among young people in Nigeria and their implications for social change. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprised all 36 states in Nigeria. Probability sampling technique was used to obtain a sample of 10,091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192;urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputting them into SPSS v21.0 for analysis and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages;measures of central tendencies were used to answer the research question while nonparametric tests such as chi-square were used to analyze non-normally distributed data at 0.5 level of significance. The results of the chi-square test of association between HCT awareness and HCT uptake showed that there was a statistically significant relationship between HCT awareness and HCT uptake among young people ages 15 to 24 years in Nigeria, X2 (1, n = 8916) = 306.66, p < 0.001. In other words, knowledge of the availability of HCT services may have influenced the possibility that the participants would use them. Among others, it was recommended that government should examine the efficacy of HCT treatments in Nigeria, along with conducting a demographic analysis of the at-risk population.