Chronic Poverty and Childhood Asthma in the Maritimes Versus the Rest of Canada

Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies

OBJECTIVE

To examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9-12 years in the UK, the Netherlands, Sweden, Australia, the USA and Canada.

METHODS

Data on 31 210 children were obtained from 7 prospective birth cohort studies across six countries. Asthma-related outcomes included ever asthma, wheezing/asthma attacks and medication control for asthma. Relative social inequalities were estimated using pooled risk ratios (RRs) adjusted for potential confounders (child age, sex, mother ethnic background and maternal age) for maternal education and household income. The Slope Index of Inequality (SII) was calculated for each cohort to evaluate absolute social inequalities.

RESULTS

Ever asthma prevalence ranged from 8.3% (Netherlands) to 29.1% (Australia). Wheezing/asthma attacks prevalence ranged from 3.9% (Quebec) to 16.8% (USA). Pooled RRs for low (vs high) maternal education and low (vs high) household income were: ever asthma (education 1.24, 95% CI 1.13 to 1.37; income 1.28, 95% CI 1.15 to 1.43), wheezing/asthma attacks (education 1.14, 95% CI 0.97 to 1.35; income 1.22, 95% CI 1.03 to 1.44) and asthma with medication control (education 1.16, 95% CI 0.97 to 1.40; income 1.25, 95% CI 1.01 to 1.55). SIIs supported the lower risk for children with more highly educated mothers and those from higher-income households in most cohorts, with few exceptions.

CONCLUSIONS

Social inequalities by household income on the risk of ever asthma, wheezing/asthma attacks, and medication control for asthma were evident; the associations were attenuated for maternal education. These findings support the need for prevention policies to address the relatively high risks of respiratory morbidity in children in families with low socioeconomic status.

Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: A macro-level investigation of American counties

This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.

Association of Low Family Income With Lung Function Among Children and Adolescents: Results of the J-SHINE Study

Background

The respiratory tract of children in low-income families is more likely to be exposed to toxins, which may lead to poor lung function. The purpose of this study was to elucidate the impact of low household income on lung function among children and adolescents in Japan.

Methods

We analyzed a population-based sample of 1,224 children aged 5 to 17 years old from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Forced expiratory volume in 1 s (FEV1) and in 6 s (FEV6) was measured. Annual household income and other potential covariates were assessed through a questionnaire. Low household income was defined as less than 3 million yen (approximately 27,000 United States dollars [USD]) per year. Multivariate regression analysis was used to adjust for potential covariates.

Results

We observed statistically significantly lower FEV1:FEV6 ratio with children in lowest-income families compared with those in highest-income families, after adjusting for child’s age and sex (coefficient = −0.082; 95% confidence interval [CI], −0.131 to −0.034). After adjusting for other covariates, including parental smoking status and parental diagnosis of asthma, a similar trend remained (coefficient = −0.054; 95% CI, −0.109 to 0.001).

Conclusions

Children in low-income families showed significantly lower lung function than those in high-income families. Prevention and early intervention are necessary to help the development of lung function among children living in low-income families.

The influence of newborn early literacy intervention programs in three canadian provinces

Low levels of literacy in early childhood can have lasting effects on children's educational and intellectual development. Many countries have implemented newborn literacy programs designed to teach parents pre-literacy promoting activities to share with their children. We conducted 2 quasi-experimental studies using 1) a pre-test/post-test design and 2) a non-equivalent control group design to examine the effect of newborn literacy programs on parents' self-reported literacy intentions/behaviors, values toward literacy, and parent-child interactions. Parents were recruited from 3 provinces, 2 with newborn literacy programs (intervention) and 1 without (control). Parents in the intervention group completed prenatal and postnatal (after participation in program) questionnaires. Parents in the control group completed 1 questionnaire. Questionnaires were designed to capture parents' literacy intentions (prenatal), behaviors (postnatal), values, and parent-child interactions (postnatal). A total of 98 parents were included in study one and 174 were included in study two. Parents' self-reported prenatal intentions and values were higher than their postnatal behaviors and values. Parents in the intervention group exhibited higher literacy behaviors and values and greater enjoyment reading to their children than parents in the control group, though they also reported reading to their children less frequently. Parents in the intervention group had significantly higher Positive Interactive scores than controls. Overall, we found participation in newborn literacy programs positively impacted parenting behaviors and attitudes. Lower postnatal within-group scores (intentions and values versus behaviors and values) may have been the result of participants' high expectations. Given our findings, we recommend that these programs continue.

Low income/socio-economic status in early childhood and physical health in later childhood/adolescence: a systematic review

To systematically review the literature on the relationship between early childhood low income/socioeconomic status (SES) and physical health in later childhood/adolescence, to identify gaps in the literature and to suggest new avenues for research. A systematic search of electronic databases from their start date to November 2011 was conducted to identify prospective longitudinal studies in industrialized countries with a measure of low income/SES in the first 5 years of life and physical health outcomes in later childhood or adolescence. STROBE criteria were used to assess study quality. Risk estimates were expressed as odds ratios with 95 % confidence intervals where possible. Heterogeneity of studies precluded meta-analysis. Nine studies fulfilled the inclusion criteria. Significant associations of early childhood low income/SES with activity-limiting illness, parent-reported poor health status, acute and recurrent infections, increasing BMI percentile and hospitalization were reported. Results for parent-reported asthma were less consistent: there was a significant association with low income/SES in early childhood in 2 studies but null findings in 3 others. This systematic review of the association of early childhood low income/SES with physical health status in later childhood and adolescence shows that, in contrast to the extensive literature on the impact of poor childhood social circumstances on adult health, the evidence base is limited. The literature points to some associations of early low income/SES with later poor health status, but many key research questions remain unanswered. Implications for further research are considered.

The impact of poverty on the current and future health status of children

Child poverty in Canada is a significant public health concern. Because child development during the early years lays the foundation for later health and development, children must be given the best possible start in life. Family income is a key determinant of healthy child development. Children in families with greater material resources enjoy more secure living conditions and greater access to a range of opportunities that are often unavailable to children from low-income families. On average, children living in low-income families or neighbourhoods have poorer health outcomes. Furthermore, poverty affects children's health not only when they are young, but also later in their lives as adults. The health sector should provide services to mitigate the health effects of poverty, and articulate the health-related significance of child poverty, in collaboration with other sectors to advance healthy public policy.

Poverty and chronic illness in early childhood: a comparison between the United kingdom and Quebec

OBJECTIVES

Our goal was to examine the association between poverty, in the first and fourth years of life and cumulatively in the first and fourth years of life, and the health of children in the fourth year of life in the UK Millennium Cohort Study and in the Quebec Longitudinal Study of Child Development (QLSCD).

METHODS

Data from the UK Millennium Cohort Study of 14 556 children and from the QLSCD of 1950 children were analyzed. Comparable measures of poverty were households in receipt of the safety-net benefit: income support in the United Kingdom and social welfare in Quebec. Three parent-reported health indicators were examined: asthma attack, long-standing illness, and limiting long-standing illness by the fourth year of life. Associations were explored with logistic regression modeling controlling for child characteristics and maternal education.

RESULTS

Poverty only in the first year of life significantly increased the risk of asthma attacks and limiting long-standing illness in the fourth year of life among UK children; trends were in the expected direction in the QLSCD but did not reach statistical significance. Poverty in the fourth year of life only significantly increased the risk of all 3 outcomes for UK children but not for Quebec children. For children experiencing poverty in both the first and fourth years of life, the risks for all 3 outcomes also increased in the United Kingdom, whereas only the risk of limiting long-standing illness increased in Quebec. Adjustment for confounding had little effect on the increased risks associated with poverty.

CONCLUSIONS

These findings suggest that experience of poverty at various times in early childhood increases the risk of asthma attacks and chronic illness in the fourth year of life; however, they also indicate that poverty at different stages of the early childhood life course may have different effects on chronic illness in different country settings.

An ecofeminist conceptual framework to explore gendered environmental health inequities in urban settings and to inform healthy public policy

This theoretical exploration is an attempt to conceptualize the link between gender and urban environmental health. The proposed ecofeminist framework enables an understanding of the link between the urban physical and social environments and health inequities mediated by gender and socioeconomic status. This framework is proposed as a theoretical magnifying glass to reveal the underlying logic that connects environmental exploitation on the one hand, and gendered health inequities on the other. Ecofeminism has the potential to reveal an inherent, normative conceptual analysis and argumentative justification of western society that permits the oppression of women and the exploitation of the environment. This insight will contribute to a better understanding of the mechanisms underlying gendered environmental health inequities and inform healthy public policy that is supportive of urban environmental health, particularly for low-income mothers.

Poverty and cumulative hospitalization in infancy and early childhood in the Quebec birth cohort: a puzzling pattern of association

OBJECTIVE

We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty-hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years.

METHOD

Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization.

RESULTS

At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04-1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73-1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66-1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99-1.60).

CONCLUSION

Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.

Duration of poverty and child health in the Quebec Longitudinal Study of Child Development: longitudinal analysis of a birth cohort

OBJECTIVES

The objective of this study was to examine the relationship between duration of poverty and the health of preschool children in the Quebec Longitudinal Study of Child Development birth cohort.

METHODS

Data from the Quebec Longitudinal Study of Child Development for 1950 children who were followed annually up to age 3 years were analyzed. Poverty was defined as having an income below the low-income cutoff from Statistics Canada. Five health indicators were examined: asthma attacks, infections, growth delay, a cumulative health-problems index, and maternal perception of the child's health. The association between duration of poverty and child health was explored with logistic regression modeling controlling for child and mother characteristics, including the mother's level of education, social support, and physical violence.

RESULTS

In this birth cohort, 13.7% (268) 3-year-old children from the Quebec Longitudinal Study of Child Development experienced intermittent poverty since birth (1-2 episodes), and another 14.4% (280) experienced chronic poverty (3-4 episodes). Children from families with chronic poverty had more frequent asthma attacks and had a higher cumulative health-problems index score, whereas children with intermittent poverty were more often perceived to be in less than very good health by their mothers. These associations remained statistically significant when controlling for child and mother characteristics. No association was observed between duration of poverty and infections or growth delay.

CONCLUSIONS

Chronic poverty affects a large number of children and has negative consequences for preschool children's health, although universal health care is available. The effects of chronic poverty may vary according to different health indicators and the age of the child.

Chronic poverty and childhood asthma in the Maritimes versus the rest of Canada

OBJECTIVE

To examine the role of higher long-term poverty rates in the Maritimes as an explanation for higher rates of asthma among children 2-7 years of age.

METHODS

Using longitudinal data from the National Longitudinal Survey of Children and Youth (NLSCY), logistic regressions examine associations between poverty duration and the probability of a child having been diagnosed with asthma, having a current asthma attack or experiencing wheezing in the past 12 months, controlling for other known determinants.

RESULTS

NLSCY data indicate that 15.9% of Maritime children have been diagnosed with asthma, 8.7% have recently had an attack and 24.1% experienced wheezing, statistically higher levels than in the rest of Canada. Children in chronic poverty show rates that are over 30% higher than the Canadian averages. Although 19.9% of Maritime children have been chronically poor compared to 11.7% elsewhere, and although poverty is associated with a higher probability of asthma/wheezing, controlling for poverty status does not eliminate the regional difference in asthma rates. Including other controls with poverty status again does not fully explain the difference.

CONCLUSION

While these findings do not completely explain why asthma prevalence rates are higher for Maritime children, they do indicate important pathways from poverty to childhood asthma. For example, chronically poor children are more likely to have had low birthweights and are less likely to have been breastfed, both of which are correlates of asthma. Such information can be useful for policy-makers. Pollutants and other environmental factors associated with asthma not included in the study may help further explain regional differences.