1
|
Carrilero N, García-Altés A. Health inequalities in childhood diseases: temporal trends in the inter-crisis period. Int J Equity Health 2024; 23:76. [PMID: 38632575 PMCID: PMC11025183 DOI: 10.1186/s12939-024-02169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. METHODS A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. RESULTS Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. CONCLUSIONS Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.
Collapse
Affiliation(s)
- Neus Carrilero
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.
- Department of Medicine and Life Sciences (MELIS-UPF), Pompeu Fabra University, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) , Barcelona, Spain.
- Research Group on Primary and Community Care in Barcelona (APICBA), Hospital del Mar Research Institute, Barcelona, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Anna García-Altés
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
2
|
Luo J, van Grieken A, Kruizinga I, Raat H. Longitudinal associations between socioeconomic status and psychosocial problems in preschool children. Eur Child Adolesc Psychiatry 2024; 33:1029-1038. [PMID: 37195487 PMCID: PMC11032269 DOI: 10.1007/s00787-023-02217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
Socioeconomic status (SES) at different points in a child's lifetime may have different effects on health outcomes. This study aimed to examine longitudinal associations between SES and psychosocial problems in preschool children (n = 2509, Mage = 24.2 ± 1.3 months). The psychosocial problems of children were assessed using the Brief Infant-Toddler Social and Emotional Assessment at age 2 years and age 3 years and categorized as having yes/no psychosocial problems. Four groups of pattern of presence/absence of psychosocial problems between age 2 and 3 years were classified: (1) 'no problems', (2) 'problems at age two', (3) 'problems at age three', and (4) 'continuing problems'. Five indicators of SES (i.e., maternal education level, single-parent family, unemployment, financial problems, and neighborhood SES) were evaluated. Results showed around one-fifth (2Y = 20.0%, 3Y = 16.0%) of children had psychosocial problems. Multinomial logistic regression models revealed low and middle maternal education levels were associated with 'problems at age two'; low maternal education level and financial problems were associated with 'problems at age three'; low and middle maternal education level, single-parent family, and unemployment were associated with 'continuing problems'. No associations were observed between neighborhood SES and any pattern. Results suggest children in a lower SES, indicated by maternal education, single-parent family, and financial stress, had higher odds of developing and continuously having psychosocial problems in early childhood. These findings call for optimally timing interventions to reduce the impact of disadvantaged SES in early childhood on psychosocial health.
Collapse
Affiliation(s)
- Jie Luo
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Ingrid Kruizinga
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Sonawane K, Zhu Y, Damgacioglu H, Garg A, Graboyes EM, Montealegre JR, Brownstein NC, Ford ME, Roberts JR, Sterba KR, Giuliano AR, Deshmukh AA. Factors associated with parental human papillomavirus vaccination intentions among adolescents from socioeconomically advantaged versus deprived households: a nationwide, cross-sectional survey. LANCET REGIONAL HEALTH. AMERICAS 2024; 31:100694. [PMID: 38500960 PMCID: PMC10945422 DOI: 10.1016/j.lana.2024.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 03/20/2024]
Abstract
Background In the USA, HPV vaccine coverage is substantially lower among adolescents from high-income households compared to their low-income counterparts. We examined and compared the factors associated with parental HPV vaccination intentions between socioeconomically divergent groups. Methods Data from unvaccinated and not fully HPV-vaccinated adolescents from the 2017-2021 National Immunization Survey (NIS)-Teen were analyzed. Socioeconomically advantaged vs. deprived groups were identified based on dichotomized income (material capital) and education (social capital). Parental intent to initiate and complete the HPV vaccine series was compared using bivariable analysis and the factors associated with lacking intent were identified. Findings The 2017-2021 NIS-Teen included a total of 212,643 participants; the final analytical sample consisted of 105,958 adolescents (an estimated 10.3 million adolescents) who were unvaccinated or not fully vaccinated. In the advantaged group, 64.7% of parents of unvaccinated adolescents (equating to 2.4 million US adolescents) had no intention to initiate the HPV vaccine compared to 40.9% of parents in the deprived group (equating to 0.2 million adolescents) (P < 0.0001; S > 13.29). The most frequent reason for lacking intent in the advantaged group was 'safety concerns' (25.5%). In the deprived group, 'lack of knowledge', 'not recommended', and 'not needed' were common reasons (nearly 15% each). Lack of intent to complete the HPV vaccine series was higher in the advantaged group (43.9%; 1.1 million adolescents) compared to the deprived group (25.2%; 0.08 million adolescents) (P < 0.0001; S > 13.29). More than half in the advantaged group (58.4%) and over a third (37.1%) in the deprived group cited 'already up to date' as the main reason for not completing the HPV vaccine series. Interpretation Lack of intent to initiate and complete the HPV vaccination series, particularly among socioeconomically advantaged parents is a significant barrier to achieving the national goal in the USA. Funding The US National Institute on Minority Health and Health Disparities, the National Center for Advancing Translational Sciences, MUSC Hollings Cancer Center Seed funding, and the US National Cancer Institutes.
Collapse
Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Yenan Zhu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Haluk Damgacioglu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Ashvita Garg
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Evan M. Graboyes
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | | | - Naomi C. Brownstein
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E. Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - James R. Roberts
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| |
Collapse
|
4
|
Reuter M, Diehl K, Richter M, Sundmacher L, Hövener C, Spallek J, Dragano N. A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes. ADVANCES IN LIFE COURSE RESEARCH 2024; 59:100593. [PMID: 38340523 DOI: 10.1016/j.alcr.2024.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants' age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children's educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.
Collapse
Affiliation(s)
- Marvin Reuter
- Junior Professorship for Sociology, esp. Work and Health, Department of Sociology, University of Bamberg, Bamberg, Germany.
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Richter
- Chair for Social Determinants of Health, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
5
|
Gillis BT, McWood LM, Brigham EF, Hinnant JB, El-Sheikh M. Family income as a moderator of relations between sleep and physical health during adolescence. Sleep Health 2023; 9:868-875. [PMID: 37914634 PMCID: PMC10841177 DOI: 10.1016/j.sleh.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Sleep duration, quality, and consistency are associated with overall physical health in adolescence, yet the effects of sleep on development may be not uniform because both sleep and physical health vary systematically along gradients of family income. To understand "for whom" sleep may be particularly beneficial, the present study tested family income as a moderator of relations between youth sleep and physical health. METHODS Three hundred twenty-three youth (M age=17.39years; 53% female; 41% Black, 59% White) wore wrist actigraphs for 1week at home. Four well-recognized sleep parameters were derived: minutes, efficiency, long wake episodes, and variability in minutes across the week. Parents reported family income, and mothers rated adolescents' physical health. In independent path models, physical health was regressed onto each indicator of sleep, family income, and Sleep × Family Income interactions to test potential moderation effects. RESULTS Associations between sleep and physical health were moderated by family income. Lower sleep efficiency, more long wake episodes, and more variability in sleep minutes were associated with poorer physical health among adolescents from lower-income families. At optimal levels of all sleep variables, income-based differences in physical health were mitigated. Youth from higher-income families tended to have better physical health regardless of their sleep. CONCLUSIONS Findings build evidence that sleep has relations with physical health for low-income youth in particular. Clinicians and other service providers working with youth might benefit from considering the role of sleep in prevention and interventions programs geared toward improving health.
Collapse
Affiliation(s)
- Brian T Gillis
- Department of Human Development & Family Science, Auburn University, Auburn, Alabama, USA
| | - Leanna M McWood
- Department of Human Development & Family Science, North Dakota Stata University, Fargo, North Dakota, USA
| | - Emily F Brigham
- Department of Human Development & Family Science, Auburn University, Auburn, Alabama, USA
| | - J Benjamin Hinnant
- Department of Human Development & Family Science, Auburn University, Auburn, Alabama, USA
| | - Mona El-Sheikh
- Department of Human Development & Family Science, Auburn University, Auburn, Alabama, USA.
| |
Collapse
|
6
|
Vidal C, Jun HJ, Latkin C. The Effects of Social Rank and Neighborhood and School Environment on Adolescent Depression and Suicidal Ideation: A Structural Equation Modeling Approach. Child Psychiatry Hum Dev 2023; 54:1425-1437. [PMID: 35347499 PMCID: PMC10120529 DOI: 10.1007/s10578-022-01347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Depression and suicide constitute major public health problems, and their prevalence has been increasing among adolescents in the United States. More research is needed to understand the association between multilevel risk factors and depression and suicidal ideation in adolescents, particularly factors related to perceived social rank and environmental stress. The present study examined relationships among family mental history of mental illness, in-utero and perinatal complications, social rank factors, environmental factors, and depression and suicidal ideation in the past month in a clinical population of adolescents. A cross-sectional survey was administered in outpatient clinics to 197 adolescents ages 12-18 who were primarily Black and female. Findings from structural equation modeling showed the largest effects for the social rank factor on depression and suicidal ideation in the past month. These findings highlight the importance of preventive interventions for coping with social hierarchies to prevent depression and suicidal ideation.
Collapse
Affiliation(s)
- Carol Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 1800 Orleans Street/Bloomberg 12N, Baltimore, MD, 21287-3335, USA.
| | - Hyun-Jin Jun
- Graduate School, University of Maryland Baltimore, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
7
|
Hübelová D, Caha J, Janošíková L, Kozumplíková A. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic. Int J Equity Health 2023; 22:183. [PMID: 37670373 PMCID: PMC10481637 DOI: 10.1186/s12939-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.
Collapse
Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Jan Caha
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Lenka Janošíková
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Alice Kozumplíková
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic.
| |
Collapse
|
8
|
Owens C, Hadley C. Subjective social status and mental health among adolescents in Ethiopia: Evidence from a panel study. SSM Popul Health 2023; 22:101382. [PMID: 36992716 PMCID: PMC10041554 DOI: 10.1016/j.ssmph.2023.101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Numerous studies have found that a relationship between subjective status and measures of human health persists even after controlling for objective measures, including income, education, and assets. However, few studies have probed how status shapes health among adolescents, particularly those in low-and-middle-income settings. This study examines the relative effects of subjective and objective status on mental health among Ethiopian adolescents. Using data from two waves of the Jimma Longitudinal Family Survey of Youth (N = 1,045), this study uses a combination of linear regression and linear mixed-effects models to examine the relationships between objective social status, subjective social status, and mental well-being among adolescents in Ethiopia. Three measures of objective status, including household income, adolescent education, and a multidimensional measure of material wealth, were assessed. Social network and support variables were constructed using factor analysis. A community version of the 10-rung McArthur ladder was used to assess the subjective socioeconomic status of adolescents. The self-reporting questionnaire was used to assess mental well-being during both waves of the study. The significant effect of higher subjective status on reports of fewer non-specific psychological distress (-0.28; 95% CI: -0.43 to -0.14) was not mediated by objective status, material deprivation, or social support covariates. The observed relationship between status and mental well-being was consistent across successive study waves. Among a cohort of adolescents in Jimma, Ethiopia, several measures of objective status are associated with subjective status. However, akin to research among adults, the findings of our study suggest that the relationship between adolescent subjective social status and mental health persists above and beyond the effects of objective status. Future research is needed on the factors, environments, and experiences that inform adolescent perceptions of status and well-being over time.
Collapse
|
9
|
Stannard S, Berrington A, Alwan NA. Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70). PLoS One 2023; 18:e0282795. [PMID: 37053250 PMCID: PMC10101483 DOI: 10.1371/journal.pone.0282795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. METHOD The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. RESULTS For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. CONCLUSIONS Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.
Collapse
Affiliation(s)
- Sebastian Stannard
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
| | - Nisreen A Alwan
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| |
Collapse
|
10
|
Udalova V, Bhatia V, Polyakova M. Association of Family Income With Morbidity and Mortality Among US Lower-Income Children and Adolescents. JAMA 2022; 328:2422-2430. [PMID: 36573975 PMCID: PMC9857424 DOI: 10.1001/jama.2022.22778] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Family income is known to be associated with children's health; the association may be particularly pronounced among lower-income children in the US, who tend to have more limited access to health resources than their higher-income peers. OBJECTIVE To investigate the association of family income with claims-based measures of morbidity and mortality among children and adolescents in lower-income families in the US enrolled in Medicaid or the Children's Health Insurance Program. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis included 795 000 participants aged 5 to 17 years enrolled in Medicaid (Medicaid Analytic eXtract claims, 2011-2012) living in families with income below 200% of the federal poverty threshold (American Community Survey, 2008-2013). Follow-up ended in December 2021. EXPOSURES Family income relative to the federal poverty threshold. MAIN OUTCOMES AND MEASURES Record of International Classification of Diseases, Ninth Revision codes for an infection, mental health disorder, injury, asthma, anemia, or substance use disorder and death record within 10 years of observation (Social Security Administration death records through 2021). RESULTS Among 795 000 individuals in the sample (all statistics weighted: mean [SD] income-to-poverty ratio, 90% [53%]; mean [SD] age, 10.6 [3.9] years; 56% aged 10 to 17 years), 33% had a diagnosed infection, 13% had a mental health disorder, 6% had an injury, 5% had asthma, 2% had anemia, 1% had a substance use disorder, and 0.6% died between 2011 and 2021, with the mean (SD) age at death of 19.8 (4.2) years. For those aged 5 to 9 years, higher family income was associated with lower adjusted prevalence of all outcomes, except mortality: children in families with an additional 100% income relative to the federal poverty threshold had 2.3 (95% CI, 1.8-2.9) percentage points fewer infections, 1.9 (95% CI, 1.5-2.2) percentage points fewer mental health diagnoses, 0.7 (95% CI, 0.5-0.8) percentage points fewer injuries, 0.3 (95% CI, 0.09-0.5) percentage points less asthma, 0.2 (95% CI, 0.08-0.3) percentage points less anemia, and 0.06 (95% CI, 0.03-0.09) percentage points fewer substance use disorder diagnoses. Except for injury and anemia, the associations were more pronounced among those aged 10 to 17 years than those 5 to 9 years (P for interaction <.05). For those aged 10 to 17 years, an additional 100% income relative to the federal poverty threshold was associated with a lower 10-year mortality rate by 0.18 (95% CI, 0.12-0.25) percentage points. CONCLUSIONS AND RELEVANCE Among children and adolescents in the US aged 5 to 17 years with family income under 200% of the federal poverty threshold who accessed health care through Medicaid or the Children's Health Insurance Program, higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Further research is needed to understand whether these associations are causal.
Collapse
Affiliation(s)
| | - Vinayak Bhatia
- Department of Statistics, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Maria Polyakova
- Department of Health Policy, School of Medicine, Stanford University, Stanford, California
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
| |
Collapse
|
11
|
Vaalavuo M, Niemi R, Suvisaari J. Growing up unequal? Socioeconomic disparities in mental disorders throughout childhood in Finland. SSM Popul Health 2022; 20:101277. [PMID: 36353094 PMCID: PMC9637807 DOI: 10.1016/j.ssmph.2022.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Problems in mental health and socioeconomic health inequalities during childhood and adolescence are receiving important scientific and political attention. This in mind, we study how current family income and parental education are associated with psychiatric disorders among children in a well-developed welfare state, Finland. To gain a deeper understanding of how these disparities develop through early life course, we study the differences between genders, age groups, types of mental disorders, and also take into account the role of parental mental disorders. We exploit high-quality Finnish register data containing the whole population aged 4-17 with information on their families and parents. Our results of linear probability models show that lower parental education is consistently associated with higher probability of mental disorders throughout childhood, although some gender and disorder-specific differences are also identified. Interestingly, household income is related to mental health in more complex ways, having both negative and positive associations with psychiatric disorders. Inequalities are stronger among boys than girls, and the strongest associations are found among boys aged 7-12 and girls aged 13-17. Parental mental disorders increase the risk of children's psychiatric disorders but do not explain socioeconomic disparities. Considering the negative effects of mental problems on socioeconomic outcomes, inequalities in childhood mental health can be expected to reinforce other social inequalities in later life and should therefore be a focus of interventions.
Collapse
Affiliation(s)
- Maria Vaalavuo
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland
| | - Ripsa Niemi
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland
| |
Collapse
|
12
|
Chen Y, Sylvia S, Dill SE, Rozelle S. Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13845. [PMID: 36360724 PMCID: PMC9654689 DOI: 10.3390/ijerph192113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.
Collapse
Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah-Eve Dill
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
13
|
Muhammad T, Sekher TV, Srivastava S. Association of objective and subjective socioeconomic markers with cognitive impairment among older adults: cross-sectional evidence from a developing country. BMJ Open 2022; 12:e052501. [PMID: 35981779 PMCID: PMC9394209 DOI: 10.1136/bmjopen-2021-052501] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/07/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study explored how various markers of objective and subjective socioeconomic status (SES) are associated with cognitive impairment among older Indian adults. DESIGN A cross-sectional study was conducted using large nationally representative survey data. SETTING AND PARTICIPANT This study used data from the Longitudinal Ageing Study in India (2017-2018). The sample included 31 464 older adults aged 60 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome variable was cognitive impairment, measured through broad domains of memory, orientation, arithmetic function, and visuo-spatial and constructive skills. We estimated descriptive statistics and presented cross-tabulations of the outcome. Χ2 test was used to evaluate the significance level of differences in cognitive impairment by subjective (ladder) and objective SES measures (monthly per-capita consumption expenditure (MPCE) quintile, education and caste status). Multivariable linear and logistic regression analyses were conducted to fulfil the objectives. RESULTS A proportion of 41.7% and 43.4% of older adults belonged to low subjective (ladder) and objective (MPCE) SES, respectively. Older adults with low subjective (adjusted OR (aOR): 2.04; p<0.05) and objective SES (aOR: 1.32; p<0.05) had higher odds of having cognitive impairment in comparison with their counterparts, with a stronger subjective SES-cognitive impairment association. Older adults with lower education or belonged to lower caste had higher odds of cognitive impairment than their counterparts. Interaction analyses revealed that older adults who belonged to lower subjective and objective (poorest MPCE quintile, Scheduled Castes and lowest education) SES had 2.45 (CI: 1.77 to 3.39), 4.56 (CI: 2.97 to 6.98) and 54.41 (CI: 7.61 to 388.93) higher odds of cognitive impairment than those from higher subjective and objective SES, respectively. CONCLUSION Subjective measures of SES were linked to cognitive outcomes, even more strongly than objective measures of SES; considering the relative ease of obtaining such measures, subjective SES measures are a promising target for future study on socioeconomic indicators of cognitive impairment.
Collapse
Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - T V Sekher
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| |
Collapse
|
14
|
Summers KM, Paganini GA, Lloyd EP. Poor Toddlers Feel Less Pain? Application of Class-Based Pain Stereotypes in Judgments of Children. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2022. [DOI: 10.1177/19485506221094087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across four studies, we investigated whether perceptions of children’s pain are influenced by their socioeconomic status (SES). We found evidence that children with low SES were believed to feel less pain than children with high SES (Study 1), and this effect was not moderated by child’s age (Study 2). Next, we examined life hardship as a mediator of this effect among children, finding that children with low SES were rated as having lived a harder life and thus as feeling less pain (Study 3). Finally, we examined downstream consequences for hypothetical treatment recommendations. We found that participants perceived children with low SES as less sensitive to pain and therefore as requiring less pain treatment than children with high SES (Study 4). Thus, we consistently observe that stereotypes of low-SES individuals as insensitive to pain may manifest in judgments of children and their recommended pain care. Implications of this work for theory and medical practice are discussed.
Collapse
|
15
|
Rattay P, Blume M, Wachtler B, Wollgast L, Spallek J, Hoffmann S, Sander L, Herr R, Herke M, Reuter M, Novelli A, Hövener C. Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study. PLoS One 2022; 17:e0266463. [PMID: 35390046 PMCID: PMC8989218 DOI: 10.1371/journal.pone.0266463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family's socioeconomic position and adolescents' self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. METHODS Using data from wave 2 of the"German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents' subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). RESULTS A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. CONCLUSION The analysis revealed how a family's position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).
Collapse
Affiliation(s)
- Petra Rattay
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Benjamin Wachtler
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Lina Wollgast
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Stephanie Hoffmann
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Lydia Sander
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Raphael Herr
- Medical Faculty Mannheim, Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Max Herke
- Medical Faculty, Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marvin Reuter
- Medical Faculty, Institute of Medical Sociology, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| |
Collapse
|
16
|
Socioeconomic status, BMI, and brain development in children. Transl Psychiatry 2022; 12:33. [PMID: 35075111 PMCID: PMC8786961 DOI: 10.1038/s41398-022-01779-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Low socioeconomic status (SES) in childhood is associated with deficits in executive function and changes in cortical morphology. Furthermore, rates of childhood obesity are greater among low SES children and childhood obesity is also associated with cortical alterations and impaired neurocognition, specifically in the domain of executive function. To investigate the influence of BMI on the relationships between SES and both neurocognition and brain morphology, we used data from the Adolescent Brain Cognitive Development (ABCD) study to construct multiple linear regression models and conduct mediation analyses. Overall, SES as measured by household income, highest level of parental education, and area deprivation, was associated with lower BMI, greater total and prefrontal cortical volume, and better performance on assessments of executive function. Mediation analysis indicated that BMI had a significant indirect effect on associations between area deprivation and both total and prefrontal cortical volumes. BMI also played a mediating role in the associations between area deprivation and composite neurocognitive scores, which were driven by performance on tasks of working memory and cognitive flexibility, but not cognitive control. These findings suggest that BMI should be considered in future studies investigating the relationship between low SES and poor neurodevelopmental outcomes.
Collapse
|
17
|
Libuy N, Bann D, Fitzsimons E. Inequalities in body mass index, diet and physical activity in the UK: Longitudinal evidence across childhood and adolescence. SSM Popul Health 2021; 16:100978. [PMID: 34950761 PMCID: PMC8671115 DOI: 10.1016/j.ssmph.2021.100978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/05/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
We use longitudinal data across a key developmental period, spanning much of childhood and adolescence (age 5 to 17, years 2006-2018) from the UK Millennium Cohort Study, a nationally representative study with an initial sample of just over 19,000. We first examine the extent to which inequalities in overweight, obesity, BMI and body fat over this period are consistent with the evolution of inequalities in health behaviours, including exercise and healthy diet markers (i.e., skipping breakfast) (n = 7,220). We next study the links between SES, health behaviours and adiposity (BMI, body fat), using rich models that account for the influence of a range of unobserved factors that are fixed over time. In this way, we improve on existing estimates measuring the relationship between SES and health behaviours on the one hand and adiposity on the other. The advantage of the individual fixed effects models is that they exploit within-individual changes over time to help mitigate biases due to unobserved fixed characteristics (n = 6,883). We observe stark income inequalities in BMI and body fat in childhood (age 5), which have further widened by age 17. Inequalities in obesity, physical activity, and skipping breakfast are observed to widen from age 7 onwards. Ordinary Least Square estimates reveal the previously documented SES gradient in adiposity, which is reduced slightly once health behaviours including breakfast consumption and physical activity are accounted for. The main substantive change in estimates comes from the fixed effects specification. Here we observe mixed findings on the SES associations, with a positive association between income and adiposity and a negative association with wealth. The role of health behaviours is attenuated but they remain important, particularly for body fat.
Collapse
Affiliation(s)
- Nicolás Libuy
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
- Corresponding author.
| | - David Bann
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
- Institute for Fiscal Studies, London, UK
| |
Collapse
|
18
|
Socioeconomic circumstances and lung function growth from early adolescence to early adulthood. Pediatr Res 2021; 90:1235-1242. [PMID: 33603209 DOI: 10.1038/s41390-021-01380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/17/2020] [Accepted: 01/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND A reduced lung function in early adulthood is associated with respiratory and non-respiratory diseases and is a long-term predictor of mortality. This study investigated the association between early socioeconomic circumstances (SEC) and lung function growth trajectories from early adolescence until early adulthood. METHODS We analysed data from the EPITeen population-based study, including adolescents born in 1990. Study waves occurred at 13, 17 and 21 years of age. Information on sociodemographic, behavioural and health factors, anthropometry and spirometry was collected. Early-life SEC were assessed using maternal education and paternal occupational position. The forced expiratory volume in the first second (FEV1) growth trajectories were drawn considering sex-and-height interactions over an 8-year period. Our sample included 2022 participants with complete information for the relevant variables. RESULTS Participants from most disadvantaged SEC presented lower FEV1 at early adolescence compared to high-SEC counterparts, but differences seem to diminish with height growth. The effect of paternal occupational position in lung function growth trajectories was moderated by height, thus individuals from fathers with less advantaged occupational position had lower FEV1 at early adolescence, but they had a faster FEV1 growth over time. CONCLUSIONS Individuals from most disadvantaged SEC presented lower lung function at early adolescence compared to high-SEC counterparts; nevertheless, a catch-up growth was observed. IMPACT Lower socioeconomic circumstances were previously associated with reduced lung function and a higher risk of respiratory diseases in adults. Fewer studies analysed the effects of early-life socioeconomic circumstances in lung function growth during adolescence. Disadvantaged socioeconomic circumstances were associated with lower lung function in early adolescence. However, social differences diminished over adolescence, suggesting a catch-up growth of lung function among those from lower socioeconomic circumstances. An improved understanding of the mechanism underlying lung function catch-up (or the absence of catch-up) might support interventions to narrow social inequalities in respiratory health and should be further investigated.
Collapse
|
19
|
Hübelová D, Kuncová M, Vojáčková H, Coufalová J, Kozumplíková A, Lategan FS, Chromková Manea BE. Inequalities in Health: Methodological Approaches to Spatial Differentiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312275. [PMID: 34886004 PMCID: PMC8656580 DOI: 10.3390/ijerph182312275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.
Collapse
Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Martina Kuncová
- Department of Economic Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Hana Vojáčková
- Department of Technical Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Jitka Coufalová
- Department of Development, City Municipality of Břeclav, 690 02 Břeclav, Czech Republic;
| | - Alice Kozumplíková
- Department of Environmental Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Francois Stefanus Lategan
- Department of Regional and Business Economics, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
| | - Beatrice-Elena Chromková Manea
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
| |
Collapse
|
20
|
Chen L, Du H, Zilioli S, Zhao S, Nie Y, Chi P. The School-Ladder Effect: Subjective Socioeconomic Status and Diurnal Cortisol Profile Among Adolescents. Psychosom Med 2021; 83:1031-1040. [PMID: 34297010 DOI: 10.1097/psy.0000000000000974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subjective socioeconomic status (SES) is a well-established psychosocial determinant of adolescents' self-report health. However, whether low subjective SES is associated with stress-related physiological risks (e.g., dysregulations in the hypothalamic-pituitary-adrenal axis activity) remains uncertain. This study examined the impact of subjective SES with different reference groups (i.e., perception of family SES relative to other students in the school versus other people in the city) on adolescents' diurnal cortisol profiles. METHODS A sample of 255 adolescents (aged 11-14 years; 53.7% boys) completed a battery of psychological scales, including school-referenced subjective SES and city-referenced subjective SES. Diurnal cortisol was assessed by collecting saliva samples four times a day across two consecutive days. Four cortisol parameters (cortisol at awakening, cortisol awakening response [CAR], cortisol slope, and total cortisol secretion [area under the curve with respect to ground {AUCg}]) were derived. RESULTS Higher levels of school-referenced subjective SES were associated with higher cortisol levels at awakening (β = 0.0483, standard error [SE] = 0.0219, p = .028), steeper cortisol slopes (β = -0.0036, SE = 0.0017, p = .034), and higher cortisol AUCg (b = 0.50, SE = 0.24, p = .036), but not with CAR (p = .77), after adjusting for covariates. In contrast, city-referenced subjective SES was not associated with any of the cortisol parameters (cortisol at awakening [p = .90], CAR [p = .74], cortisol slope [p = .84], and cortisol AUCg [p = .68]). CONCLUSIONS Our findings highlight the importance of the reference group for subjective SES and provide a further understanding of socioeconomic disparities in adolescents' stress physiology.
Collapse
Affiliation(s)
- Lihua Chen
- From the Department of Psychology (Chen, Zhao, Chi), University of Macau, Macau SAR; Institute of Advanced Studies in Humanities and Social Sciences (Du), Beijing Normal University at Zhuhai, Zhuhai, China; Departments of Psychology (Zilioli) and Family Medicine and Public Health Sciences (Zilioli), Wayne State University, Detroit, Michigan; Department of Psychology (Nie), Guangzhou University, Guangzhou; and Center for Cognitive and Brain Sciences (Chi), University of Macau, Macau SAR, China
| | | | | | | | | | | |
Collapse
|
21
|
Highlander AR, Jones DJ. Integrating Objective and Subjective Social Class to Advance Our Understanding of Externalizing Problem Behavior in Children and Adolescents: A Conceptual Review and Model. Clin Child Fam Psychol Rev 2021; 25:300-315. [PMID: 34533656 DOI: 10.1007/s10567-021-00369-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Extant research has identified both objective measures of socioeconomic status (SES) and subjective social class (SSC) as important predictors of psychosocial outcomes in childhood and adolescence, particularly with regard to externalizing symptoms. Given the importance of the associations with SES and SSC, a more nuanced and integrated conceptual understanding of early pathways of vulnerability implicated in the development and maintenance of youth externalizing problems is warranted. Thus, this review will: (1) operationalize both SES and SSC and their current standards of measurement; (2) examine current literature describing their respective associations with a range of externalizing symptoms in both children and adolescents; (3) review current theoretical models connecting SES and SSC and youth development and the strengths and limitations of those approaches; (4) propose a new conceptual socioecological model situating the impact of SES and SSC on youth externalizing problems in the context of parents and peers as a framework to further integrate existing research and guide future work; and (5) discuss potential clinical implications at the intersection of this work.
Collapse
Affiliation(s)
- April R Highlander
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
22
|
Psychological distress in late adolescence: The role of inequalities in family affluence and municipal socioeconomic characteristics in Norway. PLoS One 2021; 16:e0254033. [PMID: 34214137 PMCID: PMC8253448 DOI: 10.1371/journal.pone.0254033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
The present study aims to explore, in the national context of Norway, how municipal socioeconomic indicators affect anxiety and depressive symptom scores among senior high school students and whether this potential municipal effect is dependent on the adolescents' family affluence levels. This cross-sectional study is based on questionnaire data collected in five waves (2014-2018) of the Ungdata survey. The study sample consisted of 97,460 adolescents aged 16-18 years attending high school in 156 municipalities in Norway. Measures of psychological distress, depression, and anxiety symptoms were based on the screening instrument, Hopkins Symptom Checklist-10. Two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents' mental health. In general, the results indicate substantial psychological symptom load among the study sample. Inequalities in adolescents' psychological distress between family affluence groups were evident, with the lowest symptom loads in the most affluent families. The predicted depressive and anxiety symptoms among the students increased slightly along with the percentage of municipal residents with tertiary educations and with increasing income inequalities in their residential municipality. However, the interaction models suggest that the adverse effects of higher municipal education level and greater income inequality are, to a certain extent, steepest for adolescents with medium family affluence. This study highlights two key findings. Both municipality effects and family affluence account for a relatively small proportion of the total variance in the students' psychological symptoms loads; however, the mental health inequalities we explored between socioeconomic strata on both the individual and municipal levels are not insignificant in a public health perspective. Results are discussed in the context of psychosocial mechanisms related to social comparison and perceptions of social status that may be applicable in egalitarian welfare states such as Norway.
Collapse
|
23
|
Deer LK, Shields GS, Alen NV, Hostinar CE. Curvilinear associations between family income in early childhood and the cortisol awakening response in adolescence. Psychoneuroendocrinology 2021; 129:105237. [PMID: 34004490 PMCID: PMC9286487 DOI: 10.1016/j.psyneuen.2021.105237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 04/13/2021] [Indexed: 11/20/2022]
Abstract
Previous evidence on cortisol output and socioeconomic status (SES) has been mixed, with studies finding that lower SES can be associated with higher or lower cortisol output, and null associations have also been reported. We hypothesized that these inconsistencies may be due to an underlying curvilinear, inverted-U pattern of association, such that low income is related to increased likelihood of both low and high cortisol output. We tested these curvilinear links among family income and cortisol indices in the Avon Longitudinal Study of Parents and Children (N = 803). Maternal reports of family income when the study children were 33 and 47 months of age were averaged to estimate early-childhood family income. Three cortisol indices were derived from samples collected in adolescence (15.5 years of age): the cortisol awakening response (CAR), area under the curve (AUC) cortisol, and the diurnal cortisol slope. As hypothesized, the CAR exhibited a curvilinear, inverted-U relation with childhood income, with low childhood income being associated with both the lowest and the highest CARs. These findings suggest that discrepancies in prior findings on low SES and the CAR may be due to curvilinear patterns of association. However, childhood income was not significantly associated with adolescent cortisol diurnal slope or AUC. Future work should clarify the factors that might predispose to high versus low CAR given equivalent low SES in childhood.
Collapse
Affiliation(s)
- LillyBelle K Deer
- Center for Mind and Brain, University of California, Davis, CA, United States; Department of Psychology, University of California, Davis, CA, United States.
| | - Grant S Shields
- Center for Mind and Brain, University of California, Davis, CA, United States
| | - Nicholas V Alen
- Center for Mind and Brain, University of California, Davis, CA, United States; Department of Psychology, University of California, Davis, CA, United States
| | - Camelia E Hostinar
- Center for Mind and Brain, University of California, Davis, CA, United States; Department of Psychology, University of California, Davis, CA, United States.
| |
Collapse
|
24
|
Mira RS, Marcenes W, Stansfeld SA, Bernabé E. Cumulative socio-economic disadvantage and traumatic dental injuries during adolescence. Dent Traumatol 2020; 37:338-344. [PMID: 33220120 DOI: 10.1111/edt.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM Studies on the association between socio-economic circumstances and traumatic dental injuries (TDIs) are cross-sectional and inconclusive. The aim of this study was to investigate the association between cumulative socio-economic disadvantage and TDIs among adolescents. METHOD Data from 668 participants in the East London Adolescents Community Health Survey (RELACHS) were analysed. Family socio-economic indicators (parental employment, car ownership and eligibility for free school meals) were collected when participants were in grades 7 (11-12 years), 9 (13-14 years) and 11 (15-16 years). The number of periods (RELACHS waves) adolescents lived in socio-economic disadvantage was counted for each socio-economic measure, ranging from 0 (never in disadvantage) to 3 (always in disadvantage). Adolescents were dentally examined for TDIs at age 15-16 years. The association between each measure of cumulative socio-economic disadvantage and TDIs was tested in logistic regression models adjusting for demographic factors. RESULTS Significant positive linear trends in the prevalence of TDIs were observed by the number of periods of parental unemployment and being without a family car, but not by eligibility for free school meals. Adolescents whose parents were always unemployed had 2.06 (95% CI: 1.12-3.80) greater odds of having TDIs than those whose parents were never unemployed. Similarly, adolescents from families that never owned a car had 2.17 (95% CI: 1.26-3.74) greater odds of having TDIs than those that always had a family car. CONCLUSION Cumulative socio-economic disadvantage during adolescence was associated with greater odds of having TDIs.
Collapse
Affiliation(s)
- Rolla Saud Mira
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | | | - Stephen A Stansfeld
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eduardo Bernabé
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| |
Collapse
|
25
|
Yang-Huang J, van Grieken A, van Meel ER, He H, de Jongste JC, Duijts L, Raat H. Sociodemographic factors, current asthma and lung function in an urban child population. Eur J Clin Invest 2020; 50:e13277. [PMID: 32495383 PMCID: PMC7539956 DOI: 10.1111/eci.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aimed to assess which sociodemographic factors are associated with current asthma and indicators of lung function in 10-year-old children. METHODS We analysed data of 5237 children (Mean age: 9.7, SD: 0.3) from the Generation R Study (2012-2016), a population-based cohort study in the Netherlands. Indicators of sociodemographic factors included parental educational level, net household income, financial difficulties, parental employment status and child ethnic background. Current asthma (yes/no) was defined as ever doctor-diagnosed-asthma combined with wheezing symptoms or asthma-medication use in the past 12 months. Lung function was measured by spirometry and included forced expiratory volume in 1 second (FEV1 ), forced vital capacity (FVC), FEV1 /FVC, and forced expiratory flow after exhaling 75% of FVC (FEF75 ). Within-study sex-, height- and age-adjusted lung function measurements' z-scores were converted. RESULTS After adjustment for all sociodemographic factors, an independent association was observed between ethnic background with current asthma and lung function. Compared with children with a Dutch background, children with a nonwestern ethnic background had a higher odds of having current asthma (OR: 1.61, 95% CI: 1.02, 2.53), lower FVC z-score (-0.25, 95% CI: -0.35, -0.14), higher FEV1 /FVC z-score (0.26, 95% CI: 0.14, 0.37) and higher FEF75% z-score (0.15, 95% CI: 0.04, 0.25). CONCLUSIONS Among 10-year-old children, ethnic background was associated with current asthma and lung function after adjusting for a wide range of sociodemographic factors. No associations were found between socioeconomic status indicators and current asthma. Explanations for these associations such as language barriers, suboptimal care or pathophysiological differences require further investigation.
Collapse
Affiliation(s)
- Junwen Yang-Huang
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evelien R van Meel
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Huan He
- School of Public Administration, Southwestern University of Finance and Economics, Sichuan, China
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
26
|
Zhang L, Mersky JP, Topitzes J. Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults. CHILD ABUSE & NEGLECT 2020; 108:104658. [PMID: 32799016 DOI: 10.1016/j.chiabu.2020.104658] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/01/2020] [Accepted: 07/31/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND International interest in adverse childhood experiences (ACE) is on the rise. In China, recent research has explored the effects of ACEs on health-related outcomes, but little is known about how ACEs impact the psychological functioning of rural Chinese youth as they make transition to adulthood. OBJECTIVE This study is aimed to assess the prevalence and psychological consequences of ACEs among a group of rural Chinese young adults. PARTICIPANTS AND SETTINGS 1019 rural high school graduates from three different provinces of China participated in this study. METHODS A web-based survey was used to assess ten conventional ACEs and seven other novel ACEs using the Childhood Experiences Survey. Using validated brief measures, six indicators of psychological functioning were assessed: anxiety, depression, perceived stress, posttraumatic stress, loneliness, and suicidality. Descriptive and correlational analyses of all ACEs were performed, and multivariate regressions were conducted to test associations between ACEs and study outcomes. RESULTS Three-fourths of Chinese youth endorsed at least one of ten conventional ACEs. The most prevalent ACEs were physical abuse (52.3 %) and domestic violence (43.2 %). Among seven new adversities, prolonged parental absence (37.4 %) and parental gambling problems (19.7 %) were most prevalent. Higher conventional ACEs scores were significantly associated with poorer psychological functioning, and each type of new adversity was associated with one or more psychological problems. CONCLUSION ACEs were prevalent among rural Chinese young adults and had deleterious effects on their psychological well-being. Further work is needed to address ACEs by developing culturally appropriate assessment practices, interventions, and policy responses.
Collapse
Affiliation(s)
- Lixia Zhang
- Department of Social Work, University of Northern Iowa, 1227 W 27th St, Sabin Hall 257, Cedar Falls, IA 50614, United States.
| | - Joshua P Mersky
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, United States
| | - James Topitzes
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, United States
| |
Collapse
|
27
|
O'Neil A, Russell JD, Thompson K, Martinson ML, Peters SAE. The impact of socioeconomic position (SEP) on women's health over the lifetime. Maturitas 2020; 140:1-7. [PMID: 32972629 PMCID: PMC7273147 DOI: 10.1016/j.maturitas.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.
Collapse
Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia
| | - Kelly Thompson
- Global Women's Health, The George Institute for Global Health, University of New South Wales, Australia
| | | | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
28
|
Leavey G, Rosato M, Harding S, Corry D, Divin N, Breslin G. Adolescent mental health problems, suicidality and seeking help from general practice: A cross-sectional study (Northern Ireland Schools and Wellbeing study). J Affect Disord 2020; 274:535-544. [PMID: 32663986 DOI: 10.1016/j.jad.2020.05.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/01/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adolescent mental health problems and suicidality appear to be increasing in Western countries but contact with health services remains stubbornly low. While social disadvantage is often implicated in aetiology and help-seeking, evidence on the relative contribution of school and family life factors is limited. We sought (a) to examine the prevalence and factors associated with mental health problems in adolescent boys and girls; and (b) to examine factors associated with trust and contact with GPs for mental health problems. METHOD Cross-sectional study of adolescent pupils in Northern Ireland RESULTS: High rates of mental health problems and suicidality were recorded, especially among females. While social circumstances do not influence mental health outcomes, factors of interest were atheist/agnostic beliefs and having a bedroom to oneself. While overall trust in GPs was high, more than 36% of the sample reported low trust. GP Trust was associated with positive home life factors. Importantly, adolescents with mental health problems including suicidality were much less likely to seek help. LIMITATIONS Cross-sectional data CONCLUSIONS: This study confirms the high rates of mental health problems and suicidality among adolescents in Northern Ireland, particularly among young women. Those most in need of professional help appear least prepared to seek it. The influence of home life and environment on both poor mental health and trust and help-seeking from family doctors, is considerable and there is a need to find interventions that nurture appropriate levels of trust and help-seeking guidance for adolescents.
Collapse
Affiliation(s)
- Gerard Leavey
- The Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland.
| | - Michael Rosato
- The Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland.
| | - Seeromanie Harding
- Kings College London, Franklin-Wilkins Building, Stamford Street London, SE1 9NH, UK.
| | - Dagmar Corry
- The Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland.
| | - Natalie Divin
- The Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland.
| | - Gavin Breslin
- The Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland.
| |
Collapse
|
29
|
Association between socioeconomic status and the trajectory of insufficient sleep: Maternal emotional support as a moderator. Soc Sci Med 2020; 261:113237. [PMID: 32745826 DOI: 10.1016/j.socscimed.2020.113237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association between SES and the trajectory of insufficient sleep among children aged 0.5-8 years and to investigate whether these associations vary by age. The moderating role of maternal emotional support was further explored. METHOD Data were obtained from 20,874 children participating in the Taiwan Birth Cohort Study. Multilevel models were conducted to explore the association between SES and the trajectory of insufficient sleep. The moderating role of maternal emotional support was examined by testing the significance of the interaction between SES and emotional support. RESULTS Low parental education and poverty contributed to increased risk of insufficient sleep, and the observed associations varied by age. Specifically, the influences of parental education increased with age, and the effects of poverty were significant only among preschoolaged children. Poverty dynamics were also significantly associated with an elevated risk of insufficient sleep, but the association was mitigated by maternal emotional support. CONCLUSIONS Children with low SES exhibited increased risk of insufficient sleep. Furthermore, the relationship between SES and insufficient sleep differed by age, with varying patterns emerging for different SES indicators. However, the negative influences of low SES could be mitigated by increasing maternal emotional support. Interventions that reduce SES disparity or enhance maternal emotional support could decrease the risk of insufficient sleep among children living with an SES disadvantage.
Collapse
|
30
|
Adherence to Life-Style Recommendations and Attention-Deficit/Hyperactivity Disorder: A Population-Based Study of Children Aged 10 to 11 Years. Psychosom Med 2020; 82:305-315. [PMID: 32251098 DOI: 10.1097/psy.0000000000000787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The incidence of attention-deficit/hyperactivity disorder (ADHD) among children and youth is high, and temporal increases have been paralleled by deteriorating life-styles. Poor diet quality, physical inactivity, poor sleep habits, and sedentary behaviors have all been associated with ADHD. However, no earlier prospective study has examined the independent and combined importance of meeting established life-style recommendations in childhood for ADHD in adolescence. We examined the associations of adherence to life-style recommendations with the incidence of ADHD and the utilization of health services associated with ADHD. METHODS Life-style survey among 10- and 11-year-old students (N = 3436) was linked to administrative health data. Associations between adherence to nine established life-style recommendations with ADHD diagnosis and number of physician visits for ADHD until age 14 years were examined using Cox proportional hazard and negative binomial regression. RESULTS Before age 14 years, 10.8% of students received an ADHD diagnosis. Meeting recommendations for vegetables and fruit, meat and alternatives, saturated fat, added sugar, and physical activity was associated with fewer ADHD diagnoses. Compared with children who met one to three recommendations, meeting seven to nine recommendations was associated with substantially lower incidence of ADHD and fewer physician visits related to ADHD (hazard ratio = 0.42 [95% confidence interval = 0.28-0.61]; rate ratio = 0.38 [95% confidence interval = 0.22-0.65]). CONCLUSIONS Life-style recommendations exist to benefit development and physical health. Their promotion comes at no harm and may have benefits for ADHD. Experimental evidence is needed to clarify the potential bidirectional relationship between ADHD and adverse health behaviors.
Collapse
|
31
|
Trajectory of inequality of opportunity in child height growth: Evidence from the Young Lives study. DEMOGRAPHIC RESEARCH 2020. [DOI: 10.4054/demres.2020.42.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
32
|
Jackson MI, Kihara T. The Educational Gradient in Health among Children in Immigrant Families. POPULATION RESEARCH AND POLICY REVIEW 2019; 38:869-897. [PMID: 32788819 PMCID: PMC7418906 DOI: 10.1007/s11113-019-09558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
Educational inequality in the health of U.S. children-what social scientists refer to as the "educational gradient" in health-is present at birth for virtually every marker of health, and increases throughout childhood. However, a puzzling contradiction to this pattern has been observed among the growing population of youth in immigrant families. Some evidence suggests an ambiguous relationship between education and health among immigrant families, with a flat relationship between maternal education and maternal health behaviors and children's birth outcomes, and a stronger relationship as children become adolescents. Does an educational gradient in health emerge among children in immigrant families during childhood and adolescence? To date, we lack a prospective examination of how the gradient changes from birth throughout childhood and adolescence among this population. Moreover, while the dominant explanation for a weaker gradient among children with immigrant parents centers on the family setting, we know little about family-level dynamics among the same immigrant families as children age. Using national, longitudinal data from the Fragile Families and Child Well-Being Study, we examine the association between maternal education and children's health (measured by mothers' ratings) over the early life course (birth through age 15) among children of immigrants and children of native-born parents, and consider whether changes in children's economic status and family composition contribute to the educational gradient, or lack thereof, in child health. Analyses reveal that: (1) maternal education is strongly predictive of health, even among children of immigrants; (2) immigrant status does not appear to be protective for health within educational groups, as evidenced by poorer health among children of immigrants whose mothers have the lowest level of education, as compared to children of natives; (3) children in the least-educated immigrant families are experiencing better health trajectories as they age than children in similar native-born families; and (4) accounting for economic conditions and family composition does not reduce the size of the gradient over time.
Collapse
|
33
|
State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224417. [PMID: 31718056 PMCID: PMC6888402 DOI: 10.3390/ijerph16224417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations.
Collapse
|
34
|
Fernald LCH, Gosliner W. Alternatives to SNAP: Global Approaches to Addressing Childhood Poverty and Food Insecurity. Am J Public Health 2019; 109:1668-1677. [PMID: 31622152 DOI: 10.2105/ajph.2019.305365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) in the United States is a key element of the nation's safety net. Yet, 12.5 million US children live in households that experience food insecurity, despite national spending of $65 billion on SNAP alone.In analyses integrating data from the 36 Organisation for Economic Co-operation and Development (OECD) countries, we found that child poverty and food insecurity are much higher in the United States than in most of the other OECD countries. The United States has higher total social spending than other OECD countries, but a lower rate of spending on children and families. This international comparison suggests that potentially effective solutions implemented in other countries might help further alleviate US childhood poverty and food insecurity.Broadly, we recommend increasing investments in families with children, particularly low-income families. Our specific recommendations include increasing SNAP benefits, establishing additional benefits to support low-income families with young children, and implementing a universal child allowance. Achieving substantial reductions in child poverty and food insecurity will require overcoming many challenges, including the current US political climate, a national history of underinvestment in social programs, a lack of political will, and a culture of structural racism.
Collapse
Affiliation(s)
- Lia C H Fernald
- Lia C. H. Fernald is with the School of Public Health, University of California, Berkeley. Wendi Gosliner is with the Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley
| | - Wendi Gosliner
- Lia C. H. Fernald is with the School of Public Health, University of California, Berkeley. Wendi Gosliner is with the Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley
| |
Collapse
|
35
|
Cuéllar-Flores I, Saínz T, Velo C, González-Tomé MI, García-Navarro C, Fernández-Mcphee C, Guillén S, Ramos JT, Miralles P, Rubio R, Bernardino JI, Prieto L, Rojo P, de Ory SJ, Navarro ML. Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV. World J Pediatr 2019; 15:492-498. [PMID: 31286425 DOI: 10.1007/s12519-019-00281-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies investigating health-related quality of life (HRQoL) in youth with perinatally acquired HIV (PHIV+) are scarce. This study aimed to compare HRQoL of PHIV+ to sociodemographic-matched youth not living with HIV (HIV-), Spanish general youth population, and to explore associations between sociodemographic variables, drug consumption, and HRQoL. METHODS PHIV+ youth were randomly selected from CoRISpe database (Cohort of the Spanish Pediatric HIV Network). HRQoL was evaluated by SF-12v2. RESULTS Thirty-nine PHIV+ youth (mean age: 23.36 years, SD = 3.83) and thirty-nine HIV- youth (mean age: 22.97 years, SD = 3.80) participated in this study. PHIV+ obtained lower scores in SF-12 physical health subscale (PCS) than HIV- (P = 0.001) and Spanish general youth population (P = 0.006). PHIV+ had lower scores on the mental health subscale (MCS) than the Spanish general youth population (P < 0.001). PHIV+ who were at school obtained better scores than those were not at school. PHIV+ youth who had used cocaine and cannabis had lower scores in MCS (P = 0.002). CONCLUSIONS There is a need for HRQoL management in the associated medical follow-up.
Collapse
Affiliation(s)
| | - Talía Saínz
- Infectious Diseases Service, Paed Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Carlos Velo
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Sara Guillén
- Paed Department, Hospital de Getafe, Madrid, Spain
| | - José Tomás Ramos
- Pediatric Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Miralles
- Infectious Diseases Service, H. Gregorio Marañón, Madrid, Spain
| | - Rafael Rubio
- HIV Service, Hospital 12 de Octubre, Madrid, Spain
| | | | - Luis Prieto
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Rojo
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Maria Luisa Navarro
- Infectious Diseases Service, Paed Department, H. Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| |
Collapse
|
36
|
Impact of Race and Socioeconomic Status on Psychologic Outcomes in Childhood Cancer Patients and Caregivers. J Pediatr Hematol Oncol 2019; 41:433-437. [PMID: 30629003 DOI: 10.1097/mph.0000000000001405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complex relationships between race and socioeconomic status have a poorly understood influence on psychologic outcomes in pediatric oncology. The Family Symptom Inventory was used to assess symptoms of depression and anxiety in pediatric patients with cancer and their caregivers. Separate hierarchical linear regression models examined the relationship between demographic variables, cancer characteristics, socioeconomic status, and access to care and patient or caregiver depression/anxiety. Participants included 196 pediatric patients with cancer (mean age, 11.21 y; 49% African American) and their caregivers. On average, caregivers reported low levels of depression/anxiety. Symptoms of depression and anxiety in patients were correlated with poorer mental health in caregivers (r=0.62; P<0.01). Self-reported financial difficulty (β=0.49; P<0.001) and brain cancer diagnosis for their child (β=0.42; P=0.008) were significantly associated with depression and anxiety in caregivers. Analysis did not reveal significant associations between race, household income, or access to care and patient or caregiver depression/anxiety. Perception of financial hardship can adversely impact mental health in caregivers of children with cancer. Psychosocial assessment and interventions may be especially important for caregivers of patients with brain tumors and caregivers who report feeling financial difficulty.
Collapse
|
37
|
Johnson L, Cornish R, Boyd A, Macleod J. Socio-demographic patterns in hospital admissions and accident and emergency attendances among young people using linkage to NHS Hospital Episode Statistics: results from the Avon Longitudinal Study of Parents and Children. BMC Health Serv Res 2019; 19:134. [PMID: 30808346 PMCID: PMC6390368 DOI: 10.1186/s12913-019-3922-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/22/2019] [Indexed: 11/15/2022] Open
Abstract
Background In England emergency hospital admissions among children are increasing and the under 25s are the most frequent attenders of A&E departments. Children of lower socio-economic status (SES) have poorer health outcomes and higher hospital admission rates. NHS Hospital Episode Statistics (HES) are increasingly being used for research but lack detailed data on individual characteristics such as SES. We report the results of an Avon Longitudinal Study of Parents and Children (ALSPAC) study that linked the data of 3,189 consenting participants to HES. We describe rates of hospital admission, emergency readmissions, and A&E attendances and examine socio-demographic correlates of these. Methods Subjects were singletons and twins enrolled in ALSPAC who had provided consent for linkage to their health records by the study cut-off date (31.02.12). Linkage was carried out by the Health and Social Care Information Centre (now NHS Digital). We examined rates of admissions between birth and age 20 and A&E attendances between 14 and 20 years. Socio-demographic information collected in ALSPAC questionnaires during pregnancy were used to examine factors associated with admissions, emergency readmissions (an emergency admission within 30 days of discharge) and A&E attendances. Results Excluding birth records, we found at least one admission for 1,792/3,189 (56.2%) participants and 4,305 admissions in total. Admission rates were highest in the first year of life. Among males, admissions declined until about age 5 and then remained relatively stable; conversely, among females, they increased sharply from the age of 15. ICD 10 chapters for diseases of the digestive system and injury and poisoning accounted for the largest proportions of admissions (15.8 and 14.5%, respectively). Tooth decay was the highest single cause of admission for those aged 5–9 years. Overall, 1,518/3,189 (47.6%) of participants attended A&E at least once, with a total of 3,613 attendances between age 14 and 20 years. Individuals from more deprived backgrounds had higher rates of admissions, readmissions and A&E attendances. Conclusions Linkage between cohort studies such as ALSPAC and HES data provides unique opportunities for detailed insights into socio-demographic and other determinants of hospital activity, which can inform secondary care demand management in the NHS. Electronic supplementary material The online version of this article (10.1186/s12913-019-3922-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Leigh Johnson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Rosie Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| |
Collapse
|
38
|
Remes H, Moustgaard H, Kestilä LM, Martikainen P. Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems? J Epidemiol Community Health 2019; 73:225-231. [PMID: 30635438 DOI: 10.1136/jech-2018-211316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use. METHODS We used longitudinal register data on a 20% representative sample of all families with children aged 0-14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13-19 years in 2001-2011 (n=145 404). RESULTS Hospital admissions were 2-3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects. CONCLUSIONS The excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.
Collapse
Affiliation(s)
- Hanna Remes
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Laura M Kestilä
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Martikainen
- Department of Social Research, University of Helsinki, Helsinki, Finland.,CHESS, University of Stockholm, Stockholm, Sweden.,Max Planck Institute of Demographic Research, Rostock, Germany
| |
Collapse
|
39
|
Silva LCOSTAE, Teles J, Fragoso I. Youth sports injuries according to health-related quality of life and parental instruction. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03749-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
van Zwieten A, Saglimbene V, Teixeira-Pinto A, Howell M, Howard K, Craig JC, Wong G. The Impact of Age on Income-Related Health Status Inequalities from Birth to Adolescence: A Systematic Review with Cross-Country Comparisons. J Pediatr 2018; 203:380-390.e14. [PMID: 30266508 DOI: 10.1016/j.jpeds.2018.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine the effect of age on associations between household income and overall health from birth to adolescence, and whether age patterns vary by country. It is uncertain whether income-related health inequalities remain stable, widen, or narrow as children age, which impacts optimal timing of equity-focused interventions. STUDY DESIGN Systematic review (CRD42016038583) of MEDLINE, Embase, PsycINFO, CINAHL, SocINDEX (full-text), and EconLit (full-text) to April 2017. We included observational studies and trials in children and adolescents (0-18 years of age), examining age differences in associations between income and overall health (self-rated, clinician-rated, proxy-rated). One reviewer extracted data; 2 evaluated risk of bias. RESULTS Thirty-eight articles containing 43 studies (30 cross-sectional, 13 cohort) were identified, from high-income (n = 39) and middle-income (n = 4) countries. In the US (n = 21), positive income-health associations emerged in early childhood, and these inequalities typically widened progressively into adolescence. Relative to 0- to 3-year-olds, ratios of income-health coefficients ranged from 1.10-3.71 for 4-8 years of age, 1.26-3.86 for 9-12 years of age, 1.36-6.71 for 13-17 years. In the United Kingdom and Ireland (n = 8), inequalities emerged in early-to-mid childhood, but age patterns were less consistent. In other high-income countries (Australia, Canada, France, Germany, Japan, Republic of Korea), inequalities mostly persisted or widened with age. In middle-income countries, inequalities appeared to narrow (Indonesia n = 2) or persist (Brazil n = 2) with age. Limitations are unclear/high risk of bias and dataset overlap for some studies. CONCLUSIONS In many countries, income-related health status inequalities persist or widen as children age. Interventions that improve health equity early in the life-course are needed.
Collapse
Affiliation(s)
- Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | - Valeria Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Department of Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
41
|
Buckley L, Broadley M, Cascio CN. Socio-economic status and the developing brain in adolescence: A systematic review. Child Neuropsychol 2018; 25:859-884. [DOI: 10.1080/09297049.2018.1549209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lisa Buckley
- School of Psychology, The University of Queensland, St. Lucia, Australia
| | - Melanie Broadley
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Australia
| | - Christopher N. Cascio
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, USA
| |
Collapse
|
42
|
Chodura S, Lohaus A, Symanzik T, Möller C, Heinrichs N, Konrad K. [Demographic characteristics of foster families in Germany]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 47:211-227. [PMID: 30264651 DOI: 10.1024/1422-4917/a000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Demographic characteristics of foster families in Germany Abstract. Objective: Demographic characteristics like the level of education, job position or the distribution of age in families have a significant impact on the development of children. Therefore, in the current study, we examined the commonalities and differences of foster family samples, recruited for research, with the general population. Method: The data at hand are part of the "GROW&TREAT" project that examines the development of foster children in comparison to children who live with their biological families. Results: Differences were found in comparison to the data of the German Census Bureau for the foster family sample and the biological sample for parental education, apportionment of parental employment, and familial net income. Concerning the direct sample group comparison, differences could be observed in terms of age gap between (foster) mother and child and parental education. Furthermore, the representativeness of the foster family sample was analyzed based on reports of participating youth welfare services. Conclusions: The examined sample seems to be representative for foster family samples in research contexts. The consequences of these differences on potential research results and recruitment characteristics were further discussed.
Collapse
Affiliation(s)
- Sabrina Chodura
- 1 Arbeitseinheit Entwicklungspsychologie und Entwicklungspsychopathologie, Universität Bielefeld, Bielefeld
| | - Arnold Lohaus
- 1 Arbeitseinheit Entwicklungspsychologie und Entwicklungspsychopathologie, Universität Bielefeld, Bielefeld
| | - Tabea Symanzik
- 1 Arbeitseinheit Entwicklungspsychologie und Entwicklungspsychopathologie, Universität Bielefeld, Bielefeld
| | - Christine Möller
- 1 Arbeitseinheit Entwicklungspsychologie und Entwicklungspsychopathologie, Universität Bielefeld, Bielefeld
| | - Nina Heinrichs
- 2 Abteilung Klinische Psychologie, Psychotherapie & Diagnostik, Technische Universität Braunschweig, Braunschweig
| | - Kerstin Konrad
- 3 Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum Aachen, Aachen
| |
Collapse
|
43
|
Kassile T, Mmbando BP, Lokina R, Mujinja P. Perceptions of caretakers with different socioeconomic status about the harmful outcomes of fever in under-five children in Dodoma region, central Tanzania: A cross-sectional study. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Telemu Kassile
- Department of Biometry and Mathematics, Faculty of Science, Sokoine University of Agriculture, P. O. Box 3038, Morogoro, TanzaniaDepartment of Biometry and Mathematics, Faculty of Science, Sokoine University of Agriculture, P. O. Box 3038 , Morogoro, Tanzania
| | - Bruno P. Mmbando
- National Institute for Medical Research, Tanga Research Centre, P. O. Box 5004, Tanga, TanzaniaNational Institute for Medical Research, Tanga Research Centre, P. O. Box 5004 , Tanga, Tanzania
| | - Razack Lokina
- Department of Economics, College of Social Sciences, University of Dar es Salaam, P.O. Box 35045, Dar es Salaam, TanzaniaDepartment of Economics, College of Social Sciences, University of Dar es Salaam, P.O. Box 35045 , Dar es Salaam, Tanzania
| | - Phares Mujinja
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, TanzaniaDepartment of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015 , Dar es Salaam, Tanzania
| |
Collapse
|
44
|
Wirback T, Möller J, Larsson JO, Engström K. Social differences in diagnosed depression among adolescents in a Swedish population based cohort. BMC Psychiatry 2018; 18:216. [PMID: 29970041 PMCID: PMC6029410 DOI: 10.1186/s12888-018-1765-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population based research regarding social differences in diagnosed depression in adolescence is sparse. In this study unique material containing in-and outpatient data was used to determine if low social position in childhood increases the risk of diagnosed depression in adolescence. To further examine this association, gender differences and interactions were explored. METHODS The study population was extracted from the Stockholm Youth Cohort (SYC), a register based cohort containing psychiatric care for all young people in Stockholm County and information about social position. For the purpose of this study, all in the SYC who turned 13 years old during 2001-2007, in total 169,262 adolescents, were followed up in 2005-2011 for diagnoses of depression until age 18. Associations were estimated with Cox regression models and presented as Hazard Ratios (HR). RESULTS The risk of diagnosed depression was higher for adolescents with parents with low education (HR = 1.1, CI = 1.0-1.2) and medium education (HR = 1.1, CI = 1.1-1.2) compared to high as well as for those with lower household income (for example, medium low, HR = 1.2, CI = 1.1-1.3) and for those with parents who received an unemployment benefit (HR = 1.3, CI = 1.2-1.4). No differences were found for those with the lowest household income compared to those with the highest level. Adolescents with parents born outside the Nordic countries had a lower risk of diagnosed depression (HR = 0.7, CI = 0.6-0.7). An interaction effect was found between gender and parental education. CONCLUSIONS Social differences were found but the magnitude was modest and gender differences small.
Collapse
Affiliation(s)
- Therese Wirback
- Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, 113 65, Stockholm, Sweden.
| | - Jette Möller
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, 113 65 Stockholm, Sweden
| | - Jan-Olov Larsson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Karin Engström
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, 113 65 Stockholm, Sweden
| |
Collapse
|
45
|
Muscatell KA. Socioeconomic influences on brain function: implications for health. Ann N Y Acad Sci 2018; 1428:14-32. [DOI: 10.1111/nyas.13862] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Keely A. Muscatell
- Department of Psychology and Neuroscience; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| |
Collapse
|
46
|
Myhr A, Haugan T, Lillefjell M, Halvorsen T. Non-completion of secondary education and early disability in Norway: geographic patterns, individual and community risks. BMC Public Health 2018; 18:682. [PMID: 29855297 PMCID: PMC5984305 DOI: 10.1186/s12889-018-5551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 05/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background School non-completion and early work disability is a great public health challenge in Norway, as in most western countries. This study aims to investigate how medically based disability pension (DP) among young adults varies geographically and how municipal socioeconomic conditions interact with non-completion of secondary education in determining DP risk. Methods The study includes a nationally representative sample of 30% of all Norwegians (N = 350,699) aged 21–40 in 2010 from Statistic Norway’s population registries. Multilevel models incorporating factors at the individual, neighbourhood and municipal levels were applied to estimate the neighbourhood and municipality general contextual effects in DP receipt, and detect possible differences in the impact of municipal socioeconomic conditions on DP risk between completers and non-completers of secondary education. Results A pattern of spatial clustering at the neighbourhood (ICC = 0.124) and municipality (ICC = 0.021) levels are clearly evident, indicating that the underlying causes of DP receipt have a systematic neighbourhood and municipality variation in Norway. Non-completion of secondary education is strongly correlated with DP receipt among those younger than 40. Socioeconomic characteristics of the municipality are also significantly correlated with DP risk, but these associations are conditioned by the completion of secondary education. Living in a socioeconomically advantageous municipality (i.e. high income, high education levels and low unemployment and social security payment rates) is associated with a higher risk of DP, but only among those who do not complete their secondary education. Although the proportion of DPs was equal in rural and urban areas, it is evident that young people living in urban settings are more at risk of early DP than their counterparts living in rural parts of the country when controlling for other risk factors. Conclusion The association between school non-completion and DP risk varies between municipalities and local socioeconomic environments. The interplay between personal characteristics and the local community is important in DP risk among young adults, implying that preventive measures should be directed not only at the individual level, but also include the educational system and the local community.
Collapse
Affiliation(s)
- Arnhild Myhr
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tommy Haugan
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Technology and Society, Trondheim, Norway
| |
Collapse
|
47
|
Leivas PHS, Tejada CAO, Bertoldi AD, Santos AMAD, Jacinto PDA. Associação da posição socioeconômica e da depressão materna com a saúde das crianças: avaliação da PNAD 2008, Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:1635-1645. [DOI: 10.1590/1413-81232018235.23162015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/24/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo O estudo analisou a associação entre posição socioeconômica (renda), depressão materna e saúde da criança no Brasil, utilizando informações da Pesquisa Nacional por Amostra de Domicílios 2008 (PNAD/IBGE). A análise considerou o delineamento amostral da pesquisa e incluiu 46.874 indivíduos com idade até 9 anos. Modelos Poisson foram estimados para três desfechos de saúde da criança: saúde reportada pelos pais ou responsáveis, restrição das atividades habituais por motivo de saúde e episódios de acamamento nas duas semanas anteriores à entrevista. Os resultados apontaram associação entre a depressão da mãe e os três desfechos, mesmo após o ajuste para posição socioeconômica, características maternas (saúde autorreferida, idade, escolaridade e tabagismo), idade, sexo e cor da pele da criança, além de região geográfica, situação censitária e número de moradores do domicílio. Constatou-se ainda que a associação entre depressão materna e saúde da criança independe da posição socioeconômica. Assim, políticas de saúde pública que objetivem atenuar os efeitos adversos da depressão materna sobre a saúde da criança, precisam considerar também os estratos mais elevados de renda da sociedade.
Collapse
|
48
|
Vermeiren AP, Willeboordse M, Oosterhoff M, Bartelink N, Muris P, Bosma H. Socioeconomic multi-domain health inequalities in Dutch primary school children. Eur J Public Health 2018; 28:610-616. [DOI: 10.1093/eurpub/cky055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Angelique P Vermeiren
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Nina Bartelink
- Department of Health Promotion, CAPHRI and Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
| | - Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
49
|
Karmur BS, Kulkarni AV. Medical and socioeconomic predictors of quality of life in myelomeningocele patients with shunted hydrocephalus. Childs Nerv Syst 2018; 34:741-747. [PMID: 29249073 DOI: 10.1007/s00381-017-3691-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Children with myelomeningocele (MMC) often develop hydrocephalus, and the combination of these conditions can lead to psychosocial, cognitive, and physical health issues that decrease their health-related quality of life (HRQOL). The goal of the present study was to understand the QOL in patients with MMC and shunted hydrocephalus. METHODS Data from the Toronto Hydrocephalus QOL Database was acquired between 2004 and 2009 using parent-completed questionnaires and, when appropriate, child-completed questionnaires: Hydrocephalus Outcome Questionnaire (HOQ) and the Health Utilities Index. We identified several medical and socioeconomic factors potentially relevant to the outcome measure (e.g., level of myelomeningocele, length of stay in hospital, and shunt-related hospital admissions; family functioning, income, parental education, employment status, etc.). Linear regression models were used to examine associations between potential predictor variables and HRQOL, with P < 0.05 in the multivariate model suggesting significance. RESULTS The analysis consisted of 131 patients (mean age = 12.6, SD = 3.7). The mean HUI score was 0.51, and the mean HOQ overall health score was 0.67. There was a significant association between lower age and higher HOQ social-emotional health (P = 0.03) and HUI scores (P = 0.03), lower anatomical level of myelomeningocele and higher HUI scores (P = 0.01), better family functioning and higher HOQ overall health scores (P = 0.004), and higher family income and higher HOQ overall health, physical health, and HUI scores (P = 0.001, P = 0.003, and P = 0.02, respectively). CONCLUSION Myelomeningocele patients with shunted hydrocephalus can have a poor health-related quality of life. Our results indicate a strong association of income and family functioning on quality of life, along with younger age and lower level of myelomeningocele.
Collapse
Affiliation(s)
- Brij S Karmur
- Division of Neurosurgery, Hospital for Sick Children, Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
50
|
Rieger K, Vogel M, Engel C, Ceglarek U, Harms K, Wurst U, Lengfeld H, Richter M, Kiess W. Does physiological distribution of blood parameters in children depend on socioeconomic status? Results of a German cross-sectional study. BMJ Open 2018; 8:e019143. [PMID: 29500207 PMCID: PMC5855248 DOI: 10.1136/bmjopen-2017-019143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/05/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In the present study, we examined the relation between socioeconomic status (SES) and the physiological distribution of iron-related blood parameters. DESIGN This is a cross-sectional analysis of longitudinal population-based cohort study. SETTING Based on a sample of healthy participants from a German research centre, various blood parameters and values of clinical examinations and questionnaires were collected. PARTICIPANTS A total of 1206 healthy volunteers aged 2.5 to 19 years, one child per family randomly selected, were included. PRIMARY AND SECONDARY OUTCOME MEASURES Associations between the SES of children by Winkler-Stolzenberg Index (WSI) and its dimensions (income, education, occupation) and iron-related blood parameters (haemoglobin, ferritin and transferrin) were analysed by linear regression analyses. Gender and pubertal stage were included as covariables. Additionally, associations between SES of children by WSI and physical activity (side-to-side jumps, push-ups) as well as body mass index (BMI) were analysed by linear regression analyses. RESULTS Children with high WSI or family income showed significantly increased z-scores for haemoglobin (P=0.046; P<0.001). Children with increased WSI or family income showed significantly lower z-scores for transferrin (P<0.001). There was a significant correlation between haemoglobin and gender (P<0.001) and between transferrin and pubertal stage (P=0.024). Furthermore, physical activity was positively correlated and BMI was negatively correlated with WSI (P<0.001). DISCUSSION Our data show an association between SES and the distribution of iron-dependent parameters. Lower SES is correlated with lower values for haemoglobin and higher values for transferrin. Furthermore, we demonstrate that physical activity and BMI are associated with SES. Whereas higher SES is correlated with higher values for physical activity and lower BMI. Our parameters are standardised as z-scores with the advantages that the results are comparable across different age groups and present physiological courses. TRIAL REGISTRATION NUMBER NCT02550236; Results.
Collapse
Affiliation(s)
- Kristin Rieger
- Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Center for Pediatric Research, University Hospital Leipzig (Public-Law Institution), Leipzig, Germany
| | - Mandy Vogel
- LIFE-Leipzig Research Center for Diseases of Civilization, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University Hospital Leipzig (Public-Law Institution), Leipzig, Germany
| | - Kristian Harms
- Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, University Hospital Leipzig (Public-Law Institution), Leipzig, Germany
| | - Ulrike Wurst
- Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Center for Pediatric Research, University Hospital Leipzig (Public-Law Institution), Leipzig, Germany
| | - Holger Lengfeld
- Institute for Sociology, University of Leipzig, Leipzig, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Wieland Kiess
- Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Center for Pediatric Research, University Hospital Leipzig (Public-Law Institution), Leipzig, Germany
- LIFE-Leipzig Research Center for Diseases of Civilization, University of Leipzig, Leipzig, Germany
| |
Collapse
|