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Abduvahobov P, Cameron SJ, Ibraheem A, Herat J, Castle C. The need for stronger international support to integrate health and well-being and transform education: a perspective on developing countries. Front Public Health 2024; 12:1415992. [PMID: 39301514 PMCID: PMC11410616 DOI: 10.3389/fpubh.2024.1415992] [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: 04/11/2024] [Accepted: 08/01/2024] [Indexed: 09/22/2024] Open
Abstract
The reciprocal relationship between education and health is well-established, emphasizing the need for integrating health, nutrition, and well-being components into educational sector planning. Despite widespread acknowledgment of this need, countries lack concrete measures to achieve this integration. We examine challenges that countries have faced and the progress they have made in integrating these components into education sector plans and review the extent to which existing educational planning guidelines and tools address health and well-being. The review reveals a significant underrepresentation of health, well-being, and related themes in existing educational planning frameworks. Recent tools and frameworks developed to support a more holistic approach to education have not yet been widely adopted in standard education sector planning processes. The implementation of such approaches remains inconsistent, with significant barriers including limited cross-sectoral collaboration, lack of capacity, and insufficient funding, among others. Addressing these gaps requires improved guidance, technical support, and a multisectoral approach to education planning that includes health, nutrition, and well-being as fundamental components of foundational learning, supported by political commitment, capacity, and adequate financing.
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Affiliation(s)
- Parviz Abduvahobov
- Health and Education Section, Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
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2
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Kopinska J, Atella V, Bhattacharya J, Miller G. The changing relationship between bodyweight and longevity in high- and low-income countries. ECONOMICS AND HUMAN BIOLOGY 2024; 54:101392. [PMID: 38703461 DOI: 10.1016/j.ehb.2024.101392] [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: 04/07/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.
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Affiliation(s)
| | - Vincenzo Atella
- Department of Economics and Finance, University of Rome Tor Vergata, Italy.
| | - Jay Bhattacharya
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
| | - Grant Miller
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
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Quispe-Haro C, Szabó D, Kordas K, Capkova N, Pikhart H, Bobak M. The mediating role of air pollutants in the association between education and lung function among the elderly, the HAPIEE study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 947:174556. [PMID: 38972408 DOI: 10.1016/j.scitotenv.2024.174556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Chronic exposure to air pollutants harms human health, and at a geographical level, concentrations of air pollutants are often associated with socioeconomic disadvantage. OBJECTIVES The aim of this study was to investigate the effects of educational attainment and air pollution on lung function in older adults, and whether air pollution may mediate the effect of education. METHODS The study included 6381 individuals (mean age 58.24 ± 7.14 years) who participated in the Czech HAPPIE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study. Participants' residential addresses were linked to air pollution data, including mean exposures to PM10 (particulate matter of aerodynamic diameter below 10 μm) and NO2 (nitrogen dioxide). We used path analysis to link educational attainment and air pollutants to a standardized measure of the Forced Expiratory Volume in the first second (FEV1). RESULTS Higher levels of participants' education were associated with lower exposures to PM10 and NO2. Individuals with tertiary education had higher standardized FEV1 than individuals with primary education (88 % vs 95 %). Path analysis revealed a direct positive effect of education on FEV1, while about 12 % of the relationship between education and lung function was mediated by PM10 and NO2. CONCLUSIONS: Education (typically completed at young ages) appeared to have a protective effect on lung function later in life, and a small part of this effect was mediated by air pollution.
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Affiliation(s)
- Consuelo Quispe-Haro
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Daniel Szabó
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | | | - Hynek Pikhart
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic; Research Department of Epidemiology and Public Health, University College London, London, UK.
| | - Martin Bobak
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic; Research Department of Epidemiology and Public Health, University College London, London, UK
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Noghanibehambari H, Fletcher J. Unequal before death: The effect of paternal education on children's old-age mortality in the United States. POPULATION STUDIES 2024; 78:203-229. [PMID: 38445522 DOI: 10.1080/00324728.2023.2284766] [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: 04/01/2022] [Accepted: 06/12/2023] [Indexed: 03/07/2024]
Abstract
A growing body of research documents the relevance of parental education as a marker of family socio-economic status for children's later-life health outcomes. A strand of this literature evaluates how the early-life environment shapes mortality outcomes during infancy and childhood. However, the evidence on mortality during the life course and old age is limited. This paper contributes to the literature by analysing the association between paternal education and children's old-age mortality. We use data from Social Security Administration death records over the years 1988-2005 linked to the United States 1940 Census. Applying a family(cousin)- fixed-effects model to account for shared environment, childhood exposures, and common endowments that may confound the long-term links, we find that having a father with a college or high-school education, compared with elementary/no education, is associated with a 4.6- or 2.6-month-higher age at death, respectively, for the child, conditional on them surviving to age 47.
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Dore EC, Wurapa J. The long-term health effects of childhood exposure to social and economic policies: A scoping review. Soc Sci Med 2024; 352:117024. [PMID: 38824839 PMCID: PMC11239285 DOI: 10.1016/j.socscimed.2024.117024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
While numerous studies have found a relationship between social and economic policies and short-term health outcomes, fewer studies have explored the long-term health effects of these policies. Given the important association between childhood circumstances and health in adulthood, long-term population health consequences should be considered when designing social and economic policies. This review summarizes the existing literature on the long-term effects of childhood exposure to social and economic policies on adult health, summarizes the findings, the methods employed, and indicates areas for future research. The review process followed the JBI scoping review protocol and PRISMA-ScR reporting guidelines. The search was conducted in three electronic databases (Web of Science, Pub Med, and SCOPUS), and focused on peer-reviewed manuscripts that studied the effects of policy exposures during childhood on health in adulthood. A total of 3471 articles were collected from the databases and 18 were identified as meeting the eligibility criteria. The most commonly studied policies were safety-net policies (N = 6), followed by education policies (N = 5), civil rights policies (N = 3), government investments (N = 3), and child labor laws (N = 1). The health outcomes varied and included chronic conditions, mental health, mortality, and self-rated health. The studies also overwhelmingly employed causal inference techniques (N = 13), including difference-in-differences study designs and instrumental variable analysis. Most studies found long-term positive effects of policies that provided extra resources to historically under-resourced populations, or policies that aimed to increase equality of opportunity. However, there were some studies with null or mixed findings, especially when examining the long-term health effects of education reform. More literature is needed on this important topic, and now is the time to capitalize on longer follow-up periods in currently available data.
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Affiliation(s)
- Emily C Dore
- Emory University, Department of Sociology, 1555 Dickey Dr., Atlanta, GA, 30322, USA.
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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Newton D, Stephenson J, Azevedo L, Sah RK, Poudel AN, Richardson O. The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis. Public Health 2024; 231:198-203. [PMID: 38703494 DOI: 10.1016/j.puhe.2024.03.024] [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: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.
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Affiliation(s)
- D Newton
- University of Huddersfield, Huddersfield, United Kingdom.
| | - J Stephenson
- University of Huddersfield, Huddersfield, United Kingdom
| | - L Azevedo
- University of Huddersfield, Huddersfield, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - R K Sah
- University of Huddersfield, Huddersfield, United Kingdom
| | - A N Poudel
- University of Huddersfield, Huddersfield, United Kingdom
| | - O Richardson
- University of Huddersfield, Huddersfield, United Kingdom
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Kava CM, Watkins SL, Gilbert PA, Villhauer TJ, Welter TL, Afifi RA. E-cigarettes in college: Associations between mental health and e-cigarette use with other substances. Tob Prev Cessat 2024; 10:TPC-10-24. [PMID: 38828438 PMCID: PMC11141061 DOI: 10.18332/tpc/188712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION College students are a priority population for substance use prevention, and other studies have reported associations between mental health and e-cigarette use. This study described the association of mental health to e-cigarette and other substance use (ECIG+ use) among US college students. METHODS We used Fall 2018 and Spring 2019 National College Health Assessment data among undergraduate students aged 18-24 years (n=55654) at 138 institutions. We characterized substance use patterns and used multinomial regression to model adjusted odds of past 30-day ECIG use type [no substance use (reference); sole e-cigarette use; e-cigarette use and other substance use (ECIG+ use); no e-cigarette use but other substance use] by mental health characteristics, past 12-month diagnosis/treatment and psychological distress, individual characteristics, and college characteristics. RESULTS Alcohol was the most prevalent substance (58%) used, followed by cannabis (23%) and e-cigarettes (15%). Nearly all (95%) students who used e-cigarettes reported using another substance. Adjusted odds of ECIG+ use (vs no substance use) were higher among students with past 12-month mental health diagnosis/treatment (AOR=1.5; 95% CI: 1.4-1.6) and higher psychological distress (AOR=1.1; 95% CI: 1.1-1.2). Other characteristics significantly associated with ECIG+ use included gender identity, sexual orientation, race and ethnicity, self-rated health, year in school, cumulative grade average, fraternity/sorority membership, and current residence. CONCLUSIONS Most students who used e-cigarettes also reported other substance use, and this pattern of use was associated with poorer mental health outcomes than no substance use. Clarifying the relationship between mental health and ECIG+ use may enhance health interventions for college students.
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Affiliation(s)
- Christine M. Kava
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, United States
| | - Shannon L. Watkins
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
| | - Paul A. Gilbert
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
| | - Tanya J. Villhauer
- The Office of the Dean of Students, University of Iowa, Iowa Memorial Union, Iowa City, United States
| | | | - Rima A. Afifi
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
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van de Weijer MP, Demange PA, Pelt DHM, Bartels M, Nivard MG. Disentangling potential causal effects of educational duration on well-being, and mental and physical health outcomes. Psychol Med 2024; 54:1403-1418. [PMID: 37964430 DOI: 10.1017/s003329172300329x] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND Extensive research has focused on the potential benefits of education on various mental and physical health outcomes. However, whether the associations reflect a causal effect is harder to establish. METHODS To examine associations between educational duration and specific aspects of well-being, anxiety and mood disorders, and cardiovascular health in a sample of European Ancestry UK Biobank participants born in England and Wales, we apply four different causal inference methods (a natural policy experiment leveraging the minimum school-leaving age, a sibling-control design, Mendelian randomization [MR], and within-family MR), and assess if the methods converge on the same conclusion. RESULTS A comparison of results across the four methods reveals that associations between educational duration and these outcomes appears predominantly to be the result of confounding or bias rather than a true causal effect of education on well-being and health outcomes. Although we do consistently find no associations between educational duration and happiness, family satisfaction, work satisfaction, meaning in life, anxiety, and bipolar disorder, we do not find consistent significant associations across all methods for the other phenotypes (health satisfaction, depression, financial satisfaction, friendship satisfaction, neuroticism, and cardiovascular outcomes). CONCLUSIONS We discuss inconsistencies in results across methods considering their respective limitations and biases, and additionally discuss the generalizability of our findings in light of the sample and phenotype limitations. Overall, this study strengthens the idea that triangulation across different methods is necessary to enhance our understanding of the causal consequences of educational duration.
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Affiliation(s)
- Margot P van de Weijer
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Genetic Epidemiology, Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Perline A Demange
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Dirk H M Pelt
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Michel G Nivard
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Bose B, Raub A, Sprague A, Martin A, Bhuwania P, Kidman R, Heymann J. Do tuition-free lower secondary education policies matter for antenatal care among women in sub-saharan African countries? BMC Pregnancy Childbirth 2024; 24:250. [PMID: 38589785 PMCID: PMC11000362 DOI: 10.1186/s12884-024-06406-1] [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: 08/04/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is critical to reducing maternal and infant mortality. However, sub-Saharan Africa (SSA) continues to have among the lowest levels of ANC receipt globally, with half of mothers not meeting the WHO minimum recommendation of at least four visits. Increasing ANC coverage will require not only directly reducing geographic and financial barriers to care but also addressing the social determinants of health that shape access. Among those with the greatest potential for impact is maternal education: past research has documented a relationship between higher educational attainment and antenatal healthcare access, as well as related outcomes like health literacy and autonomy in health decision-making. Yet little causal evidence exists about whether changing educational policies can improve ANC coverage. This study fills this research gap by investigating the impact of national-level policies that eliminate tuition fees for lower secondary education in SSA on the number of ANC visits. METHODS To estimate the effect of women's exposure to tuition-free education policies at the primary and lower secondary levels on their ANC visits, a difference-in-difference methodology was employed. This analysis leverages the variation in the timing of education policies across nine SSA countries. RESULTS Exposure to tuition-free primary and lower secondary education is associated with improvements in the number of ANC visits, increasing the share of women meeting the WHO recommendation of at least four ANC visits by 6-14%. Moreover, the impact of both education policies combined is greater than that of tuition-free primary education alone. However, the effects vary across individual treatment countries, suggesting the need for further investigation into country-specific dynamics. CONCLUSIONS The findings of this study have significant implications for policymakers and stakeholders seeking to improve ANC coverage. Removing the tuition barrier at the secondary level has shown to be a powerful strategy for advancing health outcomes and educational attainment. As governments across Africa consider eliminating tuition fees at the secondary level, this study provides valuable evidence about the impacts on reproductive health outcomes. While investing in free education requires initial investment, the long-term benefits for both human development and economic growth far outweigh the costs.
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Affiliation(s)
- Bijetri Bose
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA.
| | - Amy Raub
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Aleta Sprague
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Alfredo Martin
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Pragya Bhuwania
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Rachel Kidman
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
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Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
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12
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Bann D, Courtin E, Davies NM, Wright L. Dialling back 'impact' claims: researchers should not be compelled to make policy claims based on single studies. Int J Epidemiol 2024; 53:dyad181. [PMID: 38124510 DOI: 10.1093/ije/dyad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Emilie Courtin
- Department of Health Policy, London School of Economics, London, UK
| | - Neil M Davies
- Division of Psychiatry and Department of Statistical Science, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
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Reed M, Castillo I, Georgia BW, Glass HL, Ryan D, Cygan HR. An Integrative Review of College Readiness Programs for Black High School Students; Opportunities for School Nurse Involvement. J Sch Nurs 2024; 40:26-42. [PMID: 35679088 DOI: 10.1177/10598405221105012] [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] [Indexed: 11/16/2022] Open
Abstract
Education is associated with improved health outcomes. However, fewer non-Hispanic Black Americans earn high school diplomas, baccalaureate, or advanced degrees than White Americans, placing them at higher risk for poor health outcomes. Racial disparities in education have been linked to social injustice and structural racism. Through the Framework for the 21st Century School Nursing PracticeTM, school nurses can impact academic success and college readiness for Black youth. An integrative review of the literature was conducted to describe programs to promote college readiness for Black high school students and evaluate school nurse involvement. Findings of the eighteen unique studies included in this review were: programs included mostly female participants, and most yielded improvements in students' non-cognitive skills (i.e. sense of belonging/confidence) and college knowledge. None of the programs included school nurse involvement. School nurses can advocate for anti-racist college readiness programs with intentional, asset-based approaches to position youth for success in college.
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Affiliation(s)
- Monique Reed
- College of Nursing, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
| | - Isabella Castillo
- Center for Community Health Equity Intern, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
| | - Benjamin W Georgia
- Center for Community Health Equity Intern, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
| | - Hannah L Glass
- Center for Community Health Equity Intern, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
| | - Dallas Ryan
- Center for Community Health Equity Intern, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
| | - Heide R Cygan
- College of Nursing, Rush University, 600 S. Paulina St. Ste 1080, Chicago, IL, 60612
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14
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Um S, An Y. Factors associated with overweight and obesity among women of reproductive age in Cambodia: Analysis of Cambodia Demographic and Health Survey 2021-22. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002537. [PMID: 38295032 PMCID: PMC10830042 DOI: 10.1371/journal.pgph.0002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Overweight and obesity are associated with increased chronic disease and death rates globally. In Cambodia, the prevalence of overweight and obesity among women is high and increasing. This study aimed to determine the prevalence and factors associated with overweight and obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2021-22 Cambodia Demographic and Health Survey (CDHS). Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 9,417 WRA. Multiple logistic regressions were performed using STATA V17 to examine factors associated with overweight and obesity. The prevalence of overweight and obesity among WRA was 22.56% and 5.61%, respectively. Factors independently associated with increased odds of overweight and obesity included women aged 20-29 years [AOR = 1.85; 95% CI: 1.22-2.80], 30-39 years [AOR = 3.34; 95% CI: 2.21-5.04], and 40-49 years [AOR = 5.57; 95% CI: 3.76-8.25], women from rich wealth quintile [AOR = 1.44; 95% C: 1.19-1.73], having three children or more [AOR = 1.40; 95% CI: 1.00-1.95], ever drink alcohol [AOR = 1.24; 95% CI: 1.04-1.47], and current drink alcohol [AOR = 1.2; 95% CI: 1.01-1.45]. Women completed at least secondary education were less likely being overweight and obese [AOR = 0.73; 95% CI: 0.58-0.91]. Overweight and obesity remains highly prevalent among WRA in Cambodia. Therefore, there is an urgent need to take interventions that target women from higher socio-demographic status to reduce the risk of life-threatening caused by being overweight and obese through raising awareness of important changing lifestyles.
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Affiliation(s)
- Samnang Um
- National Institute of Public Health, Phnom Penh, Cambodia
- Faculty of Social Science and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Yom An
- National Institute of Public Health, Phnom Penh, Cambodia
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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15
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Backhouse EV, Boardman JP, Wardlaw JM. Cerebral Small Vessel Disease: Early-Life Antecedents and Long-Term Implications for the Brain, Aging, Stroke, and Dementia. Hypertension 2024; 81:54-74. [PMID: 37732415 PMCID: PMC10734792 DOI: 10.1161/hypertensionaha.122.19940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cerebral small vessel disease is common in older adults and increases the risk of stroke, cognitive impairment, and dementia. While often attributed to midlife vascular risk factors such as hypertension, factors from earlier in life may contribute to later small vessel disease risk. In this review, we summarize current evidence for early-life effects on small vessel disease, stroke and dementia focusing on prenatal nutrition, and cognitive ability, education, and socioeconomic status in childhood. We discuss possible reasons for these associations, including differences in brain resilience and reserve, access to cognitive, social, and economic resources, and health behaviors, and we consider the extent to which these associations are independent of vascular risk factors. Although early-life factors, particularly education, are major risk factors for Alzheimer disease, they are less established in small vessel disease or vascular cognitive impairment. We discuss current knowledge, gaps in knowledge, targets for future research, clinical practice, and policy change.
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Affiliation(s)
- Ellen V. Backhouse
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC UK Dementia Research Institute (E.V.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
| | - James P. Boardman
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC Centre for Reproductive Health (J.P.B.), University of Edinburgh, Scotland, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC UK Dementia Research Institute (E.V.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- Edinburgh Imaging (J.M.W.), University of Edinburgh, Scotland, United Kingdom
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16
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Rehnberg J, Huisman M, Fors S, Marseglia A, Kok A. The Association between Education and Cognitive Performance Varies at Different Levels of Cognitive Performance: A Quantile Regression Approach. Gerontology 2023; 70:318-326. [PMID: 38086341 PMCID: PMC10911170 DOI: 10.1159/000535717] [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: 05/25/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Educational differences in cognitive performance among older adults are well documented. Studies that explore this association typically estimate a single average effect of education on cognitive performance. We argue that the processes that contribute to the association between education and cognitive performance are unlikely to have equal effects at all levels of cognitive performance. In this study, we employ an analytical approach that enables us to go beyond averages to examine the association between education and five measures of global and domain-specific cognitive performance across the outcome distributions. METHODS This cross-sectional study included 1,780 older adults aged 58-68 years from the Longitudinal Aging Study Amsterdam. Conditional quantile regression was used to examine variation across the outcome distribution. Cognitive outcomes included Mini-Mental State Examination (MMSE) score, crystallized intelligence, information processing speed, episodic memory, and a composite score of global cognitive performance. RESULTS The results showed that the associations between education and different cognitive measures varied across the outcome distributions. Specifically, we found that education had a stronger association with crystallized intelligence, MMSE, and a composite cognitive performance measure in the lower tail of performance distributions. The associations between education and information processing speed and episodic memory were uniform across the outcome distributions. CONCLUSION Larger associations between education and some domains of cognitive performance in the lower tail of the performance distributions imply that inequalities are primarily generated among individuals with lower performance rather than among average and high performers. Additionally, the varying associations across some of the outcome distributions indicate that estimating a single average effect through standard regression methods may overlook variations in cognitive performance between educational groups. Future studies should consider heterogeneity across the outcome distribution.
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Affiliation(s)
- Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Almar Kok
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
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17
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Kleineidam L, Stark M, Riedel-Heller SG, Pabst A, Schmiedek F, Streit F, Rietschel M, Klinger-König J, Grabe HJ, Erhardt A, Gelbrich G, Schmidt B, Berger K, Wagner M. The assessment of cognitive function in the German National Cohort (NAKO) - Associations of demographics and psychiatric symptoms with cognitive test performance. World J Biol Psychiatry 2023; 24:909-923. [PMID: 35175181 DOI: 10.1080/15622975.2021.2011408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the cognitive test battery of the German National Cohort (NAKO), a population-based mega cohort of 205,000 randomly selected participants, and to examine associations with demographic variables and selected psychiatric and neurological conditions. METHODS Initial data from 96,401 participants providing data on the cognitive performance measured by a brief cognitive test battery (12-word list recall task, semantic fluency, Stroop test, digit span backwards) was examined. Test results were summarised in cognitive domain scores using exploratory and confirmatory factor analyses. Associations with sociodemographic and psychiatric factors were analysed using linear regression and generalised additive models. RESULTS Cognitive test results were best represented by two domain scores reflecting memory and executive functions. Lower cognitive functions were associated with increasing age and male sex. Higher education and absence of childhood trauma were associated with better cognitive function. Moderate to severe levels of anxiety and depression, and a history of stroke, were related to lower cognitive function with a stronger effect on executive function as compared to memory. Some associations with cognition differed by German language proficiency. CONCLUSIONS The NAKO cognitive test battery and the derived cognitive domain scores for memory and executive function are sensitive measures of cognition.
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Affiliation(s)
- Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Melina Stark
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Florian Schmiedek
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University Giessen, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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18
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Berkman LF, Avendano M, Courtin E. Producing Change to Understand the Social Determinants of Health: The Promise of Experiments for Social Epidemiology. Am J Epidemiol 2023; 192:1835-1841. [PMID: 35943205 DOI: 10.1093/aje/kwac142] [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: 01/26/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022] Open
Abstract
In this commentary, invited for the 100th anniversary of the Journal, we discuss the addition of randomized experiments, along with natural experiments that emulate randomized trials using observational data, as designs in the social epidemiologist's toolbox. These approaches transform the way we define and ask questions about social exposures. They compel us to ask questions about how well-defined interventions change a social exposure that might lead to changes in health. As such, experiments are of unique public health and policy significance. We argue that they are a powerful approach to advance our understanding of how well-defined changes in social exposures impact health, and how credible social policy reforms may be instrumental to address health inequalities. We focus on two research designs. The first is a "pure" randomized controlled trial (RCT) in which the investigator defines and randomly assigns the intervention. The second is a natural experiment, which exploits the fact that policies or interventions in the real world often involve an element of random assignment, emulating an RCT. To give the reader our bottom line: While acknowledging their limits, we continue to be very excited about the promise of RCTs and natural experiments to advance social epidemiology.
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19
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Hoskins D, Meza JI, Del Cid MV, Kemp K, Koinis-Mitchell D, Webb M, Tolou-Shams M. Impact of Family, Neighborhood, and Schools on Behavioral Health Needs of Justice-Involved Latinx Adolescents. COUPLE & FAMILY PSYCHOLOGY 2023; 12:168-189. [PMID: 37705892 PMCID: PMC10499485 DOI: 10.1037/cfp0000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Latinx adolescents are overrepresented in the justice system and have high untreated behavioral health needs. We examined the family as well as promotive and inhibitive environments (i.e., neighborhood and school) and their associations on behavioral health among 181 first-time justice-involved Latinx adolescents. Results showed that more optimal caregiver-adolescent attachment was associated with fewer behavioral health needs; more negative caregiver-adolescent communication with greater behavioral health needs. Increased neighborhood disadvantage and negative school interactions served as inhibitive environments and were associated with greater behavioral health needs. Moderation analyses indicated that negative communication was associated with greater behavioral health needs among dyads with large acculturation differences but not for dyads close in acculturation. Findings underscore the need to assess the family relationships and communication, promotive/inhibitive environments, and acculturation differences when determining how to meet behavioral health needs among justice-involved Latinx adolescents.
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Affiliation(s)
- David Hoskins
- UCSF Benioff, Children's Hospital, Oakland, California, United States
| | | | | | - Kathleen Kemp
- UCSF Benioff, Children's Hospital, Oakland, California, United States
| | | | - Margaret Webb
- UCSF Benioff, Children's Hospital, Oakland, California, United States
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20
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Towfighi A, Berger RP, Corley AMS, Glymour MM, Manly JJ, Skolarus LE. Recommendations on Social Determinants of Health in Neurologic Disease. Neurology 2023; 101:S17-S26. [PMID: 37580147 DOI: 10.1212/wnl.0000000000207562] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
Social determinants of health (SDOH) are increasingly recognized as important drivers of inequities in neurologic disease and outcomes. However, our understanding of the biopsychosocial mechanisms by which SDOH affect neurologic disease remains in its infancy. The most robust epidemiologic research has been on the associations between education, schooling, and place-based social determinants on cognition, dementia, and cerebrovascular disease later in life. Further research is needed to more deeply understand the complex interplay of SDOH on neurologic disease. Few SDOH screening tools have been validated in populations with neurologic disease. In addition, comparison across studies and populations is hampered by lack of standardized common data elements. Experiences of populations historically underrepresented in research should be centered in future research studies, and changes should be made in recruitment expectations and measurement choices. For research on inequities, it is critical to support and incentivize institutional infrastructure to foster meaningful engagement with populations affected by research. Finally, it remains to be seen whether individual-level health or behavioral interventions or place-level, systemic or policy interventions to reduce population burden will be most effective in reducing inequities in neurologic disease and outcomes. Although numerous clinical trials have focused on addressing downstream SDOH such as health literacy and health behaviors (e.g., medication adherence, physical activity, diet), few have addressed upstream, structural determinants which may have a more profound impact on addressing inequities in neurologic disease. Ultimately, further research is needed to determine which specific SDOH should be targeted and how, when, and by whom they should be addressed to improve neurologic outcomes.
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Affiliation(s)
- Amytis Towfighi
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL.
| | - Rachel P Berger
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Alexandra M S Corley
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - M Maria Glymour
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Jennifer J Manly
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
| | - Lesli E Skolarus
- From the Departments of Neurology and Population and Public Health Sciences (A.T.), University of Southern California, Los Angeles; Department of Pediatrics (R.P.B.), Children's Hospital of Pittsburgh, University of Pittsburg Medical Center (UPMC), PA; Division of General and Community Pediatrics (A.M.S.C.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; The Center for Health and Community (M.M.G.), University of California, San Francisco; Department of Neurology (J.J.M.), Vagelos College of Physicians and Surgeons, Columbia University, New York; and Department of Neurology (L.S.), Northwestern University, Chicago, IL
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21
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Rizal MF, Black N, Johnston DW, Sweeney R. Long-term health effects of a school construction program. HEALTH ECONOMICS 2023; 32:1670-1688. [PMID: 36999221 DOI: 10.1002/hec.4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
Non-communicable diseases (NCDs) disproportionately affect people in low- and middle-income countries (LMICs), yet context-specific evidence on policies that impact NCD risk factors is lacking. We estimate the impact of a massive Indonesian primary school expansion program in the 1970s on NCD risk factors in later life using data from two surveys with very large sample sizes. We find that in non-Java regions of Indonesia, the program led to significant increases in the likelihood of overweight and high waist circumference among women, but not among men. The increase for women can be partly explained by increased consumption of high-calorie packaged and take-away meals. We find no meaningful impacts on high blood pressure for either sex. Despite the increase in body weight, the program had a negligible impact on diabetes and cardiovascular disease diagnosis. It led to an improvement in women's self-reported health outcomes in their early-40s, but these benefits largely disappeared once they reached their mid-40s.
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Affiliation(s)
- Muhammad Fikru Rizal
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nicole Black
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - David W Johnston
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
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22
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Affiliation(s)
- Neil M Davies
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- KG Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
- Division of Psychiatry, University College London, Maple House, London, UK
- Department of Statistical Sciences, University College London, London, UK
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - David Bann
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
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23
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Özmen MU. Causal Effect of Education on Tobacco Use in Low-and-Middle-Income Countries. Nicotine Tob Res 2023; 25:1474-1480. [PMID: 37018756 PMCID: PMC10632550 DOI: 10.1093/ntr/ntad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/18/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION The prevalence of smoking is unequally distributed across certain groups. One significant dimension is education inequality, where higher smoking prevalence is generally observed in lower-educated groups. However, studies investigating educational inequality are mostly associative. Meanwhile, studies carrying out a causal investigation focus typically on developed countries. In this study, we consider a panel of low-and-middle-income countries (LMICs) to investigate the causal link between education and smoking behavior. AIMS AND METHODS We use detailed micro-level household surveys for 12 LMICs where the duration of compulsory schooling has been extended. By identifying the individuals subject to higher compulsory schooling and using the exogenous variation in education caused by the increase in the duration of compulsory schooling, we estimate the causal impact of education on tobacco consumption. We rely on regression analysis to estimate the effect. RESULTS Our results reveal that those subject to higher years of compulsory schooling have lower smoking-related outcomes, suggesting that higher education significantly lowers tobacco consumption in LMICs. The effect is primarily observed for women, where, for instance, higher compulsory schooling reduces the probability of smoking by 23% and the number of cigarettes smoked by 27%. CONCLUSIONS The study's results establish the causal link between education and smoking behavior in LMICs. This significant impact suggests that education policy is still an important tool to help reduce tobacco consumption, especially in settings where the average level of education is not high initially. Moreover, discouraging men from smoking requires other measures to complement education policy. IMPLICATIONS Education might help reduce tobacco consumption. However, studies-primarily for developed countries-find mixed results. This paper investigates the causal role of education on smoking in LMICs. Education reduces tobacco consumption, especially for women. Thus, education policy can be effective in low-education settings. Nonetheless, education policy should be accompanied by other policies to discourage men from smoking.
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Affiliation(s)
- Mustafa Utku Özmen
- Department of Economics, TOBB University of Economics and Technology, Ankara, Turkey
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24
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Zhuo J, Harrigan N. Low education predicts large increase in COVID-19 mortality: the role of collective culture and individual literacy. Public Health 2023; 221:201-207. [PMID: 37487422 PMCID: PMC10284448 DOI: 10.1016/j.puhe.2023.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Although many studies have found a high correlation between socio-economic inequalities and risk of COVID-19 deaths, there is a reason to believe that much of this association is the product of differing levels of education. STUDY DESIGN We use a multi-level negative binomial regression model for analyzing COVID-19 mortality. METHODS We present multivariate models of fortnightly (n = 60) COVID-19 deaths in 3108 US counties for the period January 20, 2020, to May 10, 2022. We model the direct (unmediated) effect of education, controlling for economy, race, geography, lack of vaccination, political orientation (vote Republican), poor health, and lack of preventative health behavior. RESULTS After controlling for correlated risk factors and indirect mechanisms that mediate education's impact on COVID-19 mortality, we find a strong direct (unmediated) correlation between low education and COVID-19 mortality (incidence rate ratio = 1.17; 95% confidence interval: 1.15, 1.20). We theorize that this correlation reflects education's relationship with (1) collective cultures, such as norms of mask wearing, and (2) individual literacy, such as ability to engage with scientific communication. CONCLUSIONS Low education is strongly correlated with COVID-19 deaths, with an effect size of a university degree comparable to that of being aged >65 years. If this correlation is indeed causal, then it would imply that low education accounts for between 1 in 10 and 1 in 7 deaths in low-education counties. Education should be conceptualized as a potential high-risk factor for COVID-19 death and be taken into account when attempting to combat COVID-19 in disadvantaged communities. The effect of education cannot be reduced to its impact on vaccination or correlation with poor health or economic status, but it seems likely that low-education communities have collective cultures that expose individuals to greater risks and lack of individual literacy that limits engagement with public health messaging.
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Affiliation(s)
- J Zhuo
- Macquarie University, Level 3, 25C Wallys Walk, North Ryde, NSW, 2113, Australia.
| | - N Harrigan
- Macquarie University, Level 3, 25C Wallys Walk, North Ryde, NSW, 2113, Australia.
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25
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Huang C, Li C, Liu F, Xu R. Vaccination and risky behaviors: evidence from the hepatitis B vaccination campaign in China. JOURNAL OF POPULATION ECONOMICS 2023:1-32. [PMID: 37359470 PMCID: PMC9999080 DOI: 10.1007/s00148-023-00942-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/03/2023] [Indexed: 06/28/2023]
Abstract
Understanding the causal relationship between vaccination and individuals' risky behavioral responses has important policy implications as it affects the ultimate effectiveness of increasing access to vaccination. This paper examines the causal effects of vaccination on risky behaviors by exploring the 1992 hepatitis B vaccination campaign in China. Our empirical strategy exploits variations in age at the campaign as well as the pretreatment infection risks across provinces. Using a large cross-section of individuals born between 1981 and 1994, we find that more exposure to the hepatitis B vaccination leads to lower alcohol use during adulthood, and such impacts are almost entirely driven by men. Individuals from more educated families and people who live in urban areas tend to react more. Improved educational attainment and dissemination of related knowledge are important contributors. Our results uncover an unexpected benefit of promoting access to vaccination. Supplementary Information The online version contains supplementary material available at 10.1007/s00148-023-00942-4.
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Affiliation(s)
- Chen Huang
- Center for Human Capital and Labor Market Research, Central University of Finance and Economics, Beijing, 100081 China
| | - Cong Li
- School of Economics, Shanghai University of Finance and Economics, Shanghai, 200433 China
| | - Feng Liu
- School of Humanities and Social Science, Chinese University of Hong Kong, Shenzhen, 518172 Guangdong China
| | - Ruofei Xu
- School of Economics, Shanghai University of Finance and Economics, Shanghai, 200433 China
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Intergenerational educational trajectories and premature mortality from chronic diseases: A registry population-based study. SSM Popul Health 2022; 20:101282. [DOI: 10.1016/j.ssmph.2022.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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Liu C, Murchland AR, VanderWeele TJ, Blacker D. Eliminating racial disparities in dementia risk by equalizing education quality: A sensitivity analysis. Soc Sci Med 2022; 312:115347. [PMID: 36162365 PMCID: PMC9990698 DOI: 10.1016/j.socscimed.2022.115347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Higher risk of dementia among racial/ethnic minorities compared to White populations in the U.S. has been attributed to life-course exposures to adverse conditions such as lower educational attainment, but most studies have not considered additional disparities in education quality. We sought to determine the extent to which disparities in dementia would be reduced had different racial groups received the same quality of education, with no change to present disparities in educational attainment. METHODS We conducted a literature review to assess whether and how measures of educational attainment and quality are utilized in the development of norms for standard cognitive screening measures. In a separate search of the literature, we identified estimates of relationships between race, education quality and dementia; and calculated the adjusted association between race and dementia had education quality been equalized between Black and White participants. RESULTS Most norms for cognitive measures included educational attainment, but few addressed quality. Our search identified relevant parameter estimates: 44.3% of Black participants and 10.5% of White participants had "limited literacy" (<9th grade reading level, a potential marker of poor education quality), which was associated with a 53% greater hazard of dementia compared with "adequate literacy" (≥ 9th grade reading level) after adjusting for educational attainment. Applying these parameters to a hazard ratio of 1.37 (95%CI: 1.12,1.67) for the risk of dementia comparing Black to White participants, we obtained an adjusted hazard ratio of 1.17 (0.96,1.43), a 54% reduction. DISCUSSION Present studies are limited in their consideration of education quality. Our work using available measures from the literature suggests that if education quality were equalized across groups by race, without changing disparities in attainment, racial disparities in dementia would be reduced by about half. Future work should seek to consistently incorporate education quality in order to better understand the sources of disparities.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Cundiff JM, Lin SSH, Faulk RD, McDonough IM. Educational quality may be a closer correlate of cardiometabolic health than educational attainment. Sci Rep 2022; 12:18105. [PMID: 36302824 PMCID: PMC9613691 DOI: 10.1038/s41598-022-22666-3] [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: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 12/30/2022] Open
Abstract
Educational quality may be a closer correlate of physical health than more commonly used measures of educational attainment (e.g., years in school). We examined whether a widely-used performance-based measure of educational quality is more closely associated with cardiometabolic health than educational attainment (highest level of education completed), and whether perceived control (smaller sample only), executive functioning (both samples), and health literacy (smaller sample only) link educational quality to cardiometabolic health. In two samples (N = 98 and N = 586) collected from different regions of the US, educational quality was associated with cardiometabolic health above and beyond educational attainment, other demographic factors (age, ethnoracial category, sex), and fluid intelligence. Counter to expectations, neither perceived control, executive function, nor health literacy significantly mediated the association between educational quality and cardiometabolic health. Findings add to the growing literature suggesting that current operationalizations of the construct of education likely underestimate the association between education and multiple forms of health. To the extent that educational programs may have been overlooked based on the apparent size of associations with outcomes, such actions may have been premature.
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Affiliation(s)
- Jenny M. Cundiff
- grid.411015.00000 0001 0727 7545University of Alabama, Tuscaloosa, AL USA
| | - Shayne S.-H. Lin
- grid.411015.00000 0001 0727 7545University of Alabama, Tuscaloosa, AL USA
| | - Robert D. Faulk
- grid.411015.00000 0001 0727 7545University of Alabama, Tuscaloosa, AL USA
| | - Ian M. McDonough
- grid.411015.00000 0001 0727 7545University of Alabama, Tuscaloosa, AL USA
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Piscitello J, Altszuler AR, Mazzant JR, Babinski DE, Gnagy EM, Page TF, Molina BSG, Pelham WE. The Impact of ADHD on Maternal Quality of Life. Res Child Adolesc Psychopathol 2022; 50:1275-1288. [PMID: 35648330 PMCID: PMC9613519 DOI: 10.1007/s10802-022-00935-z] [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] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.
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Affiliation(s)
- Jennifer Piscitello
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US.
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, US
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of College of Business and Entrepreneurship, Nova Southeastern University, Davie, FL, US
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, US
| | - William E Pelham
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
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Fiorito G, Pedron S, Ochoa-Rosales C, McCrory C, Polidoro S, Zhang Y, Dugué PA, Ratliff S, Zhao WN, McKay GJ, Costa G, Solinas MG, Harris KM, Tumino R, Grioni S, Ricceri F, Panico S, Brenner H, Schwettmann L, Waldenberger M, Matias-Garcia PR, Peters A, Hodge A, Giles GG, Schmitz LL, Levine M, Smith JA, Liu Y, Kee F, Young IS, McGuinness B, McKnight AJ, van Meurs J, Voortman T, Kenny RA, Vineis P, Carmeli C. The Role of Epigenetic Clocks in Explaining Educational Inequalities in Mortality: A Multicohort Study and Meta-analysis. J Gerontol A Biol Sci Med Sci 2022; 77:1750-1759. [PMID: 35172329 PMCID: PMC10310990 DOI: 10.1093/gerona/glac041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Educational inequalities in all-cause mortality have been observed for decades. However, the underlying biological mechanisms are not well known. We aimed to assess the role of DNA methylation changes in blood captured by epigenetic clocks in explaining these inequalities. Data were from 8 prospective population-based cohort studies, representing 13 021 participants. First, educational inequalities and their portion explained by Horvath DNAmAge, Hannum DNAmAge, DNAmPhenoAge, and DNAmGrimAge epigenetic clocks were assessed in each cohort via counterfactual-based mediation models, on both absolute (hazard difference) and relative (hazard ratio) scales, and by sex. Second, estimates from each cohort were pooled through a random effect meta-analysis model. Men with low education had excess mortality from all causes of 57 deaths per 10 000 person-years (95% confidence interval [CI]: 38, 76) compared with their more advantaged counterparts. For women, the excess mortality was 4 deaths per 10 000 person-years (95% CI: -11, 19). On the relative scale, educational inequalities corresponded to hazard ratios of 1.33 (95% CI: 1.12, 1.57) for men and 1.15 (95% CI: 0.96, 1.37) for women. DNAmGrimAge accounted for the largest proportion, approximately 50%, of the educational inequalities for men, while the proportion was negligible for women. Most of this mediation was explained by differential effects of unhealthy lifestyles and morbidities of the World Health Organization (WHO) risk factors for premature mortality. These results support DNA methylation-based epigenetic aging as a signature of educational inequalities in life expectancy emphasizing the need for policies to address the unequal social distribution of these WHO risk factors.
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Affiliation(s)
- Giovanni Fiorito
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- MRC Centre for Environment and Health, School of Public Health, Imperial College
London, London, UK
| | - Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Professorship of Public Health and Prevention, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carolina Ochoa-Rosales
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Centro de Vida Saludable de la Universidad de Conceptión, Conceptiòn, Chile
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Yan Zhang
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Munich, Germany
| | - Pierre-Antoine Dugué
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Scott Ratliff
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei N Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Giuseppe Costa
- Epidemiology Unit, Regional Health Service TO3, Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Kathleen Mullan Harris
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Fulvio Ricceri
- Epidemiology Unit, Regional Health Service TO3, Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Munich, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Department of Economics, Martin Luther University, Halle-Wittenberg, Germany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Pamela R Matias-Garcia
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Allison Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lauren L Schmitz
- Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Morgan Levine
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer A Smith
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yongmei Liu
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ian S Young
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Amy Jayne McKnight
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Joyce van Meurs
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Rose A Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College
London, London, UK
| | - Cristian Carmeli
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
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Viinikainen J, Bryson A, Böckerman P, Kari JT, Lehtimäki T, Raitakari O, Viikari J, Pehkonen J. Does better education mitigate risky health behavior? A mendelian randomization study. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101134. [PMID: 35354116 DOI: 10.1016/j.ehb.2022.101134] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Education and risky health behaviors are strongly negatively correlated. Education may affect health behaviors by enabling healthier choices through higher disposable income, increasing information about the harmful effects of risky health behaviors, or altering time preferences. Alternatively, the observed negative correlation may stem from reverse causality or unobserved confounders. Based on the data from the Cardiovascular Risk in Young Finns Study linked to register-based information on educational attainment and family background, this paper identifies the causal effect of education on risky health behaviors. To examine causal effects, we used a genetic score as an instrument for years of education. We found that individuals with higher education allocated more attention to healthy habits. In terms of health behaviors, highly educated people were less likely to smoke. Some model specifications also indicated that the highly educated consumed more fruit and vegetables, but the results were imprecise in this regard. No causal effect was found between education and abusive drinking. In brief, inference based on genetic instruments showed that higher education leads to better choices in some but not all dimensions of health behaviors.
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Affiliation(s)
- Jutta Viinikainen
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland.
| | - Alex Bryson
- University College London, Social Research Institute, London, United Kingdom; National Institute of Economic and Social Research, London, United Kingdom; IZA Institute of Labor Economics, Bonn, Germany
| | - Petri Böckerman
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland; IZA Institute of Labor Economics, Bonn, Germany; Labour Institute for Economic Research LABORE, Helsinki, Finland
| | - Jaana T Kari
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland
| | - Terho Lehtimäki
- Tampere University, Department of Clinical Chemistry, Tampere, Finland; Fimlab Laboratories, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland
| | - Olli Raitakari
- University of Turku and Turku University Hospital, Centre for Population Health Research, Turku, Finland; University of Turku, Research Centre of Applied and Preventive Cardiovascular Medicine, Turku, Finland; Turku University Hospital, Department of Clinical Physiology and Nuclear Medicine, Turku, Finland
| | - Jorma Viikari
- University of Turku, Department of Medicine, Turku, Finland; Turku University Hospital, Division of Medicine, Turku, Finland
| | - Jaakko Pehkonen
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland
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Begerow T, Jürges H. Does compulsory schooling affect health? Evidence from ambulatory claims data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:953-968. [PMID: 34779933 PMCID: PMC9304067 DOI: 10.1007/s10198-021-01404-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/28/2021] [Indexed: 05/20/2023]
Abstract
Using claims data on more than 23 million statutorily insured, we investigate the causal effect of schooling on health in the largest and most comprehensive analysis for Germany to date. In a regression discontinuity approach, we exploit changes in compulsory schooling in West Germany to estimate the reduced form effect of the reforms on health, measured by doctor diagnoses in ICD-10 format covering physical as well as mental health conditions. To mitigate the problem that empirical results depend on subjective decisions made by the researcher, we perform specification curve analyses to assess the robustness of findings across various model specifications. We find that the reforms have, at best, very small impacts on the examined doctor diagnoses. In most of the specifications we estimate insignificant effects that are close to zero and often of the "wrong" sign. Therefore, our study questions the presence of the large positive effects of education on health that are found in the previous literature.
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Affiliation(s)
- Tatjana Begerow
- Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21 (FN), 42119 Wuppertal, Germany
| | - Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21 (FN), 42119 Wuppertal, Germany
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Lleras-Muney A, Price J, Yue D. The association between educational attainment and longevity using individual-level data from the 1940 census. JOURNAL OF HEALTH ECONOMICS 2022; 84:102649. [PMID: 35793610 DOI: 10.1016/j.jhealeco.2022.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
We combine individual data from the 1940 full-count census with death records and other information available on the Family Tree at familysearch.org to create the largest individual dataset to date (17 million) to study the association between years of schooling and age at death. Conditional on surviving to age 35, one additional year of education is associated with roughly 0.4 more years of life for both men and women for cohorts born 1906-1915 and smaller for earlier cohorts. Focusing on the 1906-1915 cohort we find that this association is identical when we use sibling or twin fixed effects. This association varies substantially by place of birth. For men, the association is stronger in places with greater incomes, higher quality of school, and larger investments in public health. Women also exhibit great heterogeneity in the association, but our measures of the childhood environment do not explain it.
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Affiliation(s)
- Adriana Lleras-Muney
- Department of Economics, University of California Los Angeles, Los Angeles, CA, United States
| | - Joseph Price
- Department of Economics, Brigham Young University, Provo, UT, United States
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland, College Park, MD, United States.
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Zahra F, Haberland N, Psaki S. PROTOCOL: Causal mechanisms linking education with fertility, HIV, and child mortality: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1250. [PMID: 36911344 PMCID: PMC9187904 DOI: 10.1002/cl2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In this review, we will investigate the pathways linking education and health to understand why education appears to improve health in some settings or among certain populations, and not in others, as well as to inform recommendations about how best to target investments in education to maximize the benefits to health. We will seek to answer the following key research questions, focusing specifically on the mechanisms that affect fertility, HIV, and infant and child mortality. If feasible, these answers will include meta-analyses of comparable education and mediator outcomes: (1) Do changes in education affect the primary theorized mediators (e.g., knowledge, attitudes, resources, and agency; health behaviors and harmful practices) of the relationship between education and fertility, HIV and child mortality? (2) How does the relationship between these mediators and education vary across different aspects of education (e.g., grade attainment vs. literacy/numeracy vs. attendance)?
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Kim MH, Schwartz GL, White JS, Glymour MM, Reardon SF, Kershaw KN, Gomez SL, Collin DF, Inamdar PP, Wang G, Hamad R. School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study. PLoS Med 2022; 19:e1004031. [PMID: 35727819 PMCID: PMC9258802 DOI: 10.1371/journal.pmed.1004031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/06/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) disproportionately affects Black adults in the United States. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and Black adults' CVD risk. METHODS AND FINDINGS We leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 Black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (-0.05 percentage points per SD of the segregation index; 95% CI: -0.08, -0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (-0.09 percentage points; 95% CI: -0.17, -0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. CONCLUSIONS School segregation exposure in childhood may have longstanding impacts on Black adults' cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.
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Affiliation(s)
- Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Gabriel L. Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - Sean F. Reardon
- Stanford University, Stanford, California, United States of America
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - Daniel F. Collin
- Department of Family & Community Medicine, UCSF, San Francisco, California, United States of America
| | - Pushkar P. Inamdar
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Department of Family & Community Medicine, UCSF, San Francisco, California, United States of America
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Wang G, Schwartz GL, Kim MH, White JS, Glymour MM, Reardon S, Kershaw KN, Gomez SL, Inamdar PP, Hamad R. School Racial Segregation and the Health of Black Children. Pediatrics 2022; 149:186781. [PMID: 35434734 PMCID: PMC9173588 DOI: 10.1542/peds.2021-055952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Few researchers have evaluated whether school racial segregation, a key manifestation of structural racism, affects child health, despite its potential impacts on school quality, social networks, and stress from discrimination. We investigated whether school racial segregation affects Black children's health and health behaviors. METHODS We estimated the association of school segregation with child health, leveraging a natural experiment in which school districts in recent years experienced increased school segregation. School segregation was operationalized as the Black-White dissimilarity index. We used ordinary least squares models as well as quasi-experimental instrumental variables analysis, which can reduce bias from unobserved confounders. Data from the Child Development Supplement of the Panel Study of Income Dynamics (1997-2014, n = 1248 Black children) were linked with district-level school segregation measures. Multivariable regressions were adjusted for individual-, neighborhood-, and district-level covariates. We also performed subgroup analyses by child sex and age. RESULTS In instrumental variables models, a one standard deviation increase in school segregation was associated with increased behavioral problems (2.53 points on a 27-point scale; 95% CI, 0.26 to 4.80), probability of having ever drunk alcohol (0.23; 95% CI, 0.049 to 0.42), and drinking at least monthly (0.20; 95% CI, 0.053 to 0.35). School segregation was more strongly associated with drinking behaviors among girls. CONCLUSIONS School segregation was associated with worse outcomes on several measures of well-being among Black children, which may contribute to health inequities across the life span. These results highlight the need to promote school racial integration and support Black youth attending segregated schools.
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Affiliation(s)
- Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sean Reardon
- Graduate School of Education, Stanford University, Palo Alto, California
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Jay MA, Grath-Lone LM, De Stavola B, Gilbert R. Evaluation of pushing out of children from all English state schools: Administrative data cohort study of children receiving social care and their peers. CHILD ABUSE & NEGLECT 2022; 127:105582. [PMID: 35255340 PMCID: PMC9077441 DOI: 10.1016/j.chiabu.2022.105582] [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: 11/01/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pushing out (off-rolling) occurs where pupils are illegally excluded from school. Those receiving children's social care (CSC) services (children in need (CiN), on child protection plans (CPPs) or looked after (CLA)) are thought to be at increased risk, but limited evidence inhibits understanding of this phenomenon. The extent of pushing out can be inferred from non-enrolment in administrative data. OBJECTIVE To estimate proportions of children not enrolled across secondary school (aged 11-16, up to year 11) and to explore the association between CSC history and non-enrolment in year 10/11. PARTICIPANTS AND SETTING >1 M pupils in year 7 (aged 11/12) in English state schools, 2011/12 and 2012/13. METHODS We estimated the proportion of children not enrolled across years 8 to 11, disaggregated by CSC history. We assessed with regression modelling the association between CSC history and non-enrolment in years 10/11. RESULTS Of children without CSC history, 3.8% had ≥1 year not enrolled by year 11. This was higher in those with a history CiN (8.1%), CPP (9.4%) or CLA (10.4%) status. The odds of non-enrolment in years 10/11 were higher among those with CLA history vs non-exposed peers (OR 4.76, 95% CI 4.49-5.05) as well as in those with CPP history (3.60, 3.39-3.81) and CiN history (2.53, 2.49-2.58). History of special educational needs further increased non-enrolment odds, including after confounder adjustment. CONCLUSIONS Findings imply that children with CSC history are more likely to be pushed out from school than children without, especially those with special educational needs.
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Affiliation(s)
- Matthew A Jay
- UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - Louise Mc Grath-Lone
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Bianca De Stavola
- UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Ruth Gilbert
- UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, United Kingdom
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Tertulien T, Roberts MB, Eaton CB, Cene CW, Corbie-Smith G, Manson JE, Allison M, Nassir R, Breathett K. Association between race/ethnicity and income on the likelihood of coronary revascularization among postmenopausal women with acute myocardial infarction: Women's health initiative study. Am Heart J 2022; 246:82-92. [PMID: 34998968 PMCID: PMC8918000 DOI: 10.1016/j.ahj.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/22/2021] [Accepted: 12/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Historically, race, income, and gender were associated with likelihood of receipt of coronary revascularization for acute myocardial infarction (AMI). Given public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI. METHODS Using the Women's Health Initiative Study, hazards ratio (HR) of revascularization for AMI was compared for Black and Hispanic women vs White women and among women with annual income <$20,000/year vs ≥$20,000/year over median 9.5 years follow-up(1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. Results were stratified by revascularization type: percutaneous coronary intervention and coronary artery bypass grafting(CABG). Trends by race and income were compared pre- and post-2010 using time-varying analysis. RESULTS Among 5,284 individuals with AMI (9.5% Black, 2.8% Hispanic, and 87.7% White; 23.2% <$20,000/year), Black race was associated with lower likelihood of receiving revascularization for AMI compared to White race in fully adjusted analyses [HR:0.79(95% Confidence Interval:[CI]0.66,0.95)]. When further stratified by type of revascularization, Black race was associated with lower likelihood of percutaneous coronary intervention for AMI compared to White race [HR:0.72(95% CI:0.59,0.90)] but not for CABG [HR:0.97(95%CI:0.72,1.32)]. Income was associated with lower likelihood of revascularization [HR:0.90(95%CI:0.82,0.99)] for AMI. No differences were observed for other racial/ethnic groups. Time periods (pre/post-2010) were not associated with change in revascularization rates. CONCLUSION Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management.
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Alegría M, O'Malley IS, DiMarzio K, Zhen-Duan J. Framework for Understanding and Addressing Racial and Ethnic Disparities in Children's Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:179-191. [PMID: 35361358 PMCID: PMC9382888 DOI: 10.1016/j.chc.2021.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this framework, we synthesize the results of studies addressing racial/ethnic disparities in children's mental health through 4 domains hypothesized to impact minoritized children and their families: (1) policies, (2) institutional systems, (3) neighborhoods/community system, and (4) individual/family-level factors. We focus on children and adolescents, presenting findings that may impact mental health outcomes for major racial/ethnic groups in North America: Black/African American, Latinx, Asian, and American Indian youth. We conclude by suggesting areas for needed research, including whether certain domains of influence demonstrate differential impact for inequities reduction depending on the youth's race/ethnicity.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA 02215, USA.
| | - Isabel Shaheen O'Malley
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA
| | - Karissa DiMarzio
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St, AHC-1, Miami, FL 33199, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Herd P, Sicinski K. Using sibling models to unpack the relationship between education and cognitive functioning in later life. SSM Popul Health 2022; 17:100960. [PMID: 34984219 PMCID: PMC8693027 DOI: 10.1016/j.ssmph.2021.100960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 01/11/2023] Open
Abstract
As the population ages and the prevalence of dementia increases, unpacking robust and persistent associations between educational attainment and later life cognitive functioning is increasingly important. We do know, from studies with robust causal designs, that policies that increase years of schooling improve later life cognitive functioning. Yet these studies don't illuminate why older adults with greater educational attainment have relatively preserved cognitive functioning. Studies focused on why, however, have been hampered by methodological limitations and inattention to some key explanations for this relationship. Consequently, we test explanations encompassing antecedent factors, specifically family environments, adolescent IQ, and genetic factors, as well as adult mediating mechanisms, specifically health behaviors and health. We employ the Wisconsin Longitudinal Study, which includes 80 years of prospectively collected data on a sample of 1 in every 3 high school graduates, and a selected sibling, from the class of 1957. Sibling models, and the inclusion of prospectively collected early and midlife covariates, allows us to address the explanatory and methodological limitations of the prior literature to better unpack the relationship between education and later life cognitive functioning. We find little evidence that early life genetic endowments and environments, or midlife health and health behaviors, explain the relationship. Adolescent cognition, however, does matter; higher educational attainment, linked to antecedent adolescent cognitive functioning, helps protect against lower levels of cognitive functioning in later life. Both adolescent cognition and education, however, independently associate with later life cognitive functioning at relatively similar magnitudes. Educational attainment's relationship to later life cognitive functioning is not simply a function of adolescent cognitive functioning.
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Affiliation(s)
- Pamela Herd
- Georgetown University, McCourt School of Public Policy, 37 and O Streets, NW. Old North, Suite 100, Washington, DC, 20057, USA
| | - Kamil Sicinski
- Wisconsin Longitudinal Study, University of Wisconsin-Madison, USA
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Olstad DL, Nejatinamini S, Vanderlee L, Livingstone KM, Campbell DJT, Tang K, Minaker LM, Hammond D. Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality? SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:663-691. [PMID: 35261028 DOI: 10.1111/1467-9566.13445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lana Vanderlee
- Centre Nutrition, Santé et Société (Centre NUTRISS), Pavillon des Services, Université Laval École de Nutrition, Laval, Quebec, Canada
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leia M Minaker
- Faculty of Environment, School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Valencia-Aguirre S, Arroyave I, García-Basteiro AL. Educational level and tuberculosis mortality in Colombia: growing inequalities and stagnation in reduction. CAD SAUDE PUBLICA 2022; 38:e00031721. [PMID: 35107505 DOI: 10.1590/0102-311x00031721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
We aim to describe the role of educational inequalities, for sex and age groups, in adult tuberculosis (TB) mortality in Colombia, 1999-2017. We linked mortality data to data estimation of the national population based on censuses and surveys to obtain primary, secondary, and tertiary adult (25+ years of age) age-standardized mortality rates (ASMR) by educational level. Thus, a population-based study was conducted using national secondary mortality data between 1999 and 2017. Tuberculosis age-standardized mortality rates were calculated separately by educational level, sex, and age groups, using Poisson regression models. Educational relative inequalities in adult mortality were evaluated by calculating the rate ratio, and the relative index of inequality (RII). Trends and joinpoints were evaluated by annual percentage change (APC). We found that, out of the 19,720 TB deaths reported, 69% occurred in men, and 45% in older adults (men and women, aged 65+). Men presented higher TB mortality rates than women (ASMR men = 7.1/100,000 inhabitants, ASMR women = 2.7/100,000 inhabitants). As mortality was consistently higher in the lowest educational level for both sexes and all age groups, inequalities in TB mortality were found to be high (RII = 9.7 and 13.4 among men and women, respectively) and growing at an annual rate of 8% and 1%. High and increasing inequalities, regarding educational level, in TB mortality in Colombia suggest the need to comprehensively address strategies for reducing TB by considering social determinants and including health education strategies throughout the country.
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Affiliation(s)
| | - Ivan Arroyave
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique.,Institut de Salut Global de Barcelona, Universitat de Barcelona, Barcelona, España
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MacDonald E, Arpin E, Quesnel-Vallée A. Literacy and self-rated health: Analysis of the Longitudinal and International Study of Adults (LISA). SSM Popul Health 2022; 17:101038. [PMID: 35284617 PMCID: PMC8914366 DOI: 10.1016/j.ssmph.2022.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
The relationship between education and health is well-established. The empirical literature finds that individuals with higher levels of education experience lower risks of poor health outcomes compared to individuals with less education. Outstanding to this literature is the examination of a dimension of education – literacy – and its association with health. The objective of this study was to examine the relationship between literacy (reading, numeracy) and health (self-reported health). We use data from the 2012 wave of the Canadian Longitudinal International Survey of Adults (LISA). The LISA includes rich information on health, broader sociodemographic characteristics (income, age, sex, etc.) as well as information on literacy skills from the Program for International Assessment of Adult Competencies (PIAAC). Using logistic regression, we first reaffirm the association between education and self-reported health. We then find that after controlling for measures of literacy, understood as proficiency in reading and numeracy, the magnitude of effect of education on health is reduced. Skills in literacy reduce the risk of reporting poor health, but only for the older subset of respondents (ages 40–65). Our results suggest that literacy should not be understated in empirical research on education and health, and in fact serve to sharpen our understanding of how education impacts health by drawing attention to indirect pathways. There is limited evidence on the association between literacy and health Literacy (reading, numeracy) significantly influence poor self-reported health The association is only significant for older adults (ages 40 to 65) Literacy represents an indirect pathway between education and health
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Affiliation(s)
- Emma MacDonald
- Department of Sociology, McGill University, Leacock Building, Room 717, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7, Canada
| | - Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Corresponding author.
| | - Amélie Quesnel-Vallée
- Department of Sociology, McGill University, Leacock Building, Room 717, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7, Canada
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Lleras-Muney A. EDUCATION AND INCOME GRADIENTS IN LONGEVITY: THE ROLE OF POLICY. THE CANADIAN JOURNAL OF ECONOMICS. REVUE CANADIENNE D'ECONOMIQUE 2022; 55:5-37. [PMID: 37987018 PMCID: PMC10659761 DOI: 10.1111/caje.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Education and income are strong predictors of health and longevity. In the last 20 years many efforts have been made to understand if these relationships are causal and what the possible role of policy should be as a result. The evidence from various studies is ambiguous: the effects of education and income policies on health are heterogeneous and vary over time, and across places and populations. I discuss explanations for these disparate results and suggest directions for future research.
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Affiliation(s)
- Adriana Lleras-Muney
- NATIONAL BUREAU OF ECONOMIC RESEARCH, 1050 Massachusetts Avenue, Cambridge, MA 02138
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Das S, Loba F, Mozumder K, Roy P, Das J, Das SK. Trend of maternal education in Bangladesh from 2004–2018: Analysis of demographic surveillance data. PLoS One 2022; 17:e0255845. [PMID: 35100288 PMCID: PMC8803158 DOI: 10.1371/journal.pone.0255845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Maternal education is universally recognised as a major factor in positive societal indicators (health, wellbeing, overall education, etc.) and a country’s growth and economic sustainability, yet the underlying factors contributing to maternal education have not been widely investigated, especially in developing countries.
Objective
This study investigated the 15-year trend of maternal education in Bangladesh (2004–2018) to identify the factors contributing to maternal education.
Method
This study used publicly available cross-data from five consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2018). Level of maternal education was grouped as ‘no education’, ‘incomplete primary’, ‘complete primary’, ‘incomplete secondary’, ‘complete secondary’ and ‘higher education’ (reference group). The differences in factors/exposure variables suspected to contribute to maternal education were measured for these groups for 2004–2018, and a survey multinomial logistic regression was performed to estimate the explanatory value of these factors.
Results
From 2004–2018, there was a 62% gross reduction of the no education group and a 61% gross increase in the higher education group. A gross increase was also observed for complete secondary (49%), incomplete secondary (39%) and complete primary education (14%). In multivariate analysis, in rural areas, in 2018, the probability of a woman being in the complete primary, incomplete primary or no education groups was increased (adjusted relative risk ratio: 1.21, 1.40 and 1.59), compared to 2004 (0.73, 1.09, 1.12), respectively. From 2004–2018, the factor of no television watching reduced the probability of maternal education levels. Having a husband/partner who had no education increased the probability of a woman’s education level. The probability of all maternal education levels decreased across all wealth index groups.
Conclusion
The data suggest that average maternal education level in Bangladesh increased from 2004–2018. However, an integrated effort is required to improve factors associated with maternal education to both increase maternal education and Bangladesh’s long-term sustainability.
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Affiliation(s)
- Shathi Das
- St. Gregory’s High School & College, Dhaka, Bangladesh
- * E-mail: (SD); , (SKD)
| | - Fharia Loba
- College of Education, Charles Darwin University, Darwin, Australia
| | | | - Palash Roy
- Kumudini Pharmaceutical Limited, Dhaka, Bangladesh
| | - Jui Das
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Sumon Kumar Das
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail: (SD); , (SKD)
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Matthay EC, Gottlieb LM, Rehkopf D, Tan ML, Vlahov D, Glymour MM. What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies. Epidemiol Rev 2022; 43:33-47. [PMID: 34215873 PMCID: PMC8763089 DOI: 10.1093/epirev/mxab005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
Social policies have great potential to improve population health and reduce health disparities. Increasingly, those doing empirical research have sought to quantify the health effects of social policies by exploiting variation in the timing of policy changes across places. Multiple social policies are often adopted simultaneously or in close succession in the same locations, creating co-occurrence that must be handled analytically for valid inferences. Although this is a substantial methodological challenge for researchers aiming to isolate social policy effects, only in a limited number of studies have researchers systematically considered analytic solutions within a causal framework or assessed whether these solutions are being adopted. We designated 7 analytic solutions to policy co-occurrence, including efforts to disentangle individual policy effects and efforts to estimate the combined effects of co-occurring policies. We used an existing systematic review of social policies and health to evaluate how often policy co-occurrence is identified as a threat to validity and how often each analytic solution is applied in practice. Of the 55 studies, only in 17 (31%) did authors report checking for any co-occurring policies, although in 36 studies (67%), at least 1 approach was used that helps address policy co-occurrence. The most common approaches were adjusting for measures of co-occurring policies; defining the outcome on subpopulations likely to be affected by the policy of interest (but not other co-occurring policies); and selecting a less-correlated measure of policy exposure. As health research increasingly focuses on policy changes, we must systematically assess policy co-occurrence and apply analytic solutions to strengthen studies on the health effects of social policies.
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Affiliation(s)
- Ellicott C Matthay
- Correspondence to Dr. Ellicott C. Matthay, Center for Health and Community, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143 (e-mail: )
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Fritz M, Fromell H. How to dampen the surge of non-communicable diseases in Southeast Asia: insights from a systematic review and meta-analysis. Health Policy Plan 2022; 37:152-167. [PMID: 34791261 PMCID: PMC8757494 DOI: 10.1093/heapol/czab138] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 01/04/2023] Open
Abstract
Non-communicable diseases (NCDs), such as diabetes, cancer, cardiovascular diseases and chronic respiratory diseases, have overtaken infectious diseases as the number one cause of death worldwide. The rise of these diseases is especially grave in Southeast Asia, where existing research however falls short on offering guidance on how policy can best prevent and control NCDs in the region. Additionally, low- and middle-income countries in Southeast Asia cannot directly incorporate lessons drawn from interventions in richer countries, since health system capacities and human and financial resources are thoroughly different. Preventive interventions, thus, need to correspond to local capacities and require contextual solutions. In this article, we provide a systematic review of a wide scope of NCD interventions conducted in Southeast Asia to inform about existing intervention designs and to derive sound evidence of their effectiveness. Our literature search results in 51 studies from five Southeast Asian countries from which we can extract 204 estimates. We sort the studies into six intervention categories and analyse them with respect to 23 different health and behavioural outcomes. While we find positive and significant average effects across all six types of interventions, we also document evidence of substantial publication bias. Using a meta-regression approach in which we correct for the publication bias, we instead fail to confirm positive average effects for some interventions. Especially dietary and physical activity interventions fail to achieve improvements in analysed health outcomes, while programs focusing on smoking cessation, on the take-up of preventive screening activities or educating patients on how to cope with NCDs achieve sizeable effects. We also present evidence that the size of the effect differs with the participants' characteristics as well as with design features of the intervention. For local policymakers, the results provide important knowledge on how to address the increasing NCD burden in the coming years.
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Affiliation(s)
- Manuela Fritz
- Faculty of Economics, Business and Information Systems, Chair of Development Economics, University of Passau, Innstraße 29, Passau 94032, Germany
- Department of Economics, Econometrics and Finance, University of Groningen, Nettelbosje 2, Groningen 9747 AE, The Netherlands
| | - Hanna Fromell
- Department of Economics, Econometrics and Finance, University of Groningen, Nettelbosje 2, Groningen 9747 AE, The Netherlands
- Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 4, Aarhus V 8210, Denmark
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Huang R, Wang XQ, Yang BX, Liu Z, Chen WC, Jiao SF, Chen J. Self-management of depression among Chinese community individuals: A cross-sectional study using the transtheoretical model. Perspect Psychiatr Care 2022; 58:256-265. [PMID: 33792031 DOI: 10.1111/ppc.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the self-management of depression among members of a Chinese community. DESIGN AND METHODS A cross-sectional survey was conducted in Wuhan. The Depression Prevention and Management Survey was used to identify 429 participants' stage of change, perceived benefits, process of change and self-efficacy, based on the transtheoretical model perspective. FINDINGS A majority of participants (69.0%) were at the inactive stage of depression self-management. The mean score of the process of change was 87.62 (SD = 24.83). ANOVA analysis showed gender, education, and family function were significant influencing factors in the process of change. PRACTICE IMPLICATIONS Mental health nurses need to target their approach to the level of the individual based on the transtheoretical model to assist them to enhance their awareness and motivation. More consideration should be given to gender, education, and family function in the context of depression self-management.
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Affiliation(s)
- Run Huang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiao Q Wang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Bing X Yang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wen C Chen
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Shu F Jiao
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jie Chen
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Ye X, Zhu D, Ding R, He P. The Effect of China's Compulsory Education Reforms on Physiological Health in Adulthood: A Natural Experiment. Health Policy Plan 2021; 37:376-384. [PMID: 34888661 DOI: 10.1093/heapol/czab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
Lower education is related to higher biological risks for physiological health, but it remains unclear whether the risks can be reduced through policies aimed at increasing years of education. We utilized China's compulsory education reforms as a unique natural experiment, which stipulates that primary and lower secondary education is mandatory and free for all school-age children. Using a regression discontinuity design (RDD), we assessed the effect of the reform eligibility on biomarkers. The reforms resulted in an increase in years of education for those from communities with the middle 1/3 per capita income (PCI) (β = 2.44, 95% CI = 0.23 - 4.64). Reform eligibility had no impact on allostatic risks for the total sample (β = 0.065, 95% CI = -0.70 - 0.83) and for those from communities with the lowest (β = 0.35, 95% CI = -0.77 - 1.47) or highest third of PCI (β = 0.68, 95% CI = -0.64 - 2.00), while it reduced the metabolic risk (β = -0.14, 95% CI = -0.26 - -0.015) and total allostatic load (β = -1.58, 95% CI = -3.00 - -0.16) among those from communities with the middle third PCI. The results were confirmed by sensitivity analyses of different placebo cutoff points and bandwidths. The reforms led to better physiological health to some extent, but the effect only manifested in people from communities with a moderate community PCI, and had little impact on affluent or disadvantaged groups. Our findings stressed that the institutional context and respondents' socioeconomic environment must be taken into account when assessing the health impact of China's compulsory education reforms.
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Affiliation(s)
- Xin Ye
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.,China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Olstad DL, Nejatinamini S, Kirkpatrick SI, Vanderlee L, Livingstone KM, Campbell DJT, Tang K, Minaker LM, Hammond D. Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways. J Acad Nutr Diet 2021; 122:541-554.e1. [PMID: 34626824 DOI: 10.1016/j.jand.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/16/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. OBJECTIVE This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. DESIGN Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. PARTICIPANTS AND SETTING Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. MAIN OUTCOME MEASURES Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. STATISTICAL ANALYSES PERFORMED Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. RESULTS There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. CONCLUSIONS Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- Université Laval École de Nutrition, Centre Nutrition, Santé et Société (Centre NUTRISS), Québec, Québec, Canada
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David J T Campbell
- Department of Medicine, Department of Community Health Sciences, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Karen Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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