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Zhou S, Liang Z, Li Q, Tian W, Song S, Wang Z, Huang J, Ren M, Liu G, Xu M, Zheng ZJ. Individual and area-level socioeconomic status, Life's Simple 7, and comorbid cardiovascular disease and cancer: a prospective analysis of the UK Biobank cohort. Public Health 2024; 234:178-186. [PMID: 39024928 DOI: 10.1016/j.puhe.2024.06.028] [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: 03/24/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations. STUDY DESIGN This was a population-based prospective cohort study. METHODS We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors. RESULTS Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES. CONCLUSIONS Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear.
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Affiliation(s)
- S Zhou
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Z Liang
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Q Li
- Institute of Social Development, Chinese Academy of Macroeconomic Research, Beijing, China
| | - W Tian
- Department of Global Statistics, Eli Lilly and Company, Branchburg, New Jersey, USA
| | - S Song
- Department of Health Policy & Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Z Wang
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - J Huang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - M Ren
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China
| | - G Liu
- Institute for Global Health and Development, Peking University, Beijing, China
| | - M Xu
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
| | - Z-J Zheng
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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Van Hemelrijck WMJ, Kunst AE, Sizer A, Martikainen P, Zengarini N, Costa G, Janssen F. Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin). J Epidemiol Community Health 2024:jech-2023-221702. [PMID: 38955464 DOI: 10.1136/jech-2023-221702] [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: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Socioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in inequalities is sparse. METHODS We studied trends in educational inequalities in smoking-attributable mortality (SAM) and assessed their impact on general mortality inequality trends in England and Wales (E&W), Finland, and Italy (Turin) from 1972 to 2017. We used yearly individually linked all-cause and lung cancer mortality data by educational level and sex for individuals aged 30 and older. SAM was indirectly estimated using the Preston-Glei-Wilmoth method. We calculated the slope index of inequality (SII) and performed segmented regression on SIIs for all-cause, smoking and non-SAM to identify phases in inequality trends. The impact of SAM on all-cause mortality inequality trends was estimated by comparing changes in SII for all-cause with non-SAM. RESULTS Inequalities in SAM generally declined among males and increased among females, except in Italy. Among males in E&W and Finland, SAM contributed 93% and 76% to declining absolute all-cause mortality inequalities, but this contribution varied over time. Among males in Italy, SAM drove the 1976-1992 increase in all-cause mortality inequalities. Among females in Finland, increasing inequalities in SAM hampered larger declines in mortality inequalities. CONCLUSION Our findings demonstrate that differing education-specific SAM trends by country and sex result in different inequality trends, and consequent contributions of SAM on educational mortality inequalities. The following decades of the smoking epidemic could increase educational mortality inequalities among Finnish and Italian women.
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Affiliation(s)
| | - Anton E Kunst
- Social Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Alison Sizer
- Centre for Longitudinal Information & User Support (CeLSIUS), Department of Information Studies, University College London (UCL), London, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Nicolas Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (Torino), Italy
| | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, The Hague, The Netherlands
- Faculty of Spatial Sciences, University of Groningen, Population Research Centre, Groningen, The Netherlands
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Rocha S, Bower JE, Chiang JJ, Cole SW, Irwin MR, Seeman T, Fuligni AJ. A dyadic longitudinal analysis of parent-adolescent inflammation trends and the role of shared socioeconomic characteristics on family inflammation. Brain Behav Immun Health 2024; 38:100767. [PMID: 38633057 PMCID: PMC11021828 DOI: 10.1016/j.bbih.2024.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
The objective of the present study was to evaluate the interdependency of parent-adolescent inflammation trends across time and to examine whether shared family socioeconomic characteristics explained between-family differences in parents' and adolescents' risk for inflammation. A total of N = 348 families, consisting of one parent and one adolescent child, were followed every two years in a three-wave longitudinal study. Sociodemographic questionnaires were used to determine parental educational attainment and family income-to-needs ratio (INR). At each time point, parents and adolescents collected dried blood spot (DBS) samples that were assayed for circulating CRP and log-transformed prior to analysis by longitudinal dyadic models. Models revealed significant differences in parents' and adolescents' inflammation trends over time (bint = - 0.13, p < 0.001). While parental CRP levels remained relatively stable across the study period, adolescent CRP increased by approximately 38% between study waves. Parents' average CRP levels were positively correlated with adolescents' average CRP (r = 0.32, p < 0.001), but parental change in CRP over time was not significantly related to change in adolescents' CRP over time. Family dyads with higher parental educational attainment had lower average CRP (b = -0.08, p = 0.01), but parental education did not predict change in dyads' inflammation over time. Study findings suggest that shared family socioeconomic characteristics contribute to baseline similarities in parents' and adolescents' inflammation and potentially point to adolescence as a period of inflammatory change where youth may diverge from parental inflammation trends.
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Affiliation(s)
- Sarah Rocha
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
| | - Julienne E. Bower
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Los Angeles, CA, 90095, USA
| | - Jessica J. Chiang
- Georgetown University, Department of Psychology, Washington, D.C., 20057, USA
| | - Steve W. Cole
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90095, USA
| | - Michael R. Irwin
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90095, USA
| | - Teresa Seeman
- University of California, Los Angeles, David Geffen School of Medicine, Division of Geriatrics, Los Angeles, CA, 90095, USA
| | - Andrew J. Fuligni
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Los Angeles, CA, 90095, USA
- University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90095, USA
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Liu L, Wen W, Shrubsole MJ, Lipworth LE, Mumma MT, Ackerly BA, Shu XO, Blot WJ, Zheng W. Impacts of Poverty and Lifestyles on Mortality: A Cohort Study in Predominantly Low-Income Americans. Am J Prev Med 2024; 67:15-23. [PMID: 38417593 DOI: 10.1016/j.amepre.2024.02.015] [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] [Received: 10/20/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Low socioeconomic status has been linked to increased mortality. However, the impacts of poverty, alone or combined with health behaviors, on mortality and life expectancy have not been adequately investigated. METHODS Data from the Southern Community Cohort Study was used, including nearly 86,000 participants recruited during 2002-2009 across 12 US southeastern states. Analysis was conducted from February 2022 to January 2023. RESULTS During a median follow-up of 12.1 years, 19,749 deaths were identified. A strong dose-response relationship was found between household incomes and mortality, with a 3.3-fold (95%CI=3.1-3.6) increased all-cause mortality observed for individuals in the lowest income group (<$15,000/year) compared with those in the highest group (≥$50,000/year). Within each income group, mortality monotonically increased with declining healthy lifestyle score. Risk was significantly lower among those in the lowest income but healthiest lifestyle group, compared to those with the highest income but unhealthiest lifestyle (HR=0.82, 95%CI=0.69-0.97). Poor White participants appeared to experience higher all-cause mortality than poor Black participants. Life expectancy was more than 10.0 years shorter for those in the lowest income group compared with those in the highest income group. CONCLUSIONS Poverty is strongly associated with increased risk of death, but the risks could be modestly abated by a healthier lifestyle. These findings call for a comprehensive strategy for enhancing a healthy lifestyle and improving income equality to reduce death risks, particularly among those experiencing health disparities due to poverty.
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Affiliation(s)
- Lili Liu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Loren E Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael T Mumma
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brooke A Ackerly
- Department of Political Science, Vanderbilt University, Nashville, Tennessee
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
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Saoudi I, Maltagliati S, Chalabaev A, Sarrazin P, Cheval B. Sociodemographic precursors of explicit and implicit attitudes towards physical activity. Psychol Health 2024:1-23. [PMID: 38946132 DOI: 10.1080/08870446.2024.2371964] [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: 07/31/2023] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE In high-income countries, people with low socio-economic status (SES) engage in less leisure-time physical activity (PA) than those with higher SES. Beyond a materialistic account of this difference, the role of motivational precursors-among which attitudes are emblematic-remains poorly understood, particularly when it comes to dissociating the automatic vs. deliberative components of attitudes. This pre-registered study aimed to examine the associations between SES (i.e. income and educational attainment) and motivational precursors of PA (i.e. explicit and implicit attitudes), and whether gender and age may moderate these relationships. METHOD We used data from 970 adults (64% of women; mean age = 33 ± 12 years) from the Attitudes, Identities, and Individual Differences (AIID) study. RESULTS Results of multiple linear regression analyses showed that participants with the highest level of income (>150,000$ per year) reported more positive explicit and implicit attitudes towards PA than those with lower income. Exploratory analysis further showed that women reported weaker explicit attitudes towards PA, while both explicit and implicit attitudes towards PA became weaker at age increases. In contrast, educational attainment was not significantly associated with those attitudes, and there was only mixed evidence for a moderating role of participants' gender on the pattern of associations. CONCLUSION Our findings suggest that both the explicit and implicit attitudes towards PA may be socially patterned. Future intervention studies should examine whether these attitudinal differences could be reduced, and whether such a reduction could help buffer the unequal participation in PA behaviors across social groups.
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Affiliation(s)
| | | | | | | | - Boris Cheval
- Department of Sport Sciences and Physical Education, Ecole Normale Supérieure Rennes, Bruz, France
- Laboratory VIPS, University of Rennes, Rennes, France
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6
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Lee S, Ma X, Choi Y, Kim YS. Association of physical activity and socio-economic status on mortality in older adults: a retrospective cohort study of KNHANES-mortality linked data. Sci Rep 2024; 14:14447. [PMID: 38914607 PMCID: PMC11196573 DOI: 10.1038/s41598-024-62216-7] [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: 12/11/2023] [Accepted: 05/14/2024] [Indexed: 06/26/2024] Open
Abstract
We examined the joint association of physical activity (PA) and socio-economic status (SES) on all-causes and cardiovascular disease (CVD) mortality in 6945 elderly Koreans (mean age: 71.6 years, 41.8% male) using data from the Korean National Health and Nutrition Examination Survey (2007-2013) and death data from Statistics Korea (2019). The SES included household income and education level. PA was assessed using the IPAQ and categorized according to the 2018 PA Guidelines. In stratified analyses using Cox proportional hazards by SES adherence to PA guidelines those who low household income group was associated with a reduced risk of all-cause mortality and CVD mortality, while in the lowest educational level group, it was associated with a reduced risk of all-cause mortality and CVD mortality. In the joint analysis, PA was associated with a significant reduction in all-cause mortality in all groups when compared with those who did not meet PA those who had the lowest SES. However, PA with CVD mortality risk was not significantly associated in the 'upper-middle' income and 'high school' education groups. The study revealed that PA significantly association mortality, particularly among older adults with low SES. This finding suggests the potential for targeted government interventions to promote healthy aging.
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Affiliation(s)
- Soomin Lee
- Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Xiaonan Ma
- Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Younghwan Choi
- Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Yeon Soo Kim
- Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea.
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Diniz AP, Mendonça RDD, Machado-Coelho GLL, Meireles AL. The Interaction between Education and Sex with Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Analysis of Two Brazilian Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:804. [PMID: 38929050 PMCID: PMC11203712 DOI: 10.3390/ijerph21060804] [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: 04/15/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
This cross-sectional study, carried out between October and December 2020 in two Brazilian cities, aimed to evaluate the joint association of education and sex with habitual and episodic excessive alcohol consumption during the COVID-19 pandemic. Habitual alcohol consumption was defined as drinking any quantity of alcohol at least once per week. Excessive episodic alcohol consumption was defined as the consumption of five or more drinks by men or four or more drinks by women at least once in the last 30 days. Adjusted multivariate logistic regression models were used to analyze associations of education and sex with alcohol consumption. Education was not associated with habitual alcohol consumption and excessive episodic alcohol consumption. However, when evaluating the joint effect between education and sex, it can be seen that men with low education were more likely to habitually consume (OR: 5.85; CI95:2.74-14.84) and abuse alcohol (OR: 4.45; IC95:1.54-12.82) and women with high education were more likely to have habitual (OR: 2.16; IC95:1.18-3.95) and abusive alcohol consumption (OR: 2.00; IC95:1.16-3.43). These findings highlight the modifying effect of sex on the relationship between education and alcohol consumption, such that education influenced alcohol consumption differently between sexes during the pandemic.
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Affiliation(s)
- Amanda Popolino Diniz
- Postgraduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto, Ouro Preto 35400000, MG, Brazil;
| | - Raquel de Deus Mendonça
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto 35400000, MG, Brazil;
| | | | - Adriana Lúcia Meireles
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto 35400000, MG, Brazil;
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van den Bekerom L, van Gestel LC, Schoones JW, Bussemaker J, Adriaanse MA. Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness. Health Psychol Behav Med 2024; 12:2365931. [PMID: 38903803 PMCID: PMC11188964 DOI: 10.1080/21642850.2024.2365931] [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: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. Methods A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Results Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Conclusion Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
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Affiliation(s)
- Loes van den Bekerom
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
| | - Laurens C. van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jan W. Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jet Bussemaker
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- The Institute of Public Administration, Leiden University, Leiden, the Netherlands
| | - Marieke A. Adriaanse
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
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Aida J, Inoue Y, Tabuchi T, Kondo N. Modifiable risk factors of inequalities in hypertension: analysis of 100 million health checkups recipients. Hypertens Res 2024; 47:1555-1566. [PMID: 38443615 DOI: 10.1038/s41440-024-01615-9] [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: 09/26/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/07/2024]
Abstract
Inequalities in health behaviors are thought to contribute to inequalities in hypertension. This study examined the extent to which modifiable mediating factors explain income inequalities in hypertension. This repeated cross-sectional study used data from National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from 2009 to 2015. Those aged between 40 and 74 were enrollees in the Specific Health Checkups. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90, or the use of antihypertensive medication. The mediating effects of exercise, obesity, smoking, and alcohol drinking on the association between income, as an indicator of SES, and hypertension were determined by the Karlson-Holm-Breen (KHB) method. The mean age of the 68,684,025 men and 59,118,221 women was 54.7 (SD = 9.6) and 56.7 (SD = 10.0) years, respectively. Prevalence of hypertension was higher in the lowest income group (48.6% for men, 40.2% for women) than in the highest income group (33.3% for men, 21.5% for women). Inequalities tended to increase over time. Inequalities were larger among those who did not use antihypertensive medication. Modifiable risks explained 10.6% of the association between income and hypertension for men and 15.1% for women. In men, drinking and obesity explained 8.8% and 5.5% of the inequalities in hypertension, respectively. In women, obesity explained 18.8%. Exercise increased the proportion mediated over time. Smoking explained 5.5% among women taking antihypertensive medication. There were health inequalities in hypertension among Japanese adults, and the modifiable risk factors partially explained the inequalities.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yuko Inoue
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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Black M. Should governments feed all school children? PUBLIC HEALTH IN PRACTICE 2024; 7:100465. [PMID: 38895026 PMCID: PMC11184440 DOI: 10.1016/j.puhip.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Michelle Black
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Jackisch J, Noor N, Raitakari OT, Lehtimäki T, Kähönen M, Cullati S, Delpierre C, Kivimäki M, Carmeli C. Does the effect of adolescent health behaviours on adult cardiometabolic health differ by socioeconomic background? Protocol for a population-based cohort study. BMJ Open 2024; 14:e078428. [PMID: 38806419 PMCID: PMC11138306 DOI: 10.1136/bmjopen-2023-078428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/08/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Adolescence is a sensitive period for cardiometabolic health. Yet, it remains unknown if adolescent health behaviours, such as alcohol use, smoking, diet and physical activity, have differential effects across socioeconomic strata. Adopting a life-course perspective and a causal inference framework, we aim to assess whether the effects of adolescent health behaviours on adult cardiometabolic health differ by levels of neighbourhood deprivation, parental education and occupational class. Gaining a better understanding of these social disparities in susceptibility to health behaviours can inform policy initiatives that aim to improve population health and reduce socioeconomic inequalities in cardiometabolic health. METHODS AND ANALYSIS We will conduct a secondary analysis of the Young Finns Study, which is a longitudinal population-based cohort study. We will use measures of health behaviours-smoking, alcohol use, fruit and vegetable consumption, and physical activity-as exposure and parental education, occupational class and neighbourhood deprivation as effect modifiers during adolescence (ages 12-18 years). Eight biomarkers of cardiometabolic health (outcomes)-waist circumference, body mass index, blood pressure, low-density lipoprotein cholesterol, apolipoprotein B, plasma glucose and insulin resistance-will be measured when participants were aged 33-40. A descriptive analysis will investigate the clustering of health behaviours. Informed by this, we will conduct a causal analysis to estimate effects of single or clustered adolescent health behaviours on cardiometabolic health conditional on socioeconomic background. This analysis will be based on a causal model implemented via a directed acyclic graph and inverse probability-weighted marginal structural models to estimate effect modification. ETHICS AND DISSEMINATION The Young Finns study was conducted according to the guidelines of the Declaration of Helsinki, and the protocol was approved by ethics committees of University of Helsinki, Kuopio, Oulu, Tampere and Turku. We will disseminate findings at international conferences and a manuscript in an open-access peer-reviewed journal.
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Affiliation(s)
- Josephine Jackisch
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nazihah Noor
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
| | - Olli T Raitakari
- Centre for Population Health Research & Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, TYKS Turku University Hospital, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Quality of Care Service, University of Geneva, Geneve, Switzerland
| | - Cyrille Delpierre
- CERPOP, UMR1295, Inserm, Toulouse III University-Paul Sabatier, Toulouse, France
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
- Clinicum, University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
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12
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Rathbone AP, Pearson H, Akinyemi O, Cartwright N, Tierney S, Rowlands G, Lindsey L. "You don't get side effects from social prescribing"-A qualitative study exploring community pharmacists' attitudes to social prescribing. PLoS One 2024; 19:e0301076. [PMID: 38753861 PMCID: PMC11098487 DOI: 10.1371/journal.pone.0301076] [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: 09/18/2023] [Accepted: 03/09/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies. STUDY DESIGN A qualitative phenomenological approach was used. METHODS A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed. RESULTS The sample included largely male pharmacists (63.3%) with less than five years' experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team's role to optimise health outcomes. CONCLUSIONS The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.
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Affiliation(s)
| | - Harry Pearson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Nia Cartwright
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephanie Tierney
- Nuffield Department of Primary Care Science, University of Oxford, Oxford, United Kingdom
| | - Gill Rowlands
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Lindsey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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13
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Brown RD, Pepper GV. The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health. Evol Med Public Health 2024; 12:86-96. [PMID: 38807860 PMCID: PMC11132133 DOI: 10.1093/emph/eoae009] [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: 11/20/2023] [Revised: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.
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Affiliation(s)
- Richard D Brown
- Psychology Department, Northumbria University, Newcastle, UK
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14
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Koivusilta LK, Acacio-Claro PJ, Mattila VM, Rimpelä AH. Health and health behaviours in adolescence as predictors of education and socioeconomic status in adulthood - a longitudinal study. BMC Public Health 2024; 24:1178. [PMID: 38671433 PMCID: PMC11055384 DOI: 10.1186/s12889-024-18668-7] [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: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. METHODS Surveys on health and health behaviours were sent to representative samples of 12-18-year-old Finns in 1981-1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. RESULTS In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. CONCLUSION Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes.
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Affiliation(s)
- Leena K Koivusilta
- Department of Social Research, Faculty of Social Sciences, University of Turku, 20014, Turku, Finland.
| | - Paulyn Jean Acacio-Claro
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, and Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Arja H Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
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15
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Sun W, Shan S, Hou L, Li S, Cao J, Wu J, Yi Q, Luo Z, Song P. Socioeconomic disparities in the association of age at first live birth with incident stroke among Chinese parous women: A prospective cohort study. J Glob Health 2024; 14:04091. [PMID: 38587297 PMCID: PMC11000532 DOI: 10.7189/jogh.14.04091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Stroke has become a significant public health issue in China. Although studies have shown that women's age at first live birth (AFLB) might be associated with incident stroke, there is limited evidence on this relationship among Chinese parous women. Likewise, the nature of this association across urban-rural socioeconomic status (SES) has yet to be explored. In this prospective study, we sought to investigate the associations of women's AFLB with the risk of incident stroke and its subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage) and to explore the differences of these associations as well as the population-level impacts across SES classes. Methods We used data on 290 932 Chinese parous women from the China Kadoorie Biobank who were recruited in the baseline survey between 2004 and 2008 and followed up until 2015. We used latent class analysis to identify urban-rural SES classes and Cox proportional hazard regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for AFLB's association with incident stroke. We then calculated population attributable fraction (PAF) to demonstrate the population-level impact of later AFLB on stroke. Results Around 8.9% of parous women developed stroke after AFLB. Compared with women with AFLB <22 years, those with older AFLB had a higher risk of total stroke, with fully adjusted HRs (95% CI) of 1.71 (95% CI = 1.65-1.77) for 22-24 years and 3.37 (95% CI = 3.24-3.51) for ≥25 years. The associations of AFLB with ischaemic stroke were stronger among rural-low-SES participants. We found the highest PAFs of ischaemic stroke (60.1%; 95% CI = 46.2-70.3) associated with later AFLB for urban-high-SES individuals. Conclusions Older AFLB was associated with higher risks of incident stroke and its subtypes among Chinese parous women, with stronger associations between AFLB and ischaemic stroke among rural-low-SES participants. Targeted medical advice for pregnant women of different ages could have long-term benefits for stroke prevention.
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Zhou L, Zhang R, Yang H, Zhang S, Zhang Y, Li H, Chen Y, Maimaitiyiming M, Lin J, Ma Y, Wang Y, Zhou X, Liu T, Yang Q, Wang Y. Association of plant-based diets with total and cause-specific mortality across socioeconomic deprivation level: a large prospective cohort. Eur J Nutr 2024; 63:835-846. [PMID: 38194192 DOI: 10.1007/s00394-023-03317-3] [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: 07/04/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Current evidence on the association between plant-based diet indices (PDIs) and mortality is inconsistent. We aimed to investigate the association of PDIs with all-cause and cause-specific mortality and to examine whether such associations were modified by socioeconomic deprivation level. METHODS A total of 189,003 UK Biobank participants with at least one 24-h dietary assessment were included. All food items were categorised into three groups, including healthy plant foods, less healthy plant foods, and animal foods. Three PDIs, including the overall PDI (positive scores for all plant-based food intake and inverse scores for animal-based foods), the healthful PDI (hPDI) (positive scores only for healthy plant food intake and inverse scores for others), and the unhealthful PDI (uPDI) (positive scores only for less healthy plant food intake and inverse scores for others), were calculated according to the quantities of each food subgroup in three categories. The Townsend deprivation index was used as the indicator of socioeconomic deprivation level. Cox proportional hazard models were used to estimate the hazard ratios (HRs) of PDIs for all-cause and cause-specific mortality. The modification effects of socioeconomic deprivation levels on these associations were evaluated. RESULTS During a median follow-up of 9.6 years, 9335 deaths were documented. Compared with the lowest quintile, the highest quintile of overall PDI was associated with adjusted HRs of 0.87 (95% CI 0.81-0.93) for all-cause mortality and 0.77 (0.66-0.91) for cardiovascular mortality. Compared with the lowest quintile, the highest quintile of hPDI was associated with lower risks of all-cause mortality (0.92, 0.86-0.98), and death caused by respiratory disease (0.63, 0.47-0.86), neurological disease (0.65, 0.48-0.88), and cancer (0.90, 0.82-0.99). Compared with the lowest quintile, the highest quintile of uPDI was associated with an HR of 1.29 (1.20-1.38) for all-cause mortality, 1.95 (1.40-2.73) for neurological mortality, 1.54 (1.13-2.09) for respiratory mortality, and 1.16 (1.06-1.27) for cancer mortality. The magnitudes of associations of hPDI and uPDI with mortality were larger in the most socioeconomically deprived participants (the highest tertile) than in the less deprived ones (p-values for interaction were 0.039 and 0.001, respectively). CONCLUSIONS This study showed that having a high overall PDI and hPDI were related to a reduced risk of death, while the uPDI was linked to a higher risk of death. Sticking to a healthy plant-based diet may help decrease mortality risks across socioeconomic deprivation levels, especially for those who are the most socioeconomically deprived.
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Affiliation(s)
- Lihui Zhou
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Ran Zhang
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yuan Zhang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Huiping Li
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yanchun Chen
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Maiwulamujiang Maimaitiyiming
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Jing Lin
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yue Ma
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yuan Wang
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, 300070, China.
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Aktary ML, Dunn S, Sajobi T, O'Hara H, Leblanc P, McCormack GR, Caron-Roy S, Lee YY, Reimer RA, Minaker LM, Raine KD, Godley J, Downs S, Nykiforuk CIJ, Olstad DL. The British Columbia Farmers' Market Nutrition Coupon Program Reduces Short-Term Household Food Insecurity Among Adults With Low Incomes: A Pragmatic Randomized Controlled Trial. J Acad Nutr Diet 2024; 124:466-480.e16. [PMID: 37806435 DOI: 10.1016/j.jand.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets. OBJECTIVE To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post-intervention and 16 weeks post-intervention. DESIGN Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post-intervention, and 16 weeks post-intervention. PARTICIPANTS/SETTING Adults ≥18 years with low incomes were randomized to an FMNCP group (n = 143) or a no-intervention control group (n = 142). INTERVENTION Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers' markets and were eligible to participate in nutrition skill-building activities. MAIN OUTCOME MEASURES Outcomes included short-term household food insecurity (modified version of Health Canada's 18-item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (Warwick-Edinburgh Mental Well-Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale). STATISTICAL ANALYSIS Mixed-effects linear regression and multinomial logistic regression examined between-group differences in outcomes post-intervention and 16 weeks post-intervention. RESULTS The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post-intervention, with sustained reductions in severe household food insecurity 16 weeks post-intervention (RRR 0.11, P = 0.01). No statistically significant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status post-intervention or 16 weeks post-intervention. CONCLUSIONS The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no-intervention control group.
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Buli BG, Lehtinen-Jacks S, Larm P, Nilsson KW, Hellström-Olsson C, Giannotta F. Trends in psychosomatic symptoms among adolescents and the role of lifestyle factors. BMC Public Health 2024; 24:878. [PMID: 38515098 PMCID: PMC10958834 DOI: 10.1186/s12889-024-18327-x] [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: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Adolescent mental health problems are on the rise globally, including in Sweden. One indicator of this trend is increased psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the time trends in PSS; however, the evidence base is scarce. The aim of this study was to investigate associations between time trends in PSS and lifestyle factors. METHODS The study was based on data collected from a nationally representative sample of 9,196 fifteen-year-old boys and girls in Sweden using the Health Behavior in School-aged Children (HBSC) symptom checklist. The sample comprised nearly equal proportions of girls (50.5%) and boys. The lifestyle factors examined in this study included PA, regular breakfast intake, consumption of fruits, vegetables, sweets, or soft drinks, smoking, and alcohol drunkenness. We used data from 2002 to 2018 and stratified by family affluence scale (FAS) to demonstrate how the associations varied among the FAS groups. We fitted separate regression models for the high- and low-FAS groups, where interaction terms between the year of survey and each lifestyle factor were used to estimate the level and direction of associations between the factors and trends in PSS. RESULTS There was a generally increasing trend in PSS mean scores from 2.26 in 2002 to 2.49 in 2018 (p <.001). The changes in each survey year compared to the average mean scores during the preceding years were significant in all years except 2010. Regular breakfast intake, daily fruit and vegetable consumption, and higher PA were associated with lower PSS mean scores, while smoking and drunkenness had opposite associations with PSS. The only significant interaction between survey year and the lifestyle factors was observed regarding drunkenness in the high FAS group, suggesting that the association between trends in PSS and the experience of getting drunk at least twice got stronger over time (B = 0.057; CI:0.016, 0.097; p <.01). CONCLUSIONS The results indicate increasing trends in PSS among young people in Sweden from 2002 to 2018, with a significant increase observed among adolescents in the high FAS group who reported getting drunk on at least two occasions.
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Affiliation(s)
- Benti Geleta Buli
- Department of Public Health Sciences, Mälardalen University, 721 23, Västerås, Box 883, Sweden.
| | - Susanna Lehtinen-Jacks
- Department of Public Health Sciences, Mälardalen University, 721 23, Västerås, Box 883, Sweden
| | - Peter Larm
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Kent W Nilsson
- Department of Public Health Sciences, Mälardalen University, 721 23, Västerås, Box 883, Sweden
- Center for Clinical Research, Uppsala University, Västmanland County Hospital, Uppsala, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Fabrizia Giannotta
- Department of Public Health Sciences, Mälardalen University, 721 23, Västerås, Box 883, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Turin, Turin, Italy
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Meulman I, Uiters E, Cloin M, Polder J, Stadhouders N. Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage. BMJ Open 2024; 14:e080559. [PMID: 38503421 PMCID: PMC10952876 DOI: 10.1136/bmjopen-2023-080559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU). DESIGN Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance. DATA SOURCES Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022. ELIGIBILITY CRITERIA Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC. DATA EXTRACTION AND SYNTHESIS Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy's ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU. RESULTS Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU. CONCLUSIONS SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored.
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Affiliation(s)
- Iris Meulman
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ellen Uiters
- Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariëlle Cloin
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Johan Polder
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Niek Stadhouders
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Link BG, García SJ, Firat R, La Scalla S, Phelan JC. Socioeconomic-Status-Based Disrespect, Discrimination, Exclusion, and Shaming: A Potential Source of Health Inequalities? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241232658. [PMID: 38491866 DOI: 10.1177/00221465241232658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.
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Dally D, Amith M, Mauldin RL, Thomas L, Dang Y, Tao C. A Semantic Approach to Describe Social and Economic Characteristics That Impact Health Outcomes (Social Determinants of Health): Ontology Development Study. Online J Public Health Inform 2024; 16:e52845. [PMID: 38477963 PMCID: PMC10973958 DOI: 10.2196/52845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Social determinants of health (SDoH) have been described by the World Health Organization as the conditions in which individuals are born, live, work, and age. These conditions can be grouped into 3 interrelated levels known as macrolevel (societal), mesolevel (community), and microlevel (individual) determinants. The scope of SDoH expands beyond the biomedical level, and there remains a need to connect other areas such as economics, public policy, and social factors. OBJECTIVE Providing a computable artifact that can link health data to concepts involving the different levels of determinants may improve our understanding of the impact SDoH have on human populations. Modeling SDoH may help to reduce existing gaps in the literature through explicit links between the determinants and biological factors. This in turn can allow researchers and clinicians to make better sense of data and discover new knowledge through the use of semantic links. METHODS An experimental ontology was developed to represent knowledge of the social and economic characteristics of SDoH. Information from 27 literature sources was analyzed to gather concepts and encoded using Web Ontology Language, version 2 (OWL2) and Protégé. Four evaluators independently reviewed the ontology axioms using natural language translation. The analyses from the evaluations and selected terminologies from the Basic Formal Ontology were used to create a revised ontology with a broad spectrum of knowledge concepts ranging from the macrolevel to the microlevel determinants. RESULTS The literature search identified several topics of discussion for each determinant level. Publications for the macrolevel determinants centered around health policy, income inequality, welfare, and the environment. Articles relating to the mesolevel determinants discussed work, work conditions, psychosocial factors, socioeconomic position, outcomes, food, poverty, housing, and crime. Finally, sources found for the microlevel determinants examined gender, ethnicity, race, and behavior. Concepts were gathered from the literature and used to produce an ontology consisting of 383 classes, 109 object properties, and 748 logical axioms. A reasoning test revealed no inconsistent axioms. CONCLUSIONS This ontology models heterogeneous social and economic concepts to represent aspects of SDoH. The scope of SDoH is expansive, and although the ontology is broad, it is still in its early stages. To our current understanding, this ontology represents the first attempt to concentrate on knowledge concepts that are currently not covered by existing ontologies. Future direction will include further expanding the ontology to link with other biomedical ontologies, including alignment for granular semantics.
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Affiliation(s)
- Daniela Dally
- The University of Texas Health Science Center at Houston School of Public Health, The Brownsville Region, Brownsville, TX, United States
| | - Muhammad Amith
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, United States
- Department of Internal Medicine, University of Texas Medical Branch, Galveton, TX, United States
| | - Rebecca L Mauldin
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Latisha Thomas
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Yifang Dang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States
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22
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Radó MK, Kisfalusi D, Laverty AA, van Lenthe FJ, Been JV, Takács K. Socio-economic inequalities in smoking and drinking in adolescence: Assessment of social network dynamics. Addiction 2024; 119:488-498. [PMID: 37994195 DOI: 10.1111/add.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/04/2023] [Indexed: 11/24/2023]
Abstract
AIMS We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups. DESIGN This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves. SETTING Eight Hungarian secondary schools with socio-economically diverse classes took part. PARTICIPANTS This study comprised 232 adolescents aged between 14 and 15 years in the first wave. MEASUREMENTS Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit. FINDINGS Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES. CONCLUSIONS Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.
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Affiliation(s)
- Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden
- Division of Neonatology, Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Dorottya Kisfalusi
- HUN-REN Centre for Social Sciences, Computational Social Science-Research Center for Educational and Network Studies (CSS - RECENS), Budapest, Hungary
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Károly Takács
- Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden
- HUN-REN Centre for Social Sciences, Computational Social Science-Research Center for Educational and Network Studies (CSS - RECENS), Budapest, Hungary
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23
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Zhao SS, Rogers K, Kearsley-Fleet L, Watson K, Bosworth A, Galloway J, Verstappen S, Plant D, Barton A, Hyrich KL, Humphreys JH. Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis. Rheumatology (Oxford) 2024; 63:648-656. [PMID: 37267152 PMCID: PMC10907806 DOI: 10.1093/rheumatology/kead261] [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: 03/09/2023] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To investigate the association between socioeconomic deprivation and outcomes following TNF inhibitor (TNFi) treatment. METHODS Individuals commencing their first TNFi in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA) and Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS) cohort were included. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation and categorized as 20% most deprived, middle 40% or 40% least deprived. DAS28-derived outcomes at 6 months (BSRBR-RA) and 3 months (BRAGGSS) were compared using regression models with the least deprived as referent. Risks of all-cause and cause-specific drug discontinuation were compared using Cox models in the BSRBR-RA. Additional analyses adjusted for lifestyle factors (e.g. smoking, BMI) as potential mediators. RESULTS 16 085 individuals in the BSRBR-RA were included (mean age 56 years, 76% female), of whom 18%, 41% and 41% were in the most, middle and least deprived groups, respectively. Of 3459 included in BRAGGSS (mean age 57, 77% female), proportions were 22%, 36% and 41%, respectively. The most deprived group had 0.3-unit higher 6-month DAS28 (95% CI 0.22, 0.37) and were less likely to achieve low disease activity (odds ratio [OR] 0.76; 95% CI 0.68, 0.84) in unadjusted models. Results were similar for 3-month DAS28 (β = 0.23; 95% CI 0.11, 0.36) and low disease activity (OR 0.77; 95% CI 0.63, 0.94). The most deprived were more likely to discontinue treatment (hazard ratio 1.18; 95% CI 1.12, 1.25), driven by ineffectiveness rather than adverse events. Adjusted estimates were generally attenuated. CONCLUSION Socioeconomic deprivation is associated with reduced response to TNFi. Improvements in determinants of health other than lifestyle factors are needed to address socioeconomic inequities.
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Affiliation(s)
- Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kira Rogers
- Manchester Medical School, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kath Watson
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ailsa Bosworth
- National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK
| | - James Galloway
- Centre of Rheumatic Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Darren Plant
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jenny H Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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24
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Bernini S, Conti S, Perdixi E, Jesuthasan N, Costa A, Severgnini M, Ramusino MC, Prinelli F. Investigating the individual and joint effects of socioeconomic status and lifestyle factors on mild cognitive impairment in older Italians living independently in the community: results from the NutBrain study. J Nutr Health Aging 2024; 28:100040. [PMID: 38280834 DOI: 10.1016/j.jnha.2024.100040] [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: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Despite extensive research, a clear understanding of the role of the interaction between lifestyle and socioeconomic status (SES) on cognitive health is still lacking. We investigated the joint association of socioeconomic factors in early to midlife and lifestyle in later life and Mild Cognitive Impairment (MCI). DESIGN Observational cross-sectional study. SETTING NutBrain study in northern Italy. PARTICIPANTS 773 community-dwelling adults aged 65 years and older (73.2 ± 6.0 SD, 58.6% females) participating in the NutBrain study (2019-2023). MEASUREMENTS Three SES indicators (home ownership, educational level, occupation) and five lifestyle factors (adherence to Mediterranean diet, physical activity, smoking habits, social network, leisure activities) were selected. Each factor was scored and summed to calculate SES and healthy lifestyle scores; their joint effect was also examined. The association with MCI was assessed by logistic regression controlling for potential confounders. Sex-stratified analysis was performed. RESULTS In total, 24% of the subjects had MCI. The multivariable logistic model showed that a high SES and a high lifestyle score were associated with 81.8% (OR0.182; 95%CI 0.095-0.351), and 44.1% (OR0.559; 95%CI 0.323-0.968) lower odds of having MCI, respectively. When examining the joint effect of SES and lifestyle factors, the cognitive benefits of a healthy lifestyle were most pronounced in participants with low SES. A healthier lifestyle score was found to be significantly associated with lower odds of MCI, only in females. CONCLUSIONS According to our findings, SES was positively associated with preserved cognitive function, highlighting the importance of active lifestyles in reducing socioeconomic health inequalities, particularly among those with a relatively low SES. TRIAL REGISTRATION Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).
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Affiliation(s)
- Sara Bernini
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Silvia Conti
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Elena Perdixi
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Department of Neurology, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Alfredo Costa
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Marco Severgnini
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Matteo Cotta Ramusino
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Federica Prinelli
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy.
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25
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Duarte Junior MA, Pintos Carrillo S, Martínez-Gómez D, Sotos Prieto M, Rodríguez-Artalejo F, Cabanas Sánchez V. Lifestyle behaviors, social and economic disadvantages, and all-cause and cardiovascular mortality: results from the US National Health Interview Survey. Front Public Health 2024; 12:1297060. [PMID: 38481841 PMCID: PMC10933051 DOI: 10.3389/fpubh.2024.1297060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 05/03/2024] Open
Abstract
Aim To examine the independent relationships of lifestyle and social and economic factors with all-cause and cardiovascular disease (CVD) mortality in a large representative sample of the US adult population. Furthermore, the association between the combination of lifestyle and social and economic factors with mortality was analyzed in detail. Methods The sample included 103,314 participants with valid records and eligible for mortality follow-up, and information on lifestyle factors and social and economic disadvantages (NHIS waves 2000, 2005, 2010, and 2015). An unhealthy lifestyle score was constructed using information on physical activity, alcohol consumption, diet, and smoking status. Social and economic disadvantages were assessed using information on education, receipt of dividends, employment, family's home, and access to private health. Information on mortality data was determined by the National Death Index records. Results Compared with favorable lifestyle, unfavorable lifestyle was associated with higher all-cause (HR 2.07; 95% CI 1.97-2.19) and CVD (HR 1.84; 95% CI 1.68-2.02) mortality. Higher social and economic disadvantages were also associated with higher all-cause (HR 2.44; 95% CI 2.30-2.59) and CVD mortality (HR 2.44; 95% CI 2.16-2.77), compared to low social and economic disadvantages. In joint associations, participants in the high social and economic disadvantage and unfavorable lifestyle showed a greater risk of all-cause (HR 4.06; 95% CI 3.69-4.47) and CVD mortality (HR 3.98; 95% CI 3.31-4.79). Conclusion Lifestyle and social and economic disadvantages are associated with all-cause and CVD mortality. The risk of mortality increases as the number of social and economic disadvantages and unhealthy lifestyles increases.
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Affiliation(s)
- Miguel Angelo Duarte Junior
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Salud Pintos Carrillo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Sotos Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Verónica Cabanas Sánchez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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26
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Li Y, Tang Y, Lu J, Wu H, Ren L. The dilution effect of healthy lifestyles on the risk of cognitive function attributed to socioeconomic status among Chinese older adults: A national wide prospective cohort study. J Glob Health 2024; 14:04010. [PMID: 38304974 PMCID: PMC10835516 DOI: 10.7189/jogh-14-04010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background Lower socioeconomic status (SES) is a risk factor for poor cognitive function, while a healthy lifestyle is associated with better cognitive function. We examined the complex relationship between SES and a healthy lifestyle and cognitive function among older Chinese adults. Methods We used a national prospective cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008-18, aged 65 years and older with normal cognition at baseline. Participants were categorised into the favourable group if they had four to six healthy lifestyle factors and the unfavourable group for zero to three factors. SES was classified as higher and lower by assessing the socioeconomic vulnerability index (SEVI) with six components. Cognitive function was measured using the Mini-Mental State Examination (MMSE) scores and the standardised Z-scores. We applied the linear mixed effects and time-dependent Cox regression models to explore associations and further stratified the analysis by healthy lifestyles. Results A total of 6851 participants were included (the mean age was 80.87, 43.44% had a favourable lifestyle, and 49.29% had higher SES). Over the 10-year follow-up period, SES status and lifestyle profiles significantly affected the decline in the standardised Z-scores (P < 0.05). The higher SES group with favourable lifestyles exhibited a slower cognitive decline than those with lower SES (by 0.031 points per year, P < 0.05). The association was not observed in those in the unfavourable group (0.010 points per year, P > 0.05). During a follow-up, 25.06% of participants developed cognitive impairment (MMSE<18). We also observed a significant interaction between SES and healthy lifestyles (P < 0.05), with the corresponding associations of SES being more pronounced among participants with unfavourable lifestyles (hazard ratio (HR) = 0.821; 95% confidence interval (CI) = 0.701-0.960) than those with favourable lifestyles (HR = 1.006; 95% CI = 0.844-1.200). Conclusions A healthy lifestyle may attenuate the adverse impacts of lower SES on cognitive function among older adults. This study might provide important information for protecting cognitive function, especially in low- and middle-income countries.
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Affiliation(s)
- Yao Li
- Clinical Centre for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital, Shanghai Sunshine Rehabilitation Centre, School of Medicine, Tongji University, Shanghai, China
| | - Yuhong Tang
- Clinical Centre for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital, Shanghai Sunshine Rehabilitation Centre, School of Medicine, Tongji University, Shanghai, China
| | - Jiaping Lu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hengjing Wu
- Clinical Centre for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital, Shanghai Sunshine Rehabilitation Centre, School of Medicine, Tongji University, Shanghai, China
| | - Longbing Ren
- China Centre for Health Developments, Peking University, Beijing, China
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27
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Chen G, Olsen JA, Lamu AN. The influence of parents' and partner's education on own health behaviours. Soc Sci Med 2024; 343:116581. [PMID: 38242029 DOI: 10.1016/j.socscimed.2024.116581] [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: 07/18/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
The link between educational attainment and multiple health behaviours has been explained in various ways. This paper provides new insights into the social patterning in health behaviours by investigating the influence of parents' and partners' educational attainments on a composite indicator that integrates the four commonly studied lifestyle behaviours (smoking, alcohol, physical activity and BMI). Two key outcome indicators of interests were created to reflect both ends of the "healthy - unhealthy spectrum". Data was drawn from The Tromsø Study, conducted in 2015/16 (N = 21,083, aged 40-93 years). We controlled for two indicators of early life human capital and one personality trait variable. Partners' education attainments are relatively more important for avoiding unhealthy behaviour than choosing healthy behaviour; on the contrary, parents' education is more important for healthy behaviour. Heterogeneity by sex and age was also evident. The influences of partner's education on widening the socioeconomic contrasts in health behaviours were much stronger in the younger (40-59 years) age group. In conclusion, our results support the hypothesis that own health behaviour is affected by the educational attainments of our 'nearest and dearest' (i.e. spouse, mother, and father), net of own education. This study facilitates a better understanding of education-health behaviours nexus from a life course perspective and supports the importance of family-based interventions to improve healthy behaviours.
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Affiliation(s)
- Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Jan Abel Olsen
- Centre for Health Economics, Monash University, Melbourne, Australia; Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway; Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Admassu N Lamu
- Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway; NORCE - Norwegian Research Centre, Bergen, Norway
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28
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Neufcourt L, Castagné R, Wilsgaard T, Grimsgaard S, Chadeau-Hyam M, Vuckovic D, Ugarteche-Perez A, Farbu EH, Sandanger TM, Delpierre C, Kelly-Irving M. Educational patterning in biological health seven years apart: Findings from the Tromsø Study. Psychoneuroendocrinology 2024; 160:106670. [PMID: 37992555 DOI: 10.1016/j.psyneuen.2023.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (βlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and βlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (βlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.
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Affiliation(s)
- Lola Neufcourt
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Raphaële Castagné
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ainhoa Ugarteche-Perez
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erlend Hoftun Farbu
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cyrille Delpierre
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
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29
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Gharacheh L, Amini-Rarani M, Torabipour A, Karimi S. A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus. Int J Prev Med 2024; 15:5. [PMID: 38487697 PMCID: PMC10935579 DOI: 10.4103/ijpvm.ijpvm_374_22] [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: 11/12/2022] [Accepted: 05/17/2023] [Indexed: 03/17/2024] Open
Abstract
Background As socioeconomic inequalities are key factors in access and utilization of type 2 diabetes (T2D) services, the purpose of this scoping review was to identify solutions for decreasing socioeconomic inequalities in T2D. Methods A scoping review of scientific articles from 2000 and later was conducted using PubMed, Web of Science (WOS), Scopus, Embase, and ProQuest databases. Using the Arksey and O'Malley framework for scoping review, articles were extracted, meticulously read, and thematically analyzed. Results A total of 7204 articles were identified from the reviewed databases. After removing duplicate and nonrelevant articles, 117 articles were finally included and analyzed. A number of solutions and passways were extracted from the final articles. Solutions for decreasing socioeconomic inequalities in T2D were categorized into 12 main solutions and 63 passways. Conclusions Applying identified solutions in diabetes policies and interventions would be recommended for decreasing socioeconomic inequalities in T2D. Also, the passways could be addressed as entry points to help better implementation of diabetic policies.
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Affiliation(s)
- Laleh Gharacheh
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Amini-Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Torabipour
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Karimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Damen MAW, Detaille SI, Engels JA, De Lange AH. Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:116. [PMID: 38276810 PMCID: PMC10815228 DOI: 10.3390/ijerph21010116] [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: 11/22/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.
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Affiliation(s)
- Marc A. W. Damen
- Faculty of Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Sarah I. Detaille
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Josephine A. Engels
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Annet H. De Lange
- Faculty of Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Faculty of Social Sciences, Hotel School of Management, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Department of Psychology, Campus de A Coruña, Universidade da Coruña, 15701 A Coruña, Spain
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Ku B, Ghim S. Poor Physical Health in Caregivers of Children with ADHD or ASD and its Association with Health Risk Behaviours: NHIS 2016-2018. Int J Behav Med 2024:10.1007/s12529-023-10253-3. [PMID: 38172453 DOI: 10.1007/s12529-023-10253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is a dearth of evidence regarding physical health problems and health risk behaviours (e.g., drinking, physical inactivity, smoking, and suboptimal sleep behaviour) in caregivers of children with attention deficit hyperactivity disorder or autism spectrum disorder (CCAA). The purposes of the current study were to examine differences in physical health problems between CCAA and caregivers of children without attention deficit hyperactivity disorder and autism spectrum disorder (CCWAA) and to explore health risk behaviours associated with those problems. METHOD Data from the 2016-2018 National Health Interview Survey were used in the current study. 10 common physical health problems were compared between CCAA and CCWAA by using multivariable logistic regressions. In addition, in order to detect associated health risk behaviours, decision tree analysis was performed for physical health problems in CCAA. RESULTS Of the 10 physical health problems, caregivers of children with ADHD showed significantly higher likelihood of experiencing nine (arthritis, asthma, back pain, high cholesterol, diabetes, heart problems, hypertension, neck pain, obesity), compared to CCWAA. Caregivers of children with autism spectrum disorder (ASD) showed significantly higher likelihoods of experiencing two physical health problems compared to CCWAA. The decision tree analysis revealed that age (> 42 years), and suboptimal sleep behaviour (not 7-8 hours), and smoking (current smoker) were the frequent predictors for physical health problems in CCAA. CONCLUSION The results of the current study represent an important milestone in further investigating physical health problems in CCAA.
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Affiliation(s)
- Byungmo Ku
- Department of Special Physical Education, Sports Sciecne Buliding 8405, 134 Yongindaehak-ro, Samga-dong, Cheoin-gu, Yongin-si, Gyeonggi-do, South Korea
| | - Seungbeen Ghim
- Health Management and Policy, College of Health, Oregon State University, 97333, Corvallis, OR, USA.
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Hussein T, Cartright N, Kirschner J, Nadarasa A, Rathbone AP, Lindsey L. Social prescribing in pharmacies: What is it, does it work and what does it mean for Canadian pharmacies? Can Pharm J (Ott) 2024; 157:21-24. [PMID: 38125632 PMCID: PMC10729721 DOI: 10.1177/17151635231216119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - Nia Cartright
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle, United Kingdom
| | - Jenny Kirschner
- PALS (Pharmacy Addressing Loneliness and Social isolation), Melbourne, Australia
| | - Arun Nadarasa
- International Social Prescribing Pharmacy Association, Kingsbury, United Kingdom
| | - Adam Pattison Rathbone
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle, United Kingdom
| | - Laura Lindsey
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle, United Kingdom
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Colillas-Malet E, Bosque-Prous M, Esquius L, González-Casals H, Lafon-Guasch A, Fortes-Muñoz P, Espelt A, Aguilar-Martínez A. Relationship between Diet Quality and Socioeconomic and Health-Related Factors in Adolescents by Gender. Nutrients 2023; 16:139. [PMID: 38201968 PMCID: PMC10780370 DOI: 10.3390/nu16010139] [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: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Adolescence is a key period for consolidating heathy lifestyles and proper eating habits that can last into adulthood. To analyze the diet quality of Spanish adolescents and its association with socioeconomic factors and health behaviors by gender, a cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviors, and associated determinants, collected in secondary education centers. The study population consisted of 7319 students aged 12 to 18 years. Data were collected from October 2019 to March 2020. The dependent variable was diet quality score according to the Spanish adaptation of the Healthy Eating Index (S-HEI). The independent variables included were socioeconomic factors and health behaviors. We conducted linear regression separately by gender. Diet quality score was significantly higher for girls than for boys (68 and 65, respectively, p < 0.001). For both genders, poorer diet quality was associated with a low level of physical activity [-0.9 (95% CI = -1.6:-0.2) in boys, -1.2 (95% CI = -1.9:-0.4) in girls], alcohol use [-2.5 (95% CI = -3.7:-1.3) in boys, -1.0 (95% CI = -1.9:0.0) in girls], poor self-perceived health [-1.1 (95% CI = -2.4:0.2) in boys, -3.5 (95% CI = -4.6:-2.4) in girls], and having attended Intermediate Level Training Cycles [-2.9 (95% CI = -4.3:-1.5) in boys, -1.9 (95% CI = -3.5:-0.3) in girls]. In girls, poorer diet quality also was associated with low mood [-1.1 (95% CI = -1.9:-0.3)]. The variance was 9% in boys and 12% in girls. Our results highlight the need to consider socioeconomic and health-related factors, as well as gender, when conducting interventions to promote healthy eating among adolescents.
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Affiliation(s)
- Ester Colillas-Malet
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (H.G.-C.); (A.L.-G.); (A.E.)
| | - Marina Bosque-Prous
- Epi4health Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain; (M.B.-P.); (P.F.-M.)
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), C/de Ca n’Altayó s/n, 08193 Bellaterra, Spain
| | - Laura Esquius
- Epi4health Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain; (M.B.-P.); (P.F.-M.)
| | - Helena González-Casals
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (H.G.-C.); (A.L.-G.); (A.E.)
- Centre d’Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT), 08916 Badalona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Aina Lafon-Guasch
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (H.G.-C.); (A.L.-G.); (A.E.)
- Epi4health Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain; (M.B.-P.); (P.F.-M.)
| | - Paula Fortes-Muñoz
- Epi4health Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain; (M.B.-P.); (P.F.-M.)
| | - Albert Espelt
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (H.G.-C.); (A.L.-G.); (A.E.)
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), C/de Ca n’Altayó s/n, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), C/Monforte de Lemos 3 Pabellón 11, 28029 Madrid, Spain
| | - Alicia Aguilar-Martínez
- Foodlab Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain;
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Jensen HAR, Møller SR, Christensen AI, Davidsen M, Juel K, Petersen CB. Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths. J Epidemiol Community Health 2023; 78:18-24. [PMID: 37451846 PMCID: PMC10715496 DOI: 10.1136/jech-2023-220599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years. METHODS Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated. RESULTS Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality. CONCLUSION Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.
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Affiliation(s)
| | - Sofie Rossen Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Ibarra-Sanchez AS, Abelsen B, Chen G, Wisløff T. Educational patterns of health behaviors and body mass index: A longitudinal multiple correspondence analysis of a middle-aged general population, 2007-2016. PLoS One 2023; 18:e0295302. [PMID: 38039296 PMCID: PMC10691680 DOI: 10.1371/journal.pone.0295302] [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: 08/14/2022] [Accepted: 11/10/2023] [Indexed: 12/03/2023] Open
Abstract
Social differences in body mass index and health behaviors are a major public health challenge. The uneven distribution of unhealthy body mass index and of unhealthy behaviors such as smoking, physical inactivity, and harmful alcohol consumption has been shown to mediate social inequalities in chronic diseases. While differential exposures to these health variables have been investigated, the extent to which they vary over the lifetime in the same population and their relationship with level of education is not well understood. This study examines patterns of body mass index and multiple health behaviors (smoking, physical activity and alcohol consumption), and investigates their association with education level among adults living in Northern Norway. It presents findings from a longitudinal multiple correspondence analysis of the Tromsø Study. Longitudinal data from 8,906 adults aged 32-87 in 2007-2008, with repeated measurements in 2015-2016 were retrieved from the survey's sixth and seventh waves. The findings suggest that most in the study population remained in the same categories of body mass index and the three health behaviors at the follow-up, with a clear educational gradient in healthy patterns. That is, both healthy changes and maintained healthy categories were associated with the highest education levels. Estimating differential exposures to mediators of health inequalities could benefit policy priority setting for tackling inequalities in health.
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Affiliation(s)
| | - Birgit Abelsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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de Boer WI, Mierau JO, Koning RH. Do differences in sport participation contribute to socioeconomic health inequalities? Evidence from the Lifelines cohort study on all-cause mortality, diabetes and obesity. Prev Med Rep 2023; 36:102479. [PMID: 37965127 PMCID: PMC10641690 DOI: 10.1016/j.pmedr.2023.102479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Little is known about the role of sport participation in socioeconomic health inequalities. We studied the association between different aspects of sport participation with all-cause mortality, type 2 diabetes mellitus (T2DM) and obesity, including inequalities between socioeconomic subpopulations. Using the Dutch Lifelines cohort study (n = 84,230), we assessed the associations of sport participation, as well as the amount, intensity, type and number of sports, with all-cause mortality, T2DM and obesity in individuals. We studied the effect of sport participation on health outcomes within and between educational categories. Outcomes were compared with moderate to vigorous physical activity (MVPA). Sport participation was significantly associated with lower mortality (HR = 0.81), T2DM (HR = 0.70), and obesity (HR = 0.77). No significant additional effects of the amount or intensity of sport participation were found, while participating in teams sport was associated with significantly lower mortality (HR = 0.53) compared with other types of sport. These effects were similar among educational categories. Sport participation explained between 11% (T2DM and obesity) and 22% (mortality) of health inequalities between educational categories. This was more than twice the effect size of MVPA. The sensitivity analysis with net income as the socioeconomic indicator showed similar results. Our results suggest that to reduce socioeconomic differences in health, public health policies should focus on increasing sport participation in groups with a low socioeconomic status, rather than increasing the amount or intensity of sport participation, or MVPA in general.
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Affiliation(s)
- Willem I.J. de Boer
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
- School of Sport and Exercise, HAN University of Applied Sciences, Heyendaalseweg 141, 6525 AJ Nijmegen, the Netherlands
| | - Jochen O. Mierau
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
- Aletta Jacobs School of Public Health, Postbus 716, 9700 AS Groningen, the Netherlands
| | - Ruud H. Koning
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
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Berg L, Landberg J, Thern E. Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all-cause mortality: Results from the Stockholm Public Health Cohort. Drug Alcohol Rev 2023; 42:1850-1859. [PMID: 37830637 DOI: 10.1111/dar.13759] [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: 04/09/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The social gradient in consumption behaviours has been suggested to partly explain health inequalities. The majority of previous studies have only included baseline measurements and not considered potential changes in behaviours over time. The study aimed to investigate the contribution of alcohol consumption and smoking to the social gradient in mortality and to assess whether the use of repeated measurements results in larger attenuations of the main association compared to using single baseline assessments. METHODS Longitudinal survey data from the population-based Stockholm Public Health Cohort from 2006 to 2014 was linked to register data on mortality until 2018 for 13,688 individuals and analysed through Cox regression. RESULTS Low socioeconomic position (SEP) was associated with increased mortality compared with high SEP; hazard ratios 1.56 (95% CI 1.30-1.88) for occupational status and 1.77 (95% CI 1.49-2.11) for education, after adjustment for demographic characteristics. Using repeated measurements, alcohol consumption and smoking explained 44% of the association between occupational status and all-cause mortality. Comparing repeated and baseline measures, the percentage attenuation due to alcohol consumption increased from 11% to 18%, whereas it remained similar for smoking (25-23%). DISCUSSION AND CONCLUSIONS Smoking and alcohol consumption explained a large part of the association between SEP and mortality. Comparing results from time-fixed and time-varying models, there was an increase in overall percentage attenuation that was mainly due to the increased proportion explained by alcohol consumption. Repeated measurements provide a better estimation of the contribution of alcohol consumption, but not smoking, for the association between SEP and mortality.
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Affiliation(s)
- Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Emelie Thern
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Witrick B, Dotson TS, Annie F, Kimble W, Kemper E, Hendricks B. Poverty and population health - The need for A Paradigm shift to capture the working poor and better inform public health planning. Soc Sci Med 2023; 336:116249. [PMID: 37742541 DOI: 10.1016/j.socscimed.2023.116249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Community-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations. METHODS Data were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses. FINDINGS County-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor. INTERPRETATIONS Findings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.
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Affiliation(s)
- Brian Witrick
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA.
| | - Timothy S Dotson
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA
| | - Frank Annie
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA; Charleston Area Medical Center, PO Box 1547 Charleston WV 25301, USA
| | - Wesley Kimble
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA
| | - Emily Kemper
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA
| | - Brian Hendricks
- West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA; West Virginia University, Department of Epidemiology and Biostatistics, 64 Medical Center Dr, Morgantown WV 26506, USA
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Haghish EF, Obaidi M, Strømme T, Bjørgo T, Grønnerød C. Mental Health, Well-Being, and Adolescent Extremism: A Machine Learning Study on Risk and Protective Factors. Res Child Adolesc Psychopathol 2023; 51:1699-1714. [PMID: 37535227 PMCID: PMC10627959 DOI: 10.1007/s10802-023-01105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
We examined the relationship between adolescents' extremist attitudes with a multitude of mental health, well-being, psycho-social, environmental, and lifestyle variables, using state-of-the-art machine learning procedure and nationally representative survey dataset of Norwegian adolescents (N = 11,397). Three key research questions were addressed: 1) can adolescents with extremist attitudes be distinguished from those without, using psycho-socio-environmental survey items, 2) what are the most important predictors of adolescents' extremist attitudes, and 3) whether the identified predictors correspond to specific latent factorial structures? Of the total sample, 17.6% showed elevated levels of extremist attitudes. The prevalence was significantly higher among boys and younger adolescents than girls and older adolescents, respectively. The machine learning model reached an AUC of 76.7%, with an equal sensitivity and specificity of 70.5% in the test dataset, demonstrating a satisfactory performance for the model. Items reflecting on positive parenting, quality of relationships with parents and peers, externalizing behavior, and well-being emerged as significant predictors of extremism. Exploratory factor analysis partially supported the suggested latent clusters. Out of the 550 psycho-socio-environmental variables analyzed, behavioral problems, individual and social well-being, along with basic needs such as a secure family environment and interpersonal relationships with parents and peers emerged as significant factors contributing to susceptibility to extremism among adolescents.
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Affiliation(s)
- E F Haghish
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Milan Obaidi
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychology, Copenhagen University, Copenhagen, Denmark
| | - Thea Strømme
- Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway
| | - Tore Bjørgo
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Cato Grønnerød
- Department of Psychology, University of Oslo, Oslo, Norway
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Olsen JA, Chen G, Lamu AN. The relative importance of education and health behaviour for health and wellbeing. BMC Public Health 2023; 23:1981. [PMID: 37821861 PMCID: PMC10568892 DOI: 10.1186/s12889-023-16943-7] [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: 04/13/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Indicators of socioeconomic position (SEP) and health behaviours (HB) are widely used predictors of health variations. Their relative importance is hard to establish, because HB takes a mediating role in the link between SEP and health. We aim to provide new knowledge on how SEP and HB are related to health and wellbeing. METHODS The analysis considered 14,713 Norwegians aged 40-63. Separate regressions were performed using two outcomes for health-related quality of life (EQ-5D-5 L; EQ-VAS), and one for subjective wellbeing (Satisfaction with Life Scale). As predictors, we used educational attainment and a composite measure of HB - both categorized into four levels. We adjusted for differences in childhood financial circumstances, sex and age. We estimated the percentage share of each predictor in total explained variation, and the relative contributions of HB in the education-health association. RESULTS The reference case model, excluding HB, suggests consistent stepwise education gradients in health-related quality of life. The gap between the lowest and highest education was 0.042 on the EQ-5D-5 L, and 0.062 on the EQ-VAS. When including HB, the education effects were much attenuated, making HB take the lion share of the explained health variance. HB contributes 29% of the education-health gradient when health is measured by EQ-5D-5 L, and 40% when measured by EQ-VAS. For subjective wellbeing, we observed a strong HB-gradient, but no education gradient. CONCLUSION In the institutional context of a rich egalitarian country, variations in health and wellbeing are to a larger extent explained by health behaviours than educational attainment.
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Affiliation(s)
- Jan Abel Olsen
- Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway.
- Centre for Health Economics, Monash University, Melbourne, Australia.
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
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Gireesh A, Sacker A, McMunn A, Cadar D. Role of inflammation in the socioeconomic inequalities of neurocognitive disorders. Brain Behav Immun 2023; 113:203-211. [PMID: 37494983 DOI: 10.1016/j.bbi.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Socioeconomic position has been shown to be associated with inflammation. However, little is known about the role of inflammation in socioeconomic inequalities in relation to neurocognitive disorders in later life and the potential underlying inflammatory mechanisms. This study has used longitudinal data to investigate the mediation effects of inflammation in the relationship between socioeconomic position and neurocognitive disorders in older adults. METHODS Using data from the English Longitudinal Study of Ageing (ELSA, n = 4,815), we ascertained neurocognitive disorders using a recognised consensus criterion and included the following categories: (1) No Cognitive Impairment (NOCI) (2) Cognitive Impairment No Dementia (CIND) and (3) Dementia. We examined whether socioeconomic position (education, occupation, and wealth) measured in 2008/09 was associated with neurocognitive disorders measured in 2018/19. Mediation analyses were carried out to investigate the role of inflammatory markers [C-Reactive Protein (CRP), plasma fibrinogen and white blood cells (WBC)] in the association between socioeconomic inequalities and subsequent neurocognitive disorders. Sensitivity analyses were conducted to assess the mediating role of lifestyle behaviours and body mass index (BMI). RESULTS Higher education, occupation and wealth were longitudinally associated with a lower likelihood of cognitive impairment and dementia. WBC mediated the association between latent socioeconomic position and CIND [β = -0.037 (CI: -0.06 to -0.01)], but not the association with dementia. Indirect effects were attenuated but remained significant when other mediators, such as lifestyle behaviours and BMI were considered. In a separate analysis accounting for main confounders, CRP and fibrinogen mediated the association between education and CIND, all three inflammatory biomarkers mediated the association of occupation and CIND, while WBC mediated the association between wealth and CIND. CONCLUSION These findings emphasise that socioeconomic inequalities in mid and later life could contribute to the prevalence of neurocognitive disorders in later life. Our results provide some evidence for the biological embedding of WBC in the association between socioeconomic inequalities and cognitive impairment via elevated inflammation. Future studies should explore other plausible biological mechanisms.
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Affiliation(s)
- Aswathikutty Gireesh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom; Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom.
| | - Amanda Sacker
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom.
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom.
| | - Dorina Cadar
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom; Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre, BN1 9RY, United Kingdom; Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
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Guo C, Liu Z, Fan H, Wang H, Zhang X, Fan C, Li Y, Han X, Zhang T. Associations of healthy lifestyle and three latent socioeconomic status patterns with physical multimorbidity among middle-aged and older adults in China. Prev Med 2023; 175:107693. [PMID: 37660757 DOI: 10.1016/j.ypmed.2023.107693] [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: 05/31/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Multimorbidity is an emerging global public health concern. However, complex associations of healthy lifestyle and socioeconomic status (SES) with multimorbidity have not been identified. METHODS This population-based prospective cohort study used data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) to explore these relationships. Physical multimorbidity was measured using 12 non-communicable diseases. Latent class analysis (LCA) was conducted to determine the optimal SES patterns based on annual per-capita household expenditure, occupation, education level, and health insurance. The healthy lifestyle score (0-5) was constructed comprising information on smoking, drinking, physical activity, sleep, and body shape. RESULTS Of 17,708 participants in the CHARLS, 7776 were eligible for inclusion in our analysis (13.3% with high SES, 26.1% with medium SES, and 60.6% with low SES). Compared with high SES participants, those with low SES had higher risks of incident physical multimorbidity (OR 1.22, 95% CI 1.05, 1.42), which was competitively mediated by lifestyle (mediation proportion, -10.17%, 95% CI -19.12%, -1.23%). Significant interactions were observed between lifestyle factors and SES in patients with incident diabetes. Participants with low SES and no or one healthy lifestyle factor had a higher risk of incident physical multimorbidity than those with high SES and four to five healthy lifestyle factors (OR 2.19, 95% CI 1.57, 3.04). CONCLUSION Healthy lifestyles competitively mediate a fractional proportion of socioeconomic inequity in incident physical multimorbidity. Furthermore, healthy lifestyles were associated with lower multimorbidity risk in the SES subgroups, supporting the important role of lifestyle in reducing physical multimorbidity burden.
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Affiliation(s)
- Chengnan Guo
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Hong Fan
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Haili Wang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Changjia Fan
- School of Public Health, Fudan University, Shanghai, China
| | - Yi Li
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Xinyu Han
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China.
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Harkko J, Pietiläinen O, Jousilahti P, Rahkonen O, Kouvonen A, Lallukka T. Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland. BMC Geriatr 2023; 23:570. [PMID: 37723432 PMCID: PMC10506324 DOI: 10.1186/s12877-023-04272-8] [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: 07/03/2022] [Accepted: 09/01/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. METHODS We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. RESULTS Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory. CONCLUSIONS Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Tea Lallukka
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Siegrist J, Goldberg M, Zins M, Wahrendorf M. Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study. Occup Environ Med 2023; 80:507-513. [PMID: 37369582 DOI: 10.1136/oemed-2022-108794] [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: 12/22/2022] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Studies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP. METHODS We used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30-70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort-reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale. RESULTS SEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort-reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found. CONCLUSIONS Disadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.
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Affiliation(s)
- Johannes Siegrist
- Centre for Health and Society, Institute of Medical Sociology, Professor Emeritus, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, UVSQ, UMS 011, Paris, France
| | - Marie Zins
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, UVSQ, UMS 011, Paris, France
| | - Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Kyprianidou M, Panagiotakos D, Makris KC, Kambanaros M, Christophi CA, Giannakou K. Prevalence and sociodemographic determinants of selected noncommunicable diseases among the general population of Cyprus: A large population-based cross-sectional study. Chronic Dis Transl Med 2023; 9:222-237. [PMID: 37711870 PMCID: PMC10497820 DOI: 10.1002/cdt3.70] [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: 12/17/2022] [Revised: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 09/16/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide. The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs. Methods A cross-sectional study was conducted using stratified sampling. Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire. The diseases were classified using the 10th revision of the International Classification of Diseases (ICD-10). Results In total, 1140 individuals participated in the study, among whom 590 (51.7%) had at least one chronic disease. The most prevalent NCDs were hyperlipidemia (17.4%), hypertension (12.9%), and thyroid diseases (8.4%). We identified more males than females with hyperlipidemia aged 25-44 years old and >65 years old (p = 0.024), more males compared to females with hypertension (p = 0.001) and more females compared to males with thyroid diseases (p < 0.001). Individuals with hypertension and hyperlipidemia were more likely to be married, to have completed a higher education, and to have a high annual income. Discussion In Cyprus, the majority of the general population had at least one NCD. Hyperlipidemia, hypertension, and thyroid disease are relatively common, even at younger ages, highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.
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Affiliation(s)
- Maria Kyprianidou
- Department of Health Sciences, School of SciencesEuropean University CyprusNicosiaCyprus
- Cyprus International Institute for Environmental and Public HealthCyprus University of TechnologyLimassolCyprus
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and EducationHarokopio UniversityAthensGreece
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public HealthCyprus University of TechnologyLimassolCyprus
| | - Maria Kambanaros
- Department of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Costas A. Christophi
- Cyprus International Institute for Environmental and Public HealthCyprus University of TechnologyLimassolCyprus
| | - Konstantinos Giannakou
- Department of Health Sciences, School of SciencesEuropean University CyprusNicosiaCyprus
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Mäki P, Levälahti E, Lehtinen-Jacks S, Laatikainen T. Overweight and Obesity in Finnish Children by Parents' Socioeconomic Position-A Registry-Based Study. Int J Public Health 2023; 68:1605901. [PMID: 37719660 PMCID: PMC10502218 DOI: 10.3389/ijph.2023.1605901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives: To examine associations between parents' socioeconomic position (SEP) and child overweight and obesity, using registry data. Methods: Data (final n = 194,423) on children's height, weight and parents' SEP were drawn from the national Register of Primary Health Care Visits (Avohilmo) and Statistics Finland. Risk ratios for bernoulli-distributed overweight (RROW) and obesity (RROB) according to SEP were estimated using generalized linear models and using a log -link. Results: The risk for obesity was lower in boys from high-income families (RROB 0.76), for overweight and obesity was lower in boys (RROW 0.72, RROB 0.58) and girls (RROW 0.72, RROB 0.54) with highly educated fathers, in boys (RROW 0.79, RROB 0.58) and girls (RROW 0.78, RROB 0.56) with high-educated mothers and in boys (RROW 0.85, RROB 0.77) and girls (RROW 0.80, RROB 0.69) living in urban areas, as compared to low-income families, low-educated parents, and rural residence, respectively. Conclusion: The risk of overweight and obesity was increased in children with low SEP or rural residence. Administrative registers are a valid approach to monitor childhood obesity by parents' SEP.
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Affiliation(s)
- Päivi Mäki
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Esko Levälahti
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Susanna Lehtinen-Jacks
- The Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Tiina Laatikainen
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Wills TA, Kaholokula JK, Pokhrel P, Pagano I. Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples. PLoS One 2023; 18:e0290794. [PMID: 37624834 PMCID: PMC10456168 DOI: 10.1371/journal.pone.0290794] [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: 03/31/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes. METHODS We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates. RESULTS Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey. CONCLUSIONS Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.
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Affiliation(s)
- Thomas A. Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
| | - Joseph Keawe’aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Pallav Pokhrel
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
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Ibarra-Sanchez AS, Chen G, Wisløff T. Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway. Front Public Health 2023; 11:1190087. [PMID: 37674677 PMCID: PMC10477439 DOI: 10.3389/fpubh.2023.1190087] [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: 03/20/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Methods Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Results Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Conclusion Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.
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Affiliation(s)
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Gavurova B, Kelemen M, Polishchuk V, Mudarri T, Smolanka V. A fuzzy decision support model for the evaluation and selection of healthcare projects in the framework of competition. Front Public Health 2023; 11:1222125. [PMID: 37614458 PMCID: PMC10442559 DOI: 10.3389/fpubh.2023.1222125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023] Open
Abstract
Our research aims to support decision-making regarding the financing of healthcare projects by structural funds with policies targeting reduction of the development gap among different regions and countries of the European Union as well as the achievement of economic and social cohesion. A fuzzy decision support model for the evaluation and selection of healthcare projects should rank the project applications for the selected region, accounting for the investor's wishes in the form of a regional coefficient in order to reduce the development gap between regions. On the one hand, our proposed model evaluates project applications based on selected criteria, which may be structured, weakly structured, or unstructured. On the other hand, it also incorporates information on the level of healthcare development in the region. The obtained ranking increases the degree of validity of the decision regarding the selection of projects for financing by investors, considering the level of development of the region where the project will be implemented. At the expense of European Union (EU) structural funds, a village, city, region, or state can receive funds for modernization and development of the healthcare sector and all related processes. To minimize risks, it is necessary to implement adequate support systems for decision-making in the assessment of project applications, as well as regional policy in the region where the project will be implemented. The primary goal of this study was to develop a complex fuzzy decision support model for the evaluation and selection of projects in the field of healthcare with the aim of reducing the development gap between regions. Based on the above description, we formed the following scientific hypothesis for this research: if the project selected for financing can successfully achieve its stated goals and increase the level of development of its region, it should be evaluated positively. This evaluation can be obtained using a complex fuzzy model constructed to account for the region's level of development in terms of the availability and quality of healthcare services in the region where the project will be implemented.
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Affiliation(s)
- Beata Gavurova
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Prague, Czechia
| | - Miroslav Kelemen
- Department of Flight Training, Faculty of Aeronautics, Technical University of Košice, Košice, Slovakia
| | - Volodymyr Polishchuk
- Department of Software Systems, Faculty of Information Technology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Tawfik Mudarri
- Technical University of Košice, Faculty of Mining, Ecology, Process Control and Geotechnologies, Košice, Slovakia
| | - Volodymyr Smolanka
- Department of Neurology, Neurosurgery and Psychiatry, Faculty of Medicine, Uzhhorod National University, Uzhhorod, Ukraine
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50
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Ogunlayi F, Coleman PC, Fat LN, Mindell JS, Oyebode O. Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019. BMC Public Health 2023; 23:1442. [PMID: 37501159 PMCID: PMC10375601 DOI: 10.1186/s12889-023-16275-6] [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: 09/26/2022] [Accepted: 07/09/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Previous studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003-19. METHODS This time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity. FINDINGS Prevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period. INTERPRETATION Inequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.
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Affiliation(s)
- Fatai Ogunlayi
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK.
| | - Paul C Coleman
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK
- Centre for Food Policy, City University of London, London, EC1V 0HB, UK
| | - Linda Ng Fat
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jennifer S Mindell
- Health and Social Surveys Group, Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Oyinlola Oyebode
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK
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