Building an inter-disciplinary science of health inequalities: the example of lifecourse research

Diabetes, life course and childhood socioeconomic conditions: an empirical assessment for Mexico

BACKGROUND

Demographic and epidemiological dynamics characterized by lower fertility rates and longer life expectancy, as well as higher prevalence of non-communicable diseases such as diabetes, represent important challenges for policy makers around the World. We investigate the risk factors that influence the diagnosis of diabetes in the Mexican population aged 50 years and over, including childhood poverty.

RESULTS

This work employs a probabilistic regression model with information from the Mexican Health and Aging Study (MHAS) of 2012 and 2018. Our results are consistent with the existing literature and should raise strong concerns. The findings suggest that risk factors that favor the diagnosis of diabetes in adulthood are: age, family antecedents of diabetes, obesity, and socioeconomic conditions during both adulthood and childhood.

CONCLUSIONS

Poverty conditions before the age 10, with inter-temporal poverty implications, are associated with a higher probability of being diagnosed with diabetes when older and pose extraordinary policy challenges.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

[Life course epidemiology in migrant health research]

From free choice to forced flight, there are many reasons for migration. Accordingly, the backgrounds and living conditions of migrating people are also diverse. The different associated exposures affect the health of migrants and their children. To capture such a complex phenomenon, an approach is required that takes specific living conditions during the life course of migrants into account.An established methodological approach that can accomplish this is life course epidemiology. When applied to migrating populations, it examines exposures before, during, and after migration. In epidemiological research on the health of migrant populations, it is desirable to consider all three phases. This is countered by the fact that reliable data on the entire life course is not always available.A valid, timely collection and data protection-compliant linkage of longitudinal data from different sources can improve life course-related research on the health of migrants in Germany. In the future, corresponding data should also be included from the countries of origin of migrants.

Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models

BACKGROUND

The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels.

METHODS

Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness.

RESULTS

At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings.

LIMITATIONS

Loss to follow-up may affect the generalizability of the research findings.

CONCLUSIONS

This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.

'Known to be unhealthy': Exploring how social epidemiological research constructs the category of low socioeconomic status

We examine how the category of low socioeconomic status (LSES) was constructed in European social epidemiological research and policy advice from 1977 to 2019. We analysed 22 empirical social epidemiological research publications on LSES and health, as well as six scientific advisory reports that offered government officials an overview of scientific evidence on health inequalities. We show the construction and reification of LSES as a problematic group in dominant thought, which consists of the following components: 1) the proliferation of SES concepts, indicators and groups labelled LSES; 2) generalisation through which LSES is constructed as a single population; 3) problematisation through which LSES is constructed as an inherently unhealthy population; and 4) individualisation by which a LSES personality is presented as an explanation of health differences. We also show how this knowledge is extrapolated into the policy domain in the form of scientific advisory reports. These findings provide evidence of the construction of LSES as an inherently unhealthy population through hyperproliferation and references to the objectivity of scientific research. With respect to the LSES category, the dynamics of research and policy resemble those regarding categories of ethnicity and gender. We conclude that if the construction of LSES remains unquestioned, social epidemiology might continue to (re)produce what it examines: LSES populations 'known to be unhealthy'.

Childhood Socioeconomic Status Does Not Predict Late-Life Cognitive Decline in the 1936 Lothian Birth Cohort

This study examined childhood socioeconomic status (SES) as a predictor of later life cognitive decline. Data came from 519 participants in the Lothian Birth Cohort 1936 (LBC1936) study. SES measures at 11 years of age included parental educational attainment, father's occupational status, household characteristics and a composite measure of global childhood SES (i.e., a total of low SES childhood indicators). Cognitive abilities were assessed by the Mini-Mental State Exam at ages 69.8, 72.8 and 76.7 years. Most indicators of low childhood SES (i.e., father manual worker, less than secondary school father education, household overcrowding, exterior located toilet, and global childhood SES) did not predict cognitive decline between the ages of 69.8 and 76.7. Participants with less educated mothers showed an increase in cognitive decline (β = -0.132, p = 0.048, and CI = -0.80, -0.00). The relationship between maternal educational attainment and cognitive decline became non-significant when controlling for adult SES (i.e., participant educational attainment and occupation). Adult SES did not mediate the latter relationship. This study provides new evidence that childhood SES alone is not strongly associated with cognitive decline. New knowledge is critical to improving population health by identifying life span stages in which interventions might be effective in preventing cognitive decline.

The Effect of Childhood Socioeconomic Position and Social Mobility on Cognitive Function and Change Among Older Adults: A Comparison Between the United States and England

OBJECTIVES

This study aims to examine the relationship between childhood socioeconomic position (SEP) and cognitive function in later life within nationally representative samples of older adults in the United States and England, investigate whether these effects are mediated by later-life SEP, and determine whether social mobility from childhood to adulthood affects cognitive function and decline.

METHOD

Using data from the Health and Retirement Study (HRS) and the English Longitudinal Survey of Ageing (ELSA), we examined the relationships between measures of SEP, cognitive performance and decline using individual growth curve models.

RESULTS

High childhood SEP was associated with higher cognitive performance at baseline in both cohorts and did not affect the rate of decline. This benefit dissipated after adjusting for education and adult wealth in the United States. Respondents with low childhood SEP, above median education, and high adult SEP had better cognitive performance at baseline than respondents with a similar childhood background and less upward mobility in both countries.

DISCUSSION

These findings emphasize the impact of childhood SEP on cognitive trajectories among older adults. Upward mobility may partially compensate for disadvantage early in life but does not protect against cognitive decline.

Economic Evaluation of Emotional and Personal Support in the Health Care of Women with Disabilities

It is generally accepted that people with disabilities make greater use of health services. Moreover, certain social circumstances alter the intensity of such use. This manuscript seeks to analyze the existing differences in the use of healthcare among women with and without disabilities, to study the impact of emotional and personal support (EPS) on such use and to assess the reduction of the economic cost that this factor entails. Data from the Spanish National Health Survey (SNHS-2017) and updated unit costs of health services have been used to estimate the differences in use attributable to disability and the economic impact of emotional and personal support. The empirical results show an association between disability and perceived EPS, the latter being less common among Spanish women with disabilities. In addition, within this group, EPS significantly influences the levels of use of health services. Finally, the net effect of a perceived EPS increase would translate into a reduction in the economic costs of health care for women with disabilities.

Girls' transition to adulthood and their later life socioeconomic attainment: Findings from the English longitudinal study of ageing

Transitions to adulthood represent a sensitive period for setting young people into particular life course trajectories, and the nature of these transitions have varied more for girls, historically, than for boys. We aim to investigate the long-term significance of different transitions out of full-time education for socioeconomic attainment in later life amongst postwar young women in England. Our data are from the English Longitudinal Study of Ageing for girls born during World War II and the post-war period (1939-1952, n = 1798). Using sequence analysis, we identified six types of transition out of full-time education between ages 14 and 26: Early-Work, Mid-Work, Late-Work, Early-Domestic, Late-Domestic, and Part-time Mixed. We used linear and multinomial regression models to examine associations between transition types and socioeconomic attainment outcomes from age 50, including individual income, household income and wealth, and occupational class. Our study found that later transitions into employment (Mid-Work and Late-Work) were associated with higher socioeconomic attainment after age 50 compared with women who made early transitions from education to employment (Early-Work); much of the advantage of making later transitions to employment was due to higher educational attainment. We also found that early transitions to domestic work (Early-Domestic) set young women onto trajectories of lower socioeconomic attainment than compared with those who made early transitions to employment, suggesting the nature of the transition from full-time education is as important as the timing, perhaps uniquely for women. A pathway of cumulative advantage/disadvantage is also evident in our study; results suggest a partial mediating role for educational attainment in associations between childhood social class and later life socioeconomic attainment.

Social Care Insurance: A Review of Psychological Influences on Uptake

There is not currently a developed market for long-term social care insurance in England. Policymakers are interested in what behavioral influences should be considered in the design of insurance products for long-term social care to increase uptake. This review describes the behavioral factors that might be barriers or facilitators of uptake and could be considered in future policy solutions. Behavioral factors include psychological capabilities (knowledge and understanding), which are important given that public knowledge on this topic is poor. Psychological motivations (reflective or automatic biases) may also influence consumers' decision-making. Cultural factors such as language barriers and family norms for caring are considered. Overall, the authors demonstrate processes by which the uptake of long-term social care insurance can be encouraged, pertinent to policymakers.

A Cross-Sectional Study of 0.6 Million Children with Attention-Deficit/Hyperactivity Disorder in the United States

Attention-deficit hyperactivity disorder (ADHD) is an increasingly recognized chronic neurodevelopmental disorder. This work aims at studying the prevalence and clinical characteristics of children with ADHD in the United States in the period between 2009 and 2018. Data from the National Health Interview Survey were analyzed by univariate and multivariate statistics to assess the role of socioeconomic factors in the development of ADHD. It has been studied 615,608 children, 51.2% male and 48.7% female. The prevalence of ADHD was 9.13%, with males predominating over females. The number of children with ADHD increased from 2009 to 2018 by 14.8%. As specified by multiple logistic regression analysis, males (odds ratio [OR] 2.38) who have neither mother nor father (OR 1.76) are twice as likely to have ADHD compared with their peers. In addition, family income (OR 1.40) and parent's education (OR 1.12) were significantly associated with ADHD. It has been highlighted the significance of deprivation of both family and financial comfort as primary indicators for ADHD in children. Moreover, children with ADHD were more likely to be males in the age group of 12 to 17.

[The study of health in men from a gender perspective: where we come from, where are we going]

Comprehensive and in-depth analyses of differences and inequalities in health require a broad-based approach to the study of masculinities and men's health. Interest in this issue has grown in parallel to increased concern over specific risks and vulnerabilities faced by men, but also due to the need to involve them in programs capable of promoting progress towards gender-based health equity. This article attempts to reframe these issues from the perspective of public health, providing a wider viewpoint on men's health situated within debates on the social determinants of health and the analysis of health inequalities. Based on a relational gender approach, we formulate some recommendations regarding policy and research agendas, which we argue can contribute to advancing the study and development of programs from a gender-based perspective in health.

Exploring the role of early-life circumstances, abilities and achievements on well-being at age 50 years: evidence from the 1958 British birth cohort study

OBJECTIVES

We aim to examine the relative contributions of pathways from middle childhood/adolescence to mid-life well-being, health and cognition, in the context of family socio-economic status (SES) at birth, educational achievement and early-adulthood SES. Our approach is largely exploratory, suspecting that the strongest mediators between childhood circumstances and mid-life physical and emotional well-being may be cognitive performance during school years, material and behavioural difficulties, and educational achievement. We also explore whether the effects of childhood circumstances on mid-life physical and emotional well-being differ between men and women.

SETTING/PARTICIPANTS

Data were from the National Child Development Study, a fully-representative British birth cohort sample of 17 415 people born in 1 week in 1958.

PRIMARY/SECONDARY OUTCOME MEASURES

Our four primary mid-life outcome measures are: cognitive performance, physical and emotional well-being and quality of life. Our intermediate adult outcomes are early-adulthood social class and educational/vocational qualifications.

RESULTS

Using structural equation modelling, we explore numerous pathways through childhood and early adulthood which are significantly linked to our outcomes. We specifically examine the mediating effects of the following: cognitive ability at ages 7, 11 and 16 years; childhood psychological issues; family material difficulties at age 7 years: housing, unemployment, finance; educational/vocational qualifications and social class position at age 42 years.We find that social class at birth has a strong indirect effect on the age 50 outcomes via its influence on cognitive performance in childhood and adolescence, educational attainment and mid-life social class position, together with small direct effects on qualifications and social class position at age 42 years. Teenage cognitive performance has a strong positive effect on later physical health for women, while educational/vocational qualifications have a stronger positive effect on emotional well-being for men.

CONCLUSION

Our findings provide an understanding of the legacy of early life on multiple aspects of mid-life health, well-being, cognition and quality of life, showing stronger mediated links for men from childhood social class position to early adult social class position. The observed effect of qualifications supports those arguing that education is positively associated with subsequent cognitive functioning.

Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment

BACKGROUND

Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood.

METHODS

A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches.

FINDINGS

The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future.

CONCLUSIONS

Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.

Risk work or resilience work? A qualitative study with community health workers negotiating the tensions between biomedical and community-based forms of health promotion in the United Kingdom

Emplaced health promotion interventions, delivered by community health workers are increasingly being used internationally. However, the application of epidemiological risk knowledge to individuals within such communities is not straightforward and creates tensions for community health workers who are part of the communities that they are serving. Situated qualitative interview data were co-produced with community health workers employed in a superdiverse, deprived, post-industrial region of the United Kingdom, using photo-voice methods, to develop an account of how they made sense of the challenges of their work. The analysis draws on and develops theories of risk work and resilience work, which draw on practice theory. The key findings were that, first, being a critical insider enabled community health workers to make sense of the diverse constraints on health and lifestyles within their community. Second, they understood their own public health role as limited by operating within this context, so they articulated their occupational identity as focused on supporting clients to make small but sustainable changes to their own and their families’ lifestyles. Third, the uncertainties of translating population based risk information to individual clients were (at least partially) resolved at an embodied level, with the community health workers identifying as accessible and trusted role models for the value of changed lifestyles. The article is important for policy and practice as it provides a critique of a rapidly evolving new mode of delivery of public health services, and insights on the development of this new public health workforce.

More than a snapshot in time: pathways of disadvantage over childhood

Background

Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child's development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development.

Methods

Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10-11 years.

Results

We found four distinct trajectories of children's exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the 'most disadvantaged' trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity.

Conclusions

Children's overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.

Socioeconomic Disadvantage across the Life Course Is Associated with Diet Quality in Young Adulthood

Socioeconomic position (SEP) is a key determinant of diet quality across the life course. Young adulthood is a unique period of transition where dietary inequities between groups with lower and higher SEP may widen. This study investigated associations between SEP in both childhood and young adulthood and diet quality in young adulthood. Data from 1949 Canadian young adults aged 18⁻30 who participated in the Canada Food Study were analyzed. Healthy Eating Index⁻2015 (HEI-2015) scores were calculated based on one 24-hour dietary recall. Childhood and young adult SEP were represented by self-report of participants' parent(s)' and their own highest educational level, respectively. Linear regression was used to examine associations between childhood and adult SEP and adult HEI-2015 score. Mediation analyses examined whether adult SEP mediated the relationship between childhood SEP and adult HEI-2015 score. Lower SEPs in childhood and adulthood were each associated with lower HEI-2015 scores in young adulthood. Adult SEP mediated up to 13.0% of the association between childhood SEP and adult HEI-2015 scores. Study findings provide support for key life course hypotheses and suggest latent, pathway, and cumulative effects of SEP across the early life course in shaping the socioeconomic patterning of diet quality in young adulthood.

A Longitudinal Analysis of the Intergenerational Transmission of Health Inequality

Objectives

Empirical investigations of cumulative dis/advantage typically treat health inequality as an intraindividual process rooted in early-life conditions and operating within the span of the individual life course, while literature on processes of intergenerational transmission has historically focused on socioeconomic mobility, largely overlooking health. The current study examines the persistence of work disability across generations and multiple explanations for this relationship, including the role of early-life disadvantage, childhood health, educational attainment, and social mobility.

Methods

We model latent classes of midlife work disability characterized by timing and stability using longitudinal data from the intergenerational component of the U.S. Panel Study of Income Dynamics (N = 3,328). Latent class analysis captures the initial risk of experiencing a work disability and how this risk changes across mid-life as a function of early-life conditions, childhood health, educational attainment, mobility, and parent's work disability.

Results

Early disadvantage, childhood health, and educational attainment were associated with patterns of midlife work disability, and although upward mobility provided some protection, intergenerational continuity in health remained net of all of these factors.

Discussion

Findings support the importance of looking beyond the individual life course to the transmission of health inequality across generations within families.

Association of socioeconomic status and health-related behavior with elderly health in China

Previous health studies have focused on the correlation between socioeconomic status (SES) and health. We pooled data from the Chinese Longitudinal Healthy Longevity Survey (N = 9765) conducted in 2011, and examined the association of SES and health-related behavior with elderly health in China. The cumulative health disadvantage of the elderly caused by SES can be relieved by lifelong health-related behavior. In the same SES, the odds of self-rated health (SRH) as “good,” mini-mental state examination (MMSE) as “not impaired,” and activities of daily living (ADLs) as “not impaired” among the elderly who exercised regularly, were 46.9%, 28.6%, and 62.3% lower for the elderly who rarely exercised. The elderly who started doing regular exercise from 30 years old, achieved higher SRH, ADL, and MMSE scores to some extent. The health improvement advantage for the elderly who started doing regular exercises after 60 years old, was reduced. However, the odds of SRH as “good,” MMSE as “not impaired,” and ADLs as “not impaired” were still 3.4%, 12.5%, and 17.8%, respectively, higher than the respondents who never exercised. The health-related behaviors not only promote elderly health improvement, but its duration has also been found to be associated with the extent of health improvement.

'Buying Salad Is a Lot More Expensive than Going to McDonalds': Young Adults' Views about What Influences Their Food Choices

Young adults (18⁻30 years of age) are an 'at-risk' group for poor dietary behaviours and less healthy food choices. Previous research with young adults has looked at the barriers and enablers driving their food choices, focusing primarily on university and college students. However, there is less research using qualitative methods with young adults as a broader population group. This study aimed to explore the experiences of young adults in two different yet similar settings: Sydney, Australia and Glasgow, Scotland. Eight focus groups of young adult participants, ranging in size from 2⁻6 participants, were held in Sydney, Australia (n = 14) and Glasgow, Scotland (n = 16) to discuss, explore and compare the determinants and influences of their food choices. Focus group transcripts were coded thematically based on a process of narrative analysis. Three major narratives were identified across both locations: value of food; appeal of food; and emotional connections with food. These narratives were underpinned by a broader narrative of 'performing adulthood.' This narrative reflected a belief amongst participants that they should make rational, informed choices about food despite this conflicting with their broader food environment. Future research could examine which environment-level or policy-based interventions are most acceptable to young adults in terms of influencing their food choices and dietary behaviours.

Socioeconomic position and sedentary behavior in Brazilian adolescents: A life-course approach

Socioeconomic position (SEP) is a potential correlate of sedentary behavior in adolescents. The aim of this study was to examine the associations between SEP and self-reported and objective measures of sedentary behavior in adolescents, using a life-course approach. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N=5249). Cross-sectional and longitudinal associations between multiple SEP indicators (maternal education, family income, SEP composite, cumulative family income) at birth, 11, 15 and 18years, and five sedentary behavior outcomes (≥4h/day screen time; ≥4h/day TV; ≥2h/day computer; ≥2h/day video game; ≥12.7h/day objectively measured sedentary time) at 11, 15 and 18years, were examined. In cross-sectional analyses, higher SEP was positively associated with more screen time at ages 11 and 15years. There was a consistent and positive association between higher SEP with time spent using a computer, and with sedentary time assessed through accelerometry. SEP at birth had a positive and direct effect on screen, computer and total sedentary time at 18years. Participants in the highest cumulative income group had higher odds of high sedentary behavior in screen (OR: 2.40; 95% CI: 1.50-3.54), computer (OR: 7.35; 95% CI: 4.19-12.89) and total sedentary time (OR: 5.40; 95% CI: 3.53-10.35), respectively, compared with their counterparts with lower cumulative income. Our findings showed that SEP is an early determinant of sedentary behavior in adolescents.

Beyond Disaster Preparedness: Building a Resilience-Oriented Workforce for the Future

Enhancing citizens' and communities' resilience is critical to adapt successfully to ongoing challenges faced by communities, as well as acute shocks resulting from disasters. While significant progress has been made in this area, several research and practice gaps remain. A crucial next step to advance resilience is the development of a resilience-oriented workforce. This narrative review examines existing literature to determine key components of a resilience-oriented workforce, with a focus on organizational structures, training and education, and leadership models. Reviewed articles spanned a variety of study types, including needs assessments of existing workforce, program evaluations, and reviews/commentaries. A resilience-oriented workforce spans many disciplines and training programs will need to reflect that. It requires a collaborative organizational model that promotes information sharing structures. Leadership models should foster a balance between workforce autonomy and operation as a collective entity. Optimal strategies to develop a resilience-oriented workforce have yet to be realized and future research will need to collect and synthesize data to promote and evaluate the growth of this field.

Transitioning From Successful Aging: A Life Course Approach

Objective: The life course perspective and representative U.S. data are used to test Rowe and Kahn’s Successful Aging (SA) conceptualization. Four sets of influences (childhood experiences, social structural factors, adult attainments, and later life behaviors) on SA transitions are examined to determine the relative role of structural factors and individual behaviors in SA. Method: Eight waves of Health and Retirement Study data for 12,108 respondents, 51 years and older, are used in logistic regression models predicting transitions out of SA status. Results: Social structural factors and childhood experiences had a persistent influence on transitions from SA, even after accounting for adult attainments and later life behaviors—both of which also impact SA outcomes. Discussion: The findings on sustained social structural influences call into question claims regarding the modifiability of SA outcomes originally made in presentation of the SA model. Implications for policy and the focus and timing of intervention are considered.

Qualitative Research Methods to Advance Research on Health Inequities Among Previously Incarcerated Women Living With HIV in Alabama

Justice-involved HIV-positive women have poor health outcomes that constitute health inequities. Researchers have yet to embrace the range of qualitative methods to elucidate how psychosocial histories are connected to pathways of vulnerability to HIV and incarceration for this key population. We used life course narratives and intersubjectivity-predicated on interview dialogue-to investigate how familial and social settings established their social patterning of HIV, incarceration risk, and poor health. Working with two Alabama community-based organizations, we recruited and interviewed 24 HIV-positive cisgender women with cyclical incarceration. We analyzed the data by charting women's life histories and conducting iterative content analyses. Participants described chaotic home environments, marked by exposure to trauma in childhood. The majority experienced repeated sexual and physical abuse that went undiagnosed and untreated until adulthood. Adolescence and young adulthood were characterized by onset of substance use, violent intimate partnerships, and subsequent behavioral and mental health problems. In adulthood, risk behaviors persisted for decades and women lacked mental health treatment and social support. Life course narratives and intersubjectivity contributed to knowledge by affording agency to marginalized participants to reflect on and narrate their life stories; instilling needed trust for researchers to investigate the complex risk pathways and psychosocial histories with this population; illuminating the nature, timing, sequence, and frequency of events underlying women's vulnerability and exposure to HIV and incarceration; and clarifying that early shaping events in childhood are connected to later risk environments and behaviors in adolescence and adulthood, suggesting the need for earlier interventions than are typically proposed.

Intergenerational social mobility and subjective wellbeing in later life

Whereas a great deal of literature has been devoted to investigating the link between intergenerational social mobility and health, the few studies that have examined the association between social mobility and life satisfaction have produced conflicting findings. In the present study, we attempt to rectify several shortcomings common to previous work by examining the association between intergenerational social mobility and both life satisfaction and self-rated health as measured in later-life. Our sample consisted of individuals born in Scotland in 1936, who took part in the Scottish Mental Survey 1947 and were subsequently followed-up into later-life. Regression analyses demonstrated that satisfaction with life at age 78 was not significantly predicted by childhood or adulthood socioeconomic status, or by the amount of social mobility experienced from parental occupational social class. In contrast, self-rated health at age 78 was significantly predicted by adult socioeconomic status and by education, but not by social mobility from parental occupational social class. These results suggest that efforts to promote upwards social mobility may not result in better subjective wellbeing, despite the apparent benefits for health.

Southern Women at Risk: Narratives of Familial and Social HIV Risk in Justice-Involved U.S. Women in Alabama

Justice-involved HIV-positive women, particularly those in the U.S. South, are a hidden, understudied population. Little work has explored their psychosocial histories in relation to their HIV risk. We conducted a content analysis of their life history narratives from childhood to present, via in-depth interviews with 24 such women in 2 Alabama cities. Findings included the following: (a) In childhood/adolescence, consistent HIV risk factors were present, beginning with early sexual abuse and induction into alcohol/substance use; (b) By early adulthood, HIV and incarceration risks were compounded in social settings, through cyclical substance use, revictimization, and reoffending;

[Social inequality and health: Status and prospects of socio-epidemiological research in Germany]

Social differences in morbidity and mortality have always been a central topic in public health research. In recent years, there has been a growing research interest that has clearly resonated with the general public and the political arena as well. This article describes the development and establishment of social epidemiology in Germany and presents the current status of research. In addition, it describes different models for explaining health inequalities. On this basis, selected challenges and prospects of socio-epidemiological research are demonstrated. The reason why the analysis of social differences in morbidity and mortality will continue to be a key task of public health research in the national and international context in the future is also explained.

Life Course Pathways of Economic Hardship and Mobility and Midlife Trajectories of Health

We utilize over 40 years of prospective data from the Panel Study of Income Dynamics (N = 1,229) and repeated-measures latent class analysis to examine how long-term patterns of stability and change in economic hardship from childhood to adulthood are related to subsequent trajectories of midlife health. We review conceptual and methodological approaches to examining health inequality across the life course and highlight the contribution of a person-centered, disaggregated approach to modeling health and its association with long-term pathways of economic resources, including changing resources associated with mobility. Findings suggest those who experienced early mobility out of economic hardship were less likely than those in persistent economic hardship to experience a high-risk health trajectory, while experiencing later mobility did not lessen this risk. We conclude with a call for further investigation into the role of social mobility and the timing, degree, and direction of change in investigations of health inequality.

Ehnicity and Health Disparities Among the Elderly in Taiwan

Two measures of health, an index of functional and disability status and global selfrated health, and their transitions over a seven-year period were compared across two ethnic groups of elders in Taiwan: Mainlanders and Taiwanese. This ethnic division is considered a salient dimension of social stratification, shaping the two groups of elders'pathways through life. The results showed that Taiwanese elders experience a disproportionate burden on the two measures of health in part because of their lower socioeconomic status (SES). Also, Taiwanese elders are more likely to develop adverse health transitions than their Mainlander counterparts, and variations in perceptions of chronic illnesses may exist across ethnicity. The results suggest that both ethnicity and SES play important roles in linking social status to health status among this cohort of elders. Ethnicity and SES affect health collectively, and different components of SES may not confer the same health benefits across ethnic groups.

The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review

This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.

Socioeconomic inequalities in health trajectories in Switzerland: are trajectories diverging as people age?

Do socioeconomic differences in health status increase as people age, reflecting cumulative advantage or disadvantage in health trajectories? Life course research hypothesises that cumulative advantage/disadvantage (CAD) is an important underlying social process that shape inequalities as people age. The objective of this study is to examine whether health trajectories are diverging as people age across socioeconomic positions (education, employment status and income). In a random sample of 3,665 respondents living in Switzerland (Swiss Household Panel 2004-2011), trajectories of self-rated health, body mass index, depression and medicated functioning were examined with multilevel regression models. The results showed that employment status and income were associated with diverging health trajectories among men; however, only a few associations supported the CAD hypothesis. Education was rarely associated with diverging health trajectories. In conclusion, little evidence was found to support the CAD model.

Drinking problems and mortality risk in the United States

OBJECTIVE

We examine the links between 41 problems related to alcohol consumption and the risk of death among adults in the United States.

METHOD

We use Cox proportional hazards models and data from the nationally representative prospective National Health Interview Survey-Linked Mortality Files (NHIS-LMF).

RESULTS

Drinking problems are relatively common among moderate and heavy drinkers and these problems are associated with increases in the risk of death. The strongest associations between problem drinking and mortality involved cases in which physicians, family members, or friends intervened to suggest reduced drinking. Losing one's job because of drinking problems within their lifetime (HR = 1.36, 95% confidence interval [CI]: 1.11, 1.65) was strongly linked to mortality risk. Social risks were equally or more strongly linked to mortality than physiological consequences of alcohol abuse such as lifetime reports of needing a drink to stop shaking or getting sick (HR = 1.23, 95% CI: 1.09, 1.40). Most importantly, these associations were evident despite statistical controls for alcohol consumption levels and demographic, social, economic, behavioral, health, and geographic factors.

CONCLUSIONS

Our results highlight the independent and additive effects of alcohol-related problems and alcohol consumption levels on the risk of death. We recommend that studies examining the mortality risks of alcohol consumption take into account drinking status and also specific drinking-related problems, paying particular attention to social problems related to alcohol use or abuse.

Socioeconomic Associations with ADHD: Findings from a Mediation Analysis

BACKGROUND

Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear.

AIMS

The current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK.

METHODS

Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association.

RESULTS

Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association.

CONCLUSIONS

Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.

Socioeconomic Status Across the Life Course and Cognitive Function Among Older Adults: An Examination of the Latency, Pathways, and Accumulation Hypotheses

OBJECTIVE

This study investigated the relationship between life course socioeconomic status (SES) and cognitive function among older adults in the United States over a 12-year observation period. The mediation of adult SES on the association between childhood SES and cognition was examined, along with the relationship between cumulative SES and cognition.

METHOD

Using a nationally representative sample from the Health and Retirement Study, cognitive status and change in cognition from 1998 to 2010 were examined using growth curve models.

RESULTS

The results showed that cognitive function varied within-persons and between-persons. SES disadvantage in childhood was associated with lower cognitive function at baseline. Adult SES mediated the relationship between childhood SES and cognitive function. Persons with higher cumulative SES demonstrated an advantage in cognitive function.

DISCUSSION

Childhood SES and adult SES both had relationships with cognitive status and, to a lesser degree, change in cognition in later life.

Economic hardship in childhood and adult health trajectories: An alternative approach to investigating life-course processes

In this study, we advance existing research on health as a life course process by conceptualizing and measuring both childhood disadvantage and health as dynamic processes in order to investigate the relationship between trajectories of early life socioeconomic conditions and trajectories of health in midlife. We utilize a trajectory-based analysis that takes a disaggregated, person-centered approach to understand dynamic trajectories of health as latent variables that reflect the timing, duration and change in health conditions experienced by respondents over a period of 10 years in midlife as a function of stability and change in exposure to economic hardship in early life. Results from repeated-measures latent class analysis of longitudinal data from the Panel Study of Income Dynamics indicate that economic hardship in childhood has long-term, negative consequences for health both among individuals beginning life and remaining in poverty as well as those moving into poverty. In contrast, adults with more advantaged early life experiences, or who moved out of poverty during the period of observation, were at a lower risk of experiencing health trajectories characterized by the early onset or increasing risk of disease. We argue that a person-centered, disaggregated approach to the study of the relationship between socioeconomic status and health across the life course holds potential for the study of health inequality and that a greater focus on trajectory-based analysis is needed.

Health disparities of adults with intellectual disabilities: what do we know? What do we do?

BACKGROUND

Recent attention to health of people with intellectual disabilities has used a health disparities framework. Building on historical context, the paper summarizes what is known about health disparities from reports and research and provide direction on what to do to reduce these disparities among adults with intellectual disabilities.

METHODS

The present authors examined literature from 2002 to 2011 on health disparities and people with disabilities looking for broad themes on documenting disparities and on research approaches and methods.

RESULTS

Multiple countries published reports on health of people with intellectual disabilities. Researchers summarized existing research within a health disparities framework. A number of promising methodologies are identified such as health services research, health indicators, enhanced surveillance and mixed-methods.

CONCLUSIONS

Strategies to reduce health disparities include use of data to educate decision makers, attention to social determinants and a life-course model and emphasis on leveraging inclusion in mainstream services where possible.

Trends in income-related health inequalities in self-assessed health in Korea, 1998-2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46-59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46-59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.

Factors of change and cumulative factors in self-rated health trajectories: a systematic review

In Western societies, self-rated health (SRH) inequalities have increased over the past decades. Longitudinal studies suggest that the SRH trajectories of disadvantaged populations are declining at a faster rate than those of advantaged populations, resulting in an accumulation of (dis)advantages over the life course, as postulated by the Cumulative Advantage/Disadvantage (CAD) model. The objectives of this study are to conduct a systematic review of the factors influencing SRH trajectories in the adult population and to assess to what extent the findings support the CAD model. Based on the inclusion criteria, 36 articles, using 15 nationally representative databases, were reviewed. The results show that young age, high socioeconomic position and marital transitions (entering a partnership) are advantageous factors of change in SRH trajectories. However, evidence for cumulative influences supporting the CAD model remains limited: gender, ethnicity, education and employment status are only moderately associated with growing influences over time, and the cumulative influences of income, occupation, age and marital status are weak. In conclusion, this systematic review provides consolidated evidence on the factors influencing SRH trajectories, though the inclusion of only 15 nationally representative databases may limit the generalization of the results.

Adolescents' use of alcohol, tobacco and illicit drugs in relation to prenatal alcohol exposure: modifications by gender and ethnicity

AIMS

The study aimed to investigate (a) the association between low to moderate prenatal alcohol exposure (PAE) and the use of alcohol, tobacco and illicit drugs in adolescence and (b) whether the associations are modified by gender and ethnicity.

METHODS

The subjects of the study were 5922 children and adolescents, aged from 11 to 17 years, enrolled in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (the KiGGS study). Information on PAE is based on parental self-report questionnaires. Use of alcohol, tobacco and illicit drugs was assessed through self-report questionnaires for adolescents.

RESULTS

Low to moderate PAE was associated with an increased risk of drinking alcohol (adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.34, 2.18) and also of illicit drug use (adjusted OR 1.62, 95% CI 1.23, 2.14). The associations between PAE and the use of alcohol, tobacco and illicit drugs differed according to gender and ethnicity. Gender-stratified analyses resulted in adverse effects of PAE on drinking alcohol, smoking and illicit drug use in females; however, in German males, the associations disappeared. Stronger associations between PAE and the outcome measures were found in non-Germans.

CONCLUSIONS

Our findings indicate that low to moderate levels of maternal alcohol intake during pregnancy are a risk factor for use of alcohol, tobacco and illicit drugs by the offspring, with stronger associations in females and non-Germans.

Exploring the adequacy of smoking cessation support for pregnant and postpartum women

Background

Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach.

Methods

Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming.

Results

Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues.

Conclusions

The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers’ competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.

Highlights from a workshop on opportunities for cancer prevention during preadolescence and adolescence

In an effort to explore opportunities for cancer prevention during preadolescence and adolescence, the Cancer Prevention Across the Lifespan workgroup within the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC) convened an informal panel of experts for a 2-day workshop August 9-10, 2011. In this report, we provide highlights from the workshop. A central theme of the workshop was that preadolescence and adolescence are times of unique susceptibility and vulnerability within the lifespan. Participants discussed the evidence linking exposures during adolescence (e.g., risky behaviors, chemicals, medical imaging procedures) and subsequent cancer risk during adulthood. Participants also discussed potential opportunities to intervene on risk factors for cancer at multiple levels during adolescence, the importance of more focused approaches to adequately address health disparities, and the ongoing need for transdisciplinary and translational prevention research. Future opportunities for the CDC include further leveraging surveillance data from sources such as the National Health and Nutrition Examination Survey, the Youth Risk Behavior Surveillance System, and the National Children's Study and continuing to build on collaborations with other federal agencies and with national, state, and local organizations. Many ideas and insights generated during the workshop will be put into action as CDC continues to explore opportunities for cancer prevention during youth and across the lifespan.

The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women

INTRODUCTION

Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64.

METHODS

Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles.

RESULTS

The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women.

CONCLUSIONS

This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.

Changes in family socio-economic status as predictors of self-efficacy in 13-year-old Polish adolescents

OBJECTIVES

The aim of this study is to determine the impact that raised mother's education and a relative change in family affluence might have on adolescent general self-efficacy (GSE).

METHODS

Data on 600 children born in Poland in January 1995 and their families were used. Data from early childhood and adolescence (2008) were considered and the change between these two periods was determined.

RESULTS

Family affluence increased in 37.3 % of families with mothers, who had raised their education level (12.6 % of the sample), in comparison to 26.8 % in the group with no change, p < 0.001. The average GSE scores in those groups were 73.4 and 68.1, respectively, p < 0.001. In the best linear regression model adjusted for gender, the independent predictors of GSE turned out to be mother's education change and the family's current affluence.

CONCLUSIONS

Raised mother's education level may encourage building up developmental assets in older children. Based on the structural model, where self-efficacy is the mediator of the relationship between socio-economic status change and the quality of life (KIDSCREEN-10) these results may be of importance in further research.