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Park H, Kim T, Kim J. Longitudinal pathways from adolescent depressive symptoms to cardiovascular disease risk in adulthood. Soc Sci Med 2023; 318:115657. [PMID: 36608363 DOI: 10.1016/j.socscimed.2023.115657] [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: 07/19/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
RATIONALE Despite existing literature on the impact of adolescent depressive symptoms on a variety of youth outcomes, little is known about whether and how adolescent depressive symptoms are associated with physical health in adulthood. OBJECTIVE This study aimed to investigate the longitudinal association between adolescent depressive symptoms and cardiovascular disease (CVD) risk in adulthood. An extensive list of potential mechanisms underlying this association, including health behaviors, substance use, academic effort and achievement, and school-based relationships, was also examined. METHODS Using the sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3011), this study employed sibling fixed-effects models to address unobservable family-level confounders, such as genetic factors, parental and familial characteristics, and school and neighborhood environments. RESULTS Adolescent depressive symptoms were associated with an increased risk of CVD in about 13 years later (b = 0.698). Sibling fixed-effects estimates revealed that, despite some attenuation (approximately 31%), this association is robust to adjustment for unobserved family-level heterogeneity. Substance use and academic effort/achievement explained about 35% and 16% of the association between adolescent depressive symptoms and adult CVD risk, respectively. In contrast, health behaviors and school-based relationships played little or no role in mediating the association. CONCLUSION The findings of this study suggest that policymakers and practitioners may wish to develop interventions to reduce adolescent depressive symptoms and to help adolescents with depressive symptoms avoid substance use and promote effort in school. Early interventions targeting adolescents with depressive symptoms may be a cost-effective strategy for preventing adult physical health problems.
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Affiliation(s)
- Hansol Park
- Department of Health Policy and Management, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| | - Taehoon Kim
- Department of Economics, Kyung Hee University, Seoul, South Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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Usman AC, Bulut S, Kaplan M. An investigation of family factors that predict smoking among high school adolescents. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2144507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kokaua J, Ruhe T, Bowden N, Theodore R, Jensen S, Jensen W, Sorenson D, Richards R. Parental education and hospitalisations among Pacific children: A cross-sectional study using linked administrative data in New Zealand’s Integrated Data Infrastructure. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2094967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jesse Kokaua
- Centre for Pacific Health-Va’a O Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Troy Ruhe
- Centre for Pacific Health-Va’a O Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Nicholas Bowden
- Big Data Theme, A Better Start National Science Challenge, Women and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Reremoana Theodore
- National Centre for Lifecourse Research (NCLR), University of Otago, Dunedin, New Zealand
| | | | | | - Debra Sorenson
- Pasifika Medical Association (PMA), Auckland, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health-Va’a O Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Children's education and level of health care utilization among parents: a pooled cross-sectional study from national population-based survey in India. GeroScience 2021; 43:2497-2514. [PMID: 34313941 DOI: 10.1007/s11357-021-00415-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/29/2021] [Indexed: 01/01/2023] Open
Abstract
The study of upward spill over on parents of their offspring's education is vital for understanding the family dynamics and role of adult children in the decisions of parents. Such association has widespread implication and application on ageing policies. We use pooled data from population-based cross-sectional health consumption surveys conducted by the National Sample Survey Organization in 2014 and 2018 (rounds 71 and 75, respectively) in this study. The analysis is restricted to individuals aged 60 and above, who are head of the household or their spouse and have children aged 25 years or above. The analysis is carried out for inpatient and outpatient cases separately. For inpatient analysis, the dependent variable is designed as a rank variable representing an increasing level of health care utilization. For the same partial proportional odds are calculated. For outpatient cases, the dependent variable is binary that takes the value 0 if the parents use public facilities and 1 if private facilities are used. Here, binary logistic regression is used for analysis. The odds of parents using a higher level of inpatient as well as outpatient health care are higher for those with better-educated children (inpatient: OR are 2.6 (p < 0.001, CI: 2.0-3.5); outpatient: OR are 1.5 (p < 0.001, CI: 1.1-2.2)). Education of children does influence the level of health care utilization among parents. Therefore, policy interventions can target offspring of working age group, who can assimilate information better and transfer it to their parents.
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Suh SH, Song SH, Choi HS, Kim CS, Bae EH, Ma SK, Kim SW. Parental educational status independently predicts the risk of prevalent hypertension in young adults. Sci Rep 2021; 11:3698. [PMID: 33580117 PMCID: PMC7881088 DOI: 10.1038/s41598-021-83205-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/18/2021] [Indexed: 01/13/2023] Open
Abstract
Identification of individuals at risk of hypertension development based on socio-economic status have been inconclusive, due to variable definitions of low socio-economic status. We investigated whether educational status of individuals or their parents predicts prevalent hypertension in young adult population, by analyzing data of more than 37,000 non-institutionalized subjects from Korea National Health and Nutrition Examination Survey 2008 to 2017. Although low educational status of individual subjects was robustly associated with elevation of systolic blood pressure and increased prevalence of hypertension in general population, its impact on prevalent hypertension differed across age subgroups, and was remarkably attenuated in young adults. Parental educational status was significantly associated with prevalent hypertension in young adults, but not or only marginally in elderly population. Low parental educational status was also associated with high sodium intake in young adults, irrespective of subject’s own educational status. These collectively indicate that parental educational status, rather than individual’s own educational status, better and independently predicts prevalent hypertension in young adults, and that young adults with low parental educational status are prone to intake more sodium, possibly contributing to the increased risk of hypertension development. We expect that our findings could help define young individuals at risk of high sodium intake and hypertension.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Su Hyun Song
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Maternal Education in Early Life and Risk of Metabolic Syndrome in Young Adult American Females and Males: Disentangling Life Course Processes Through Causal Models. Epidemiology 2020; 30 Suppl 2:S28-S36. [PMID: 31569150 DOI: 10.1097/ede.0000000000001068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Maternal education in a child's early life may directly affect the child's adult cardiometabolic health, but this is difficult to disentangle from biological, social, and behavioral life course processes that are associated with maternal education. These processes may also differ between males and females. METHODS Using data from the National Longitudinal Study of Adolescent to Adult Health (1995-2009) (N = 4,026 females and 3,192 males), we estimated sex-stratified associations between maternal attainment of less than high school (<HS), high school diploma (HS), or college degree (CD) at the respondent's birth and respondent's risk of metabolic syndrome (MetS); we used marginal structural models (MSM) to account for the influence of major life course risk factors, such as childhood maltreatment, adolescent overweight, adult education, household income, smoking, and physical activity, in mediating associations between maternal education and offspring MetS risk. RESULTS Each higher level of maternal education was associated with a 36% (Relative Risk = 0.64 [95% Confidence Interval (CI): 0.50-0.82]) reduced risk of MetS among females, but only 19% (RR = 0.81 [95% CI: 0.64-1.01]) reduction among males (P-value interaction < 0.05). Stronger inverse associations were also observed for waist circumference and glycated hemoglobin (HbA1c) among females compared with males (-5 cm vs. -2.4 cm and -1.5% vs. -1.0%, respectively). CONCLUSION High maternal education in early life was associated with a lower risk of MetS in young adulthood even after accounting for life course risk factors, particularly among females. Results were robust to altered model specifications.
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Chang M, Lee HY, Seo SM, Koh YS, Park HJ, Kim PJ, Seung KB. The impact of educational attainment on cardiorespiratory fitness and metabolic syndrome in Korean adults. Medicine (Baltimore) 2020; 99:e19865. [PMID: 32332649 PMCID: PMC7440071 DOI: 10.1097/md.0000000000019865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the relationship between educational attainment and cardiorespiratory fitness (CRF) as a predictor of metabolic syndrome in a Korean population.In this single-center, retrospective cross-sectional study, 988 healthy adults (601 men and 387 women) who underwent regular health check-up in Seoul St. Mary's Hospital were analyzed. Educational attainment was categorized into 3 groups according to their final grade of educational course: middle or high school (≤12 years of education), college or university (12-16 years of education), and postgraduate (≥16 years of education). CRF was assessed by cardiopulmonary exercise testing, biceps strength, hand grip strength, bioelectrical impedance analysis, and echocardiography. Metabolic syndrome was diagnosed according to the 3rd report of the National Cholesterol Education Program.Among the subjects, 357 (36.1%) had metabolic syndrome. The postgraduate group had significantly higher peak oxygen consumption (VO2), biceps strength, hand grip strength, and peak expiratory flow than other groups (all P < .001). This group showed better left ventricular diastolic function, in terms of deceleration time of mitral inflow, maximal tricuspid valve regurgitation velocity, and left atrial volume index than other groups. Peak VO2 (%) was significantly correlated with all the parameters of metabolic syndrome, including insulin resistance (r = -0.106, P = .002), waist circumference (r = -0.387, P < .001), triglyceride (r = -0.109, P = .001), high density lipoprotein-cholesterol (r = 0.219, P < .001), systolic blood pressure (r = -0.143, P < .001), and diastolic blood pressure (r = -0.177, P < .001). And Peak VO2 (%) was found to be a predictor of metabolic syndrome (adjusted β = .988, P < .001). However, the level of education was not able to predict metabolic syndrome (postgraduate group; β = .955, P = .801).Although the postgraduate group had better CRF than other groups, the educational attainment could not exclusively predict metabolic syndrome in this study. Further research is needed to reveal the socioeconomic mechanism of developing metabolic syndrome.
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Affiliation(s)
- Mineok Chang
- Division of Cardiology, Seoul National University Hospital
| | - Hea-Yeon Lee
- Health promotion center, Seoul St. Mary's Hospital
| | - Suk Min Seo
- Division of Cardiology, Eunpyeong St. Mary's Hospital
| | - Yoon-Seok Koh
- Division of Cardiology, Uijeongbu St. Mary's Hospital
| | - Hun-Jun Park
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Pum-Joon Kim
- Division of Cardiology, Eunpyeong St. Mary's Hospital
| | - Ki-Bae Seung
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
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Whitley JC, Peralta CA, Haan M, Aiello AE, Lee A, Ward J, Zeki Al Hazzouri A, Neuhaus J, Moyce S, López L. The association of parental and offspring educational attainment with systolic blood pressure, fasting blood glucose and waist circumference in Latino adults. Obes Sci Pract 2018; 4:582-590. [PMID: 30574351 PMCID: PMC6298209 DOI: 10.1002/osp4.307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of the study is to evaluate the association of intergenerational educational attainment with cardiovascular disease (CVD) risk factors among US Latinos. Methods We used cross‐sectional data from the Niños Lifestyle and Diabetes Study, an offspring cohort of middle‐aged Mexican‐Americans whose parents participated in the Sacramento Latino Study on Aging. We collected educational attainment, demographic and health behaviours and measured systolic blood pressure (SBP), fasting glucose and waist circumference. We evaluated the association of parental, offspring and a combined parent–offspring education variable with each CVD risk factor using multivariable regression. Results Higher parental education was associated only with smaller offspring waist circumference. In contrast, higher offspring education was associated with lower SBP, fasting glucose and smaller waist circumference. Adjustment for parental health behaviours modestly attenuated these offspring associations, whereas adjustment for offspring health behaviours and income attenuated the associations of offspring education with offspring SBP and fasting glucose but not smaller waist circumference, even among offspring with low parental education. Conclusions Higher offspring education is associated with lower levels of CVD risk factors in adulthood, despite intergenerational exposure to low parental education.
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Affiliation(s)
- J C Whitley
- University of California, San Francisco San Francisco CA USA
| | - C A Peralta
- University of California, San Francisco San Francisco CA USA
| | - M Haan
- University of California, San Francisco San Francisco CA USA
| | - A E Aiello
- Gillings School of Public Health University of North Carolina Chapel Hill NC USA
| | - A Lee
- University of California, San Francisco San Francisco CA USA
| | - J Ward
- Gillings School of Public Health University of North Carolina Chapel Hill NC USA
| | | | - J Neuhaus
- University of California, San Francisco San Francisco CA USA
| | - S Moyce
- College of Nursing Montana State University MT USA
| | - L López
- University of California, San Francisco San Francisco CA USA
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Mawditt C, Sacker A, Britton A, Kelly Y, Cable N. Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies. Prev Med 2018; 110:67-80. [PMID: 29428172 DOI: 10.1016/j.ypmed.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 11/18/2022]
Abstract
Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.
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Affiliation(s)
- Claire Mawditt
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Amanda Sacker
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Yvonne Kelly
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Noriko Cable
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
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Tillmann T, Vaucher J, Okbay A, Pikhart H, Peasey A, Kubinova R, Pajak A, Tamosiunas A, Malyutina S, Hartwig FP, Fischer K, Veronesi G, Palmer T, Bowden J, Davey Smith G, Bobak M, Holmes MV. Education and coronary heart disease: mendelian randomisation study. BMJ 2017; 358:j3542. [PMID: 28855160 PMCID: PMC5594424 DOI: 10.1136/bmj.j3542] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D and SSGAC), comprising 112 studies from predominantly high income countries. Findings from mendelian randomisation analyses were then compared against results from traditional observational studies (164 170 participants). Finally, genetic data from six additional consortia were analysed to investigate whether longer education can causally alter the common cardiovascular risk factors.Participants The main analysis was of 543 733 men and women (from CARDIoGRAMplusC4D and SSGAC), predominantly of European origin.Exposure A one standard deviation increase in the genetic predisposition towards higher education (3.6 years of additional schooling), measured by 162 genetic variants that have been previously associated with education.Main outcome measure Combined fatal and non-fatal coronary heart disease (63 746 events in CARDIoGRAMplusC4D).Results Genetic predisposition towards 3.6 years of additional education was associated with a one third lower risk of coronary heart disease (odds ratio 0.67, 95% confidence interval 0.59 to 0.77; P=3×10-8). This was comparable to findings from traditional observational studies (prevalence odds ratio 0.73, 0.68 to 0.78; incidence odds ratio 0.80, 0.76 to 0.83). Sensitivity analyses were consistent with a causal interpretation in which major bias from genetic pleiotropy was unlikely, although this remains an untestable possibility. Genetic predisposition towards longer education was additionally associated with less smoking, lower body mass index, and a favourable blood lipid profile.Conclusions This mendelian randomisation study found support for the hypothesis that low education is a causal risk factor in the development of coronary heart disease. Potential mechanisms could include smoking, body mass index, and blood lipids. In conjunction with the results from studies with other designs, these findings suggest that increasing education may result in substantial health benefits.
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Affiliation(s)
- Taavi Tillmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Julien Vaucher
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Aysu Okbay
- Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruzena Kubinova
- Centre for Environmental Health Monitoring, National Institute of Public Health, Prague, Czech Republic
| | - Andrzej Pajak
- Chair of Epidemiology and Population Studies, Institute of Public Health, Faculrty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sofia Malyutina
- Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, SB RAS, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - Fernando Pires Hartwig
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Tom Palmer
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Jack Bowden
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michael V Holmes
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
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Kubota Y, Heiss G, MacLehose RF, Roetker NS, Folsom AR. Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. JAMA Intern Med 2017; 177:1165-1172. [PMID: 28604921 PMCID: PMC5710437 DOI: 10.1001/jamainternmed.2017.1877] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Estimates of lifetime risk may help raise awareness of the extent to which educational inequalities are associated with risk of cardiovascular disease (CVD). OBJECTIVE To estimate lifetime risks of CVD according to categories of educational attainment. DESIGN, SETTING, AND PARTICIPANTS Participants were followed from 1987 through December 31, 2013. All CVD events (coronary heart disease, heart failure, and stroke) were confirmed by physician review and International Classification of Diseases codes. A total of 13 948 whites and African Americans who were 45 to 64 years old and free of CVD at baseline were included from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota). The data analysis was performed from June 7 to August 31, 2016. EXPOSURES Educational attainment. MAIN OUTCOMES AND MEASURES We used a life table approach to estimate lifetime risks of CVD from age 45 through 85 years according to educational attainment. We adjusted for competing risks of death from underlying causes other than CVD. RESULTS The sample of 13 948 participants was 56% female and 27% African American. During 269 210 person-years of follow-up, we documented 4512 CVD events and 2401 non-CVD deaths. Educational attainment displayed an inverse dose-response relation with cumulative risk of CVD, which became evident in middle age, with the most striking gap between those not completing vs completing high school. In men, lifetime risks of CVD were 59.0% (95% CI, 54.0%-64.1%) for grade school, 52.5% (95% CI, 47.7%-56.8%) for high school education without graduation, 50.9% (95% CI, 47.3%-53.9%) for high school graduation, 47.2% (95% CI, 41.5%-52.5%) for vocational school, 46.4% (95% CI, 42.8%-49.6%) for college with or without graduation, and 42.2% (95% CI, 36.6%-47.0%) for graduate/professional school; in women, 50.8% (95% CI, 45.7%-55.8%), 49.3% (95% CI, 45.1%-53.1%), 36.3% (95% CI, 33.4%-39.1%), 32.2% (95% CI, 26.0%-37.3%), 32.8% (95% CI, 29.1%-35.9%), and 28.0% (95% CI, 21.9%-33.3%), respectively. Educational attainment was inversely associated with CVD even within categories of family income, income change, occupation, or parental educational level. CONCLUSIONS AND RELEVANCE More than 1 in 2 individuals with less than high school education had a lifetime CVD event. Educational attainment was inversely associated with the lifetime risk of CVD, regardless of other important socioeconomic characteristics. Our findings emphasize the need for further efforts to reduce CVD inequalities related to educational disparities.
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Affiliation(s)
- Yasuhiko Kubota
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Gerardo Heiss
- Department of Epidemiology, the University of North Carolina, Chapel Hill, North Carolina
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas S Roetker
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Pretty J, Rogerson M, Barton J. Green Mind Theory: How Brain-Body-Behaviour Links into Natural and Social Environments for Healthy Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070706. [PMID: 28665327 PMCID: PMC5551144 DOI: 10.3390/ijerph14070706] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 12/15/2022]
Abstract
We propose a Green Mind Theory (GMT) to link the human mind with the brain and body, and connect the body into natural and social environments. The processes are reciprocal: environments shape bodies, brains, and minds; minds change body behaviours that shape the external environment. GMT offers routes to improved individual well-being whilst building towards greener economies. It builds upon research on green exercise and nature-based therapies, and draws on understanding derived from neuroscience and brain plasticity, spiritual and wisdom traditions, the lifeways of original cultures, and material consumption behaviours. We set out a simple metaphor for brain function: a bottom brain stem that is fast-acting, involuntary, impulsive, and the driver of fight and flight behaviours; a top brain cortex that is slower, voluntary, the centre for learning, and the driver of rest and digest. The bottom brain reacts before thought and directs the sympathetic nervous system. The top brain is calming, directing the parasympathetic nervous system. Here, we call the top brain blue and the bottom brain red; too much red brain is bad for health. In modern high-consumption economies, life has often come to be lived on red alert. An over-active red mode impacts the gastrointestinal, immune, cardiovascular, and endocrine systems. We develop our knowledge of nature-based interventions, and suggest a framework for the blue brain-red brain-green mind. We show how activities involving immersive-attention quieten internal chatter, how habits affect behaviours across the lifecourse, how long habits take to be formed and hard-wired into daily practice, the role of place making, and finally how green minds could foster prosocial and greener economies. We conclude with observations on twelve research priorities and health interventions, and ten calls to action.
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Affiliation(s)
- Jules Pretty
- School of Biological Sciences, University of Essex, Colchester CO4 3SQ, UK.
| | - Mike Rogerson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK.
| | - Jo Barton
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK.
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13
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De Neve JW, Kawachi I. Spillovers between siblings and from offspring to parents are understudied: A review and future directions for research. Soc Sci Med 2017; 183:56-61. [PMID: 28478353 DOI: 10.1016/j.socscimed.2017.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND While a large literature has highlighted the protective effects of human capital on an individual's health and to some extent their offspring's health, little evidence is available on the positive spillover benefits of human capital for other family members. We conducted a scoping review of the evidence and identify future directions for research. METHODS We systematically searched the public health and economics literature on spillover effects from human capital, as indicated by educational attainment, to the health and/or survival of family members. We assessed (i) downward spillover effects (from parents and/or grandparents to offspring), (ii) horizontal spillover effects (from partners, spouses, and/or siblings), and (iii) upward spillover effects (from offspring to their parents and/or grandparents). We assessed the frequency of studies, their study designs, findings, and identified priority areas to inform future research on spillover effects of human capital. FINDINGS A total of 567 studies met our selection criteria. 286 studies assessed downward spillovers, 22 studies assessed horizontal spillovers, and five studies assessed upward spillovers. Studies on horizontal and upward spillovers found universally positive associations between additional education and better health in family members. The majority of studies used cross-sectional and longitudinal study designs as opposed to (quasi-)experimental designs. Further research is needed on horizontal and upward spillovers and research in low-resource settings, in addition to understanding what level of education matters the most, as well as mechanisms. CONCLUSIONS Although positive spillovers of human capital between siblings and from offspring to parents are likely, they have been understudied. Estimates of the returns to human capital that exclude these benefits may be too low.
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Affiliation(s)
- Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston MA 02115, United States.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston MA 02115, United States.
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14
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Falkstedt D, Möller J, Zeebari Z, Engström K. Prevalence, co-occurrence, and clustering of health-risk behaviors among people with different socio-economic trajectories: A population-based study. Prev Med 2016; 93:64-69. [PMID: 27663427 DOI: 10.1016/j.ypmed.2016.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/08/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
Abstract
Only a few previously published studies have investigated the co-occurrence and clustering of health-risk behaviors in people with different socio-economic trajectories from childhood to adulthood. This study was based on data collected through the Stockholm County Council's public health surveys. We selected the 24,241 participants aged 30 to 65years, who responded to a postal questionnaire in 2010. Information on parents' and participants' educational levels was used for classification of four socio-economic trajectories, from childhood to adulthood: the 'stable high', the 'upwardly mobile', the 'downwardly mobile', and the 'stable low'. Information on daily smoking, risky drinking, physical inactivity, and poor diet was used for assessment of health-risk behaviors: their prevalence, co-occurrence, and clustering. We found all health-risk behaviors to be more prevalent among women and men with a downwardly mobile or stable low socio-economic trajectory. Accordingly, having three or four co-occurring health-risk behaviors were much more likely (up to 4 times, in terms of odds ratios) in these groups as compared to the women and men with an upwardly mobile or a stable high socio-economic trajectory. However, clustering of the health-risk behaviors was not found to be stronger in those with a downwardly mobile or stable low socio-economic trajectory. Thus, the fact that women and men with a disadvantageous socio-economic career were found to have co-occurring health-risk behaviors more often than people with an advantageous socio-economic career seemed to be generated by differences in prevalence of the health-risk behaviors, not by differences in clustering of the behaviors.
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Affiliation(s)
- Daniel Falkstedt
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Jette Möller
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Zangin Zeebari
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - Karin Engström
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
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15
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Kwok MK, Schooling CM, Leung GM, Subramanian SV. Grandparental education, parental education and adolescent blood pressure. Prev Med 2016; 90:59-65. [PMID: 27311341 DOI: 10.1016/j.ypmed.2016.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/08/2016] [Accepted: 06/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Maternal and paternal education could affect childhood blood pressure differently. Grandparental education might also play a role. Disentangling their contribution to childhood blood pressure may shed light on the persistence of disparities and potential windows of intervention. METHODS Using 5604 participants from a Chinese birth cohort born in 1997 and followed-up until ~13years (68% of follow-up), we examined the associations of parental education and grandparental education with age-, sex, and height-specific blood pressure z-scores or prehypertension status. RESULTS Parental education was inversely associated with adolescent systolic (-0.11 z-score, equivalent to -1.17mmHg, 95% confidence interval (CI) -0.19 to -0.04 for grade ≥12 compared with grade ≤9) and diastolic blood pressure (-0.07 z-score, equivalent to -0.79mmHg, 95% CI -0.11 to -0.04). The magnitude of association was similar for maternal or paternal education. Grandparental education was not associated with adolescent blood pressure. No association with prehypertension was found. CONCLUSIONS In an economically developed non-Western setting, both maternal and paternal, but not grandparental, education was associated with adolescent blood pressure. Blood pressure may be responsive to contemporary family socioeconomic conditions that may be scrutinized for suitable interventions.
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Affiliation(s)
- Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; City University of New York Graduate School of Public Health and Health Policy, New York, United States.
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Subu V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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16
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Juneau CE, Benmarhnia T, Poulin AA, Côté S, Potvin L. Socioeconomic position during childhood and physical activity during adulthood: a systematic review. Int J Public Health 2015; 60:799-813. [PMID: 26298440 DOI: 10.1007/s00038-015-0710-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES A growing body of evidence links socioeconomic position early in life and physical activity during adulthood. This systematic review aimed to summarize this evidence. METHODS Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age ≥18 years. Studies were rated according to three key methodological quality criteria: (1) was childhood socioeconomic position assessed prospectively? (2) Was socioeconomic position during adulthood included in the statistical analysis? (3) Was a validated instrument used to measure of physical activity? RESULTS Forty-two publications were included. Twenty-six (61.9 %) found a significant association between socioeconomic position early in life and physical activity during adulthood. Twenty-one studies met at least two methodological quality criteria. Among those, the proportion was higher: 15/21 (71.4 %). Associations were of weak to moderate strength, positive for physical activity during leisure time, and negative for transports and work. CONCLUSIONS The bulk of the evidence supports the notion that there is a life course association between socioeconomic position early in life and physical activity during adulthood. Studies using more rigorous methodology supported this conclusion more consistently.
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Affiliation(s)
- C E Juneau
- École de Santé Publique, Faculté de Médecine, Université de Montréal, Succursale Centre-ville, C.P. 6128, Montreal, QC, H3C 3J7, Canada.
| | - T Benmarhnia
- École de Santé Publique, Faculté de Médecine, Université de Montréal, Succursale Centre-ville, C.P. 6128, Montreal, QC, H3C 3J7, Canada
| | - A A Poulin
- École de Santé Publique, Faculté de Médecine, Université de Montréal, Succursale Centre-ville, C.P. 6128, Montreal, QC, H3C 3J7, Canada
| | - S Côté
- École de Santé Publique, Faculté de Médecine, Université de Montréal, Succursale Centre-ville, C.P. 6128, Montreal, QC, H3C 3J7, Canada
| | - L Potvin
- École de Santé Publique, Faculté de Médecine, Université de Montréal, Succursale Centre-ville, C.P. 6128, Montreal, QC, H3C 3J7, Canada
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17
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Elhakeem A, Cooper R, Bann D, Hardy R. Childhood socioeconomic position and adult leisure-time physical activity: a systematic review. Int J Behav Nutr Phys Act 2015; 12:92. [PMID: 26138985 PMCID: PMC4501082 DOI: 10.1186/s12966-015-0250-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/17/2015] [Indexed: 11/12/2022] Open
Abstract
Regular leisure-time physical activity (LTPA) benefits health and is thought to be less prevalent in lower socioeconomic groups. Evidence suggests that childhood socioeconomic circumstances can impact on adult health and behaviour however, it is unclear if this includes an influence on adult LTPA. This review tested the hypothesis that a lower childhood socioeconomic position (SEP) is associated with less frequent LTPA during adulthood. Studies were located through a systematic search of MEDLINE, Embase, PsycINFO, CINAHL and SPORTDiscus and by searching reference lists. Eligible studies were English-language publications testing the association between any indicator of childhood SEP and an LTPA outcome measured during adulthood. Forty-five papers from 36 studies, most of which were European, were included. In most samples, childhood SEP and LTPA were self-reported in midlife. Twenty-two studies found evidence to support the review's hypothesis and thirteen studies found no association. Accounting for own adult SEP partly attenuated associations. There was more evidence of an association in British compared with Scandinavian cohorts and in women compared with men. Results did not vary by childhood SEP indicator or age at assessment of LTPA. This review found evidence of an association between less advantaged childhood SEP and less frequent LTPA during adulthood. Understanding how associations vary by gender and place could provide insights into underlying pathways.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK.
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK.
| | - David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK.
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Veenstra G, Abel T. Capital interplays and the self-rated health of young men: results from a cross-sectional study in Switzerland. Int J Equity Health 2015; 14:38. [PMID: 25927454 PMCID: PMC4410456 DOI: 10.1186/s12939-015-0167-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/10/2015] [Indexed: 12/22/2022] Open
Abstract
Introduction We apply capital interplay theory to health inequalities in Switzerland by investigating the interconnected effects of parental cultural, economic and social capitals and personal educational stream on the self-rated health of young Swiss men who live with their parents. Methods We apply logistic regression modelling to self-rated health in original cross-sectional survey data collected during mandatory conscription of Swiss male citizens in 2010 and 2011 (n = 23,975). Results In comparison with sons whose parents completed mandatory schooling only, sons with parents who completed technical college or university were significantly more likely to report very good or excellent self-rated health. Parental economic capital was an important mediating factor in this regard. Number of books in the home (parental cultural capital), family economic circumstances (parental economic capital) and parental ties to influential people (parental social capital) were also independently associated with the self-rated health of the sons. Although sons in the highest educational stream tended to report better health than those in the lowest, we found little evidence for a health-producing intergenerational transmission of capitals via the education stream of the sons. Finally, the positive association between personal education and self-rated health was stronger among sons with relatively poorly educated parents and stronger among sons with parents who were relatively low in social capital. Conclusions Our study provides empirical support for the role of capital interplays, social processes in which capitals interpenetrate or co-constitute one another, in the intergenerational production of the health of young men in Switzerland.
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Affiliation(s)
- Gerry Veenstra
- Department of Sociology, University of British Columbia, 6303 N. W. Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
| | - Thomas Abel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Schori D, Hofmann K, Abel T. Social inequality and smoking in young Swiss men: intergenerational transmission of cultural capital and health orientation. Int J Public Health 2013; 59:261-70. [PMID: 24362449 DOI: 10.1007/s00038-013-0537-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 11/14/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Smoking is related to income and education and contributes to social inequality in morbidity and mortality. Socialisation theories focus on one's family of origin as regards acquisition of norms, attitudes and behaviours. Aim of this study is to assess associations of daily smoking with health orientation and academic track in young Swiss men. Further, to assess associations of health orientation and academic track with family healthy lifestyle, parents' cultural capital, and parents' economic capital. METHODS Cross-sectional data were collected during recruitment for compulsory military service in Switzerland during 2010 and 2011. A structural equation model was fitted to a sample of 18- to 25-year-old Swiss men (N = 10,546). RESULTS Smoking in young adults was negatively associated with academic track and health orientation. Smoking was negatively associated with parents' cultural capital through academic track. Smoking was negatively associated with health orientation which in turn was positively associated with a healthy lifestyle in the family of origin. CONCLUSIONS Results suggest two different mechanisms of intergenerational transmissions: first, the family transmission path of health-related dispositions, and secondly, the structural transmission path of educational inequality.
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Affiliation(s)
- Dominik Schori
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,
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20
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Educational differences in smoking among adolescents in Germany: what is the role of parental and adolescent education levels and intergenerational educational mobility? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3015-32. [PMID: 23877770 PMCID: PMC3734474 DOI: 10.3390/ijerph10073015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
Background: Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents’ own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends’ smoking behaviour. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends’ smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20–0.53; girls: OR 0.52; 95% CI 0.37–0.73). Conclusions: Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.
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Slopen N, Goodman E, Koenen KC, Kubzansky LD. Socioeconomic and other social stressors and biomarkers of cardiometabolic risk in youth: a systematic review of less studied risk factors. PLoS One 2013; 8:e64418. [PMID: 23691213 PMCID: PMC3656855 DOI: 10.1371/journal.pone.0064418] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/13/2013] [Indexed: 12/29/2022] Open
Abstract
Background Socioeconomic disadvantage and other social stressors in childhood have been linked with cardiometabolic diseases in adulthood; however the mechanisms underlying these observed associations and the timing of their emergence are unclear. The aim of this review was to evaluate research that examined relationships between socioeconomic disadvantage and other social stressors in relation to less-studied cardiometabolic risk factors among youth, including carbohydrate metabolism-related factors, lipids, and central adiposity. Methods We searched PubMed and ISI Web of Science to identify relevant publications between 2001 and 2013.Studies were selected based on 4 criteria: (1) the study examined an association between at least one social or economic stressor and one relevant outcome prior to age 21; (2) the sample originated from a high-income country; (3) the sample was not selected based on a health condition; and (4) a central aim was to evaluate the effect of the social or economic stressor on at least one relevant outcome. Abstracts were screened and relevant publications were obtained and evaluated for inclusion criteria. We abstracted data from selected articles, summarized them by exposures and outcomes, and assigned an evidence grade. Results Our search identified 37 publications from 31 studies. Socioeconomic disadvantage was consistently associated with greater central adiposity. Research to date does not provide clear evidence of an association between childhood stressors and lipids or carbohydrate metabolism-related factors. Conclusions This review demonstrates a paucity of research on the relationship of socioeconomic disadvantage and other social stressors to lipid and carbohydrate metabolism-related factors in youth. Accordingly, it is not possible to form strong conclusions, particularly with regard to stressors other than socioeconomic disadvantage. Findings are used to inform priorities for future research. An improved understanding of these pathways is critical for identifying novel prevention targets and intervention opportunities to protect the long-term health of children and adolescents.
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Affiliation(s)
- Natalie Slopen
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, United States of America.
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