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Haider F, Bernabé E, Delgado-Angulo EK. Education mediates the relationship of parental socioeconomic status with subjective adult oral health. Health Qual Life Outcomes 2023; 21:86. [PMID: 37563734 PMCID: PMC10416478 DOI: 10.1186/s12955-023-02169-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Evidence shows that both socioeconomic status (SES) during childhood and education are associated with adult oral health. However, whether the range of opportunities families have regarding their children's education mediate the effect of childhood disadvantage on oral health later in life remains unknown. The aim of this study was to evaluate the mediating role of education in the association between parental SES and subjective oral health status in middle adulthood. METHODS Data from 6703 members of the British Cohort Study 1970 were analyzed. Parental SES was measured using the 7-class National Statistics Socio-Economic Classification (NS-SEC) at age 10 years. Five measures of education (type of high school, highest qualification, age left full-time education, status of institution and field of study) were obtained from ages 16 and 42 years. Subjective oral health was measured with a single global item at age 46 years. Causal mediation analysis was performed, using a weighting-based approach, to evaluate how much of the effect of parental SES on subjective oral health was mediated by the measures of education separately and jointly. RESULTS Overall, 23.6% of individuals reported poor oral health. Parental SES was associated with every measure of education, and they were also associated with subjective oral health in regression models adjusted for confounders. The effect of parental SES on subjective oral health was partially mediated by each measure of education, with a proportion mediated of 53.2% for the institution status, 46.5% for the field of study, 42.8% for the school type, 38.9% for the highest qualification earned and 38.4% for the age when full-time education was discontinued. The proportion of the effect of parental SES on subjective oral health jointly mediated by all measures of education was 81.1%. CONCLUSION This study found a substantial mediating role of education in the association between parental SES and subjective oral health in middle adulthood.
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Affiliation(s)
- Faten Haider
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, Turner street, E1 2AD, London, UK.
| | - Elsa Karina Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Perú
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Higher education and health at midlife: Evaluating the role of college quality. SSM Popul Health 2022; 19:101228. [PMID: 36164493 PMCID: PMC9508472 DOI: 10.1016/j.ssmph.2022.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
Using the longitudinal data from the National Longitudinal Survey of Youth-1979 linked with external data on college characteristics (N = 7056), this study illustrates an independent stratifying role of college quality in shaping health. College quality has significant and positive influences on physical health, and this positive association tends to strengthen across 40 and 50. By contrast, attending higher-quality colleges is not associated with mental health at either age 40 or age 50. Decompositions were conducted to assess the extent to which early life and demographic characteristics, employment and economic conditions, health behaviors, and family relationships account for observed patterns. Our study highlights the necessity for future research on education and health to incorporate characteristics of schools attended; reveals variation in the college quality-health nexus by specific health outcomes; and provides new insights into understanding health inequalities across the life course. This study illustrates an independent stratifying role of college quality in shaping health. College quality has significant and positive influences on physical health, and this positive association tends to strengthen across 40 and 50. Attending higher-quality colleges is not associated with mental health at either age 40 or age 50.
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Stephens CR, Easton JF, Robles-Cabrera A, Fossion R, de la Cruz L, Martínez-Tapia R, Barajas-Martínez A, Hernández-Chávez A, López-Rivera JA, Rivera AL. The Impact of Education and Age on Metabolic Disorders. Front Public Health 2020; 8:180. [PMID: 32671006 PMCID: PMC7326131 DOI: 10.3389/fpubh.2020.00180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022] Open
Abstract
Metabolic disorders, such as obesity, elevated blood pressure, dyslipidemias, insulin resistance, hyperglycemia, and hyperuricemia have all been identified as risk factors for an epidemic of important and widespread chronic-degenerative diseases, such as type 2 diabetes and cardiovascular disease, that constitute some of the world's most important public health challenges. Their increasing prevalence can be associated with an aging population and to lifestyles within an obesogenic environment. Taking educational level as a proxy for lifestyle, and using both logistic and linear regressions, we study the relation between a wide set of metabolic biomarkers, and educational level, body mass index (BMI), age, and sex as correlates, in a population of 1,073 students, academic and non-academic staff at Mexico's largest university (UNAM). Controlling for BMI and sex, we consider educational level and age as complementary measures-degree and duration-of exposure to metabolic insults. Analyzing the role of education across a wide spectrum of educational levels (from primary school to doctoral degree), we show that higher education correlates to significantly better metabolic health when compared to lower levels, and is associated with significantly less risk for waist circumference, systolic blood pressure, glucose, glycosylated hemoglobin, triglycerides, high density lipoprotein and metabolic syndrome (all p < 0.05); but not for diastolic blood pressure, basal insulin, uric acid, low density lipoprotein, and total cholesterol. We classify each biomarker, and corresponding metabolic disorder, by its associated set of statistically significant correlates. Differences among the sets of significant correlates indicate various aetiologies and the need for targeted population-specific interventions. Thus, variables strongly linked to educational level are candidates for lifestyle change interventions. Hence, public policy efforts should be focused on those metabolic biomarkers strongly linked to education, while adopting a different approach for those biomarkers not linked as they may be poor targets for educational campaigns.
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Affiliation(s)
- Christopher R Stephens
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior, Mexico City, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico
| | - Jonathan F Easton
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior, Mexico City, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico
| | - Adriana Robles-Cabrera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico.,Doctorado en Ciencias Biomedicas, Universidad Nacional Autónoma de México, Circuito Escolar, Ciudad Universitaria, Mexico City, Mexico
| | - Ruben Fossion
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior, Mexico City, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico
| | - Lizbeth de la Cruz
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior, Ciudad Universitaria, Mexico City, Mexico
| | - Ricardo Martínez-Tapia
- Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior, Ciudad Universitaria, Mexico City, Mexico
| | - Antonio Barajas-Martínez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior, Ciudad Universitaria, Mexico City, Mexico
| | - Alejandro Hernández-Chávez
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior, Ciudad Universitaria, Mexico City, Mexico
| | - Juan Antonio López-Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico.,Facultad de Ciencias, Universidad Nacional Autónoma de México, Circuito Exterior, Ciudad Universitaria, Mexico City, Mexico
| | - Ana Leonor Rivera
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior, Mexico City, Mexico.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva 20, Insurgentes Cuicuilco, Mexico City, Mexico
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Butler J, Black C, Craig P, Dibben C, Dundas R, Hilton Boon M, Johnston M, Popham F. The long-term health effects of attending a selective school: a natural experiment. BMC Med 2020; 18:77. [PMID: 32241252 PMCID: PMC7118818 DOI: 10.1186/s12916-020-01536-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Education is widely associated with better physical and mental health, but isolating its causal effect is difficult because education is linked with many socioeconomic advantages. One way to isolate education's effect is to consider environments where similar students are assigned to different educational experiences based on objective criteria. Here we measure the health effects of assignment to selective schooling based on test score, a widely debated educational policy. METHODS In 1960s Britain, children were assigned to secondary schools via a test taken at age 11. We used regression discontinuity analysis to measure health differences in 5039 people who were separated into selective and non-selective schools this way. We measured selective schooling's effect on six outcomes: mid-life self-reports of health, mental health, and life limitation due to health, as well as chronic disease burden derived from hospital records in mid-life and later life, and the likelihood of dying prematurely. The analysis plan was accepted as a registered report while we were blind to the health outcome data. RESULTS Effect estimates for selective schooling were as follows: self-reported health, 0.1 worse on a 4-point scale (95%CI - 0.2 to 0); mental health, 0.2 worse on a 16-point scale (- 0.5 to 0.1); likelihood of life limitation due to health, 5 percentage points higher (- 1 to 10); mid-life chronic disease diagnoses, 3 fewer/100 people (- 9 to + 4); late-life chronic disease diagnoses, 9 more/100 people (- 3 to + 20); and risk of dying before age 60, no difference (- 2 to 3 percentage points). Extensive sensitivity analyses gave estimates consistent with these results. In summary, effects ranged from 0.10-0.15 standard deviations worse for self-reported health, and from 0.02 standard deviations better to 0.07 worse for records-derived health. However, they were too imprecise to allow the conclusion that selective schooling was detrimental. CONCLUSIONS We found that people who attended selective secondary school had more advantaged economic backgrounds, higher IQs, higher likelihood of getting a university degree, and better health. However, we did not find that selective schooling itself improved health. This lack of a positive influence of selective secondary schooling on health was consistent despite varying a wide range of model assumptions.
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Affiliation(s)
- Jessica Butler
- Centre for Health Data Science, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Corri Black
- Centre for Health Data Science, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Chris Dibben
- Institute of Geography, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Michelle Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Marjorie Johnston
- Centre for Health Data Science, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Frank Popham
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK.
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Lee S, Alvarado-Leiton F, Vasquez E, Davis RE. Impact of the Terms " Regular" or " Pasable" as Spanish Translation for "Fair" of the Self-Rated Health Question Among US Latinos: A Randomized Experiment. Am J Public Health 2019; 109:1789-1796. [PMID: 31622137 DOI: 10.2105/ajph.2019.305341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine measurement comparability of a Spanish version of self-rated health (SRH) with pasable as an alternative to regular for the response category "fair" in the English version.Methods. We translated "fair" into 2 Spanish versions: regular and pasable. We implemented a split-half experiment in 3 surveys independently conducted from October 2015 to January 2016, from April to November 2016, and from August to November 2017. Within each survey, we randomly assigned Spanish-interviewed Latino respondents to 1 of the 2 SRH versions. The total sample included 3261 Latino and 738 non-Latino White adults in the United States.Results. Spanish-interviewed Latinos reported substantively more favorable health on SRH with pasable than with regular. When pasable instead of regular was used for SRH, we observed a larger difference between respondents reporting positive versus negative SRH on objective health measures, including the frequency of doctor's visits. Furthermore, when we accounted for correlates of health, Latino-White disparities were attenuated with pasable.Conclusions. We recommend using pasable instead of regular for SRH Spanish translations to improve measurement equivalence in cross-lingual and cross-cultural research.
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Affiliation(s)
- Sunghee Lee
- Sunghee Lee and Fernanda Alvarado-Leiton are with the Institute for Social Research, University of Michigan, Ann Arbor. Elizabeth Vasquez is with the School of Public Health, University at Albany, State University of New York, Albany. Rachel E. Davis is with the School of Public Health, University of South Carolina, Columbia
| | - Fernanda Alvarado-Leiton
- Sunghee Lee and Fernanda Alvarado-Leiton are with the Institute for Social Research, University of Michigan, Ann Arbor. Elizabeth Vasquez is with the School of Public Health, University at Albany, State University of New York, Albany. Rachel E. Davis is with the School of Public Health, University of South Carolina, Columbia
| | - Elizabeth Vasquez
- Sunghee Lee and Fernanda Alvarado-Leiton are with the Institute for Social Research, University of Michigan, Ann Arbor. Elizabeth Vasquez is with the School of Public Health, University at Albany, State University of New York, Albany. Rachel E. Davis is with the School of Public Health, University of South Carolina, Columbia
| | - Rachel E Davis
- Sunghee Lee and Fernanda Alvarado-Leiton are with the Institute for Social Research, University of Michigan, Ann Arbor. Elizabeth Vasquez is with the School of Public Health, University at Albany, State University of New York, Albany. Rachel E. Davis is with the School of Public Health, University of South Carolina, Columbia
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Melaku YA, Appleton S, Reynolds AC, Sweetman AM, Stevens DJ, Lack L, Adams R. Association Between Childhood Behavioral Problems and Insomnia Symptoms in Adulthood. JAMA Netw Open 2019; 2:e1910861. [PMID: 31490538 PMCID: PMC6735491 DOI: 10.1001/jamanetworkopen.2019.10861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Importance Life-course determinants of insomnia, particularly the long-term association of childhood behavioral problems with insomnia later in life, are unknown. As childhood behaviors are measurable and potentially modifiable, understanding their associations with insomnia symptoms may provide novel insights into early intervention strategies to reduce the burden. Objective To investigate the association between behavioral problems at 5, 10, and 16 years of age and self-reported insomnia symptoms at 42 years of age. Design, Setting, and Participants This cohort study used data from the United Kingdom 1970 Birth Cohort Study, an ongoing large-scale follow-up study. Participants were followed up from birth (1970) to age 42 years (2012). Missing data were imputed via multiple imputation. Statistical analysis was performed from February 1 to July 15, 2019. Exposures Behavior measured at 5, 10, and 16 years of age using the Rutter Behavioral Scale (RBS). Children's behavior was classified as normal (≤80th percentile), moderate behavioral problems (>80th to ≤95th percentile), and severe behavioral problems (>95th percentile) based on their RBS score. Main Outcomes and Measures Self-reported difficulties initiating or maintaining sleep (DIMS) were collected using a self-administered questionnaire at 42 years of age. Log-binomial logistic regression, adjusted for several potential confounders, was used to estimate the association of childhood behavioral problems with insomnia symptoms in adulthood. Sensitivity analyses were conducted to check robustness of the findings. Results Participants were followed up from a baseline age of 5 years (n = 8050; 3854 boys and 4196 girls), 10 years (n = 9090; 4365 boys and 4725 girls), or 16 years (n = 7653; 3575 boys and 4078 girls) until age 42 years. There was a 39% higher risk of DIMS (odds ratio [OR], 1.39; 95% CI, 1.04-1.84; P = .06 for trend) for participants with severe behavioral problems at 5 years of age compared with those with a normal RBS score. The odds of DIMS plus not feeling rested on waking (DIMS plus) in participants with severe behavioral problems at 5 years of age were 29% higher (odds ratio, 1.29; 95% CI, 0.97-1.70; P = .14 for trend) than participants with a normal RBS score, although this result was not statistically significant. Moderate and severe behavioral problems at 16 years of age were positively associated with DIMS and DIMS plus (moderate: OR, 1.28; 95% CI, 1.07-1.52; severe: OR, 1.67; 95% CI, 1.22-2.30; P < .001 for trend) and DIMS plus (moderate: OR, 1.32; 95% CI, 1.11-1.56; severe: OR, 1.47; 95% CI, 1.09-1.98; P < .001 for trend). Externalizing behavioral problems at 5 and 10 years of age were positively associated with insomnia symptoms at 42 years of age. Conclusions and Relevance This study is the first to show associations of early-life behavioral problems, particularly early- and middle-childhood externalizing problems, with insomnia symptoms in adulthood. These findings underline the importance of addressing insomnia from a life-course perspective and considering the benefits of early behavioral intervention to sleep health.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia
- Freemason’s Centre for Men’s Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy C. Reynolds
- The Appleton Institute, The University of Central Queensland, Wayville, South Australia, Australia
- School of Health, Medical and Applied Sciences, The University of Central Queensland Adelaide Campus, Wayville, South Australia, Australia
| | - Alexander M. Sweetman
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David J. Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Leon Lack
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- College of Education, Psychology, and Social Work, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Freemason’s Centre for Men’s Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Adesanya A. O, Rojas BM, Darboe A, Beogo I. Socioeconomic differential in self-assessment of health and happiness in 5 African countries: Finding from World Value Survey. PLoS One 2017; 12:e0188281. [PMID: 29176854 PMCID: PMC5703504 DOI: 10.1371/journal.pone.0188281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/03/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Factors that contribute to wealth related inequalities in self-rated health (SRH) and happiness remains unclear most especially in sub-Saharan countries (SSA). This study aims to explore and compare socioeconomic differentials in SRH and happiness in five SSA countries. Methods Using the 2010/2014 World Values Survey (WVS), we obtained a sample of 9,869 participants of age 16 and above from five SSA countries (Nigeria, Ghana, South Africa, Rwanda and Zimbabwe). Socioeconomic inequalities were quantified using the concentration index. The contribution of each predictor to concentration index’s magnitude was obtained by means of regression based decomposition analysis. Results Poor SRH ranges from approximately 9% in Nigeria to 20% in Zimbabwe, whereas unhappiness was lower in Rwanda (9.5%) and higher in South Africa (23.3%). Concentration index was negative for both outcomes in all countries, which implies that poor SRH and unhappiness are excessively concentrated among the poorest socioeconomic strata. Although magnitudes differ across countries, however, the major contributor to wealth-related inequality in poor SRH is satisfaction with financial situation whereas for unhappiness the major contributors are level of income and satisfaction with financial situation. Conclusions This study underscores an association between wealth related inequalities and poor SRH and unhappiness in the context of SSA. Improving equity in health, as suggested by the commission of social determinants of health may be useful in fighting against the unfair distribution of resources. Thus, knowledge about the self-rating of health and happiness can serve as proxy estimates for understanding the distribution of health care access and economic resources needed for well-being in resident countries.
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Affiliation(s)
| | - Bomar Mendez Rojas
- International Health Program, National Yang Ming University, Taipei, Taiwan
| | - Amadou Darboe
- Ministry of Health and Social Welfare, Banjul, The Gambia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso
- Université Laval, rue de l'Université, Québec (Québec), Canada
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Kaseliene S, Mesceriakova-Veliuliene O, Vladickiene J, Kalediene R, Seseikaite N, Stankunas M. Monitoring Health Inequalities at the Municipal Level: Lithuanian Experience. Open Med (Wars) 2017; 12:163-170. [PMID: 28730174 PMCID: PMC5471921 DOI: 10.1515/med-2017-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess the attitudes of Lithuanian public health professionals towards health inequality monitoring in municipalities. The survey was conducted in public health bureaus (PHBs) and administrations of municipalities in March 2015. All employees of PHBs, all municipal doctors and all employees of health departments were invited to participate in the study (N=318; response rate, 47.2%). The study participants had positive attitudes towards the importance of health inequality monitoring at the municipal level, meanwhile systematic health inequality monitoring was assessed moderately. The majority of the interviewed professionals working at PHBs and municipalities (91.4% and 88.2%, respectively) declared that health indicators were monitored and analysed in their institutions. The respondents acknowledged the importance of routine monitoring of health indicators for assessment of inequalities, but these indicators were not monitored systematically in every municipality and PHB. Public health professionals identified the following measures for better health inequality monitoring: to strengthen intersectoral collaboration, formulate specific objectives of health programmes, promote actions in reducing health inequalities. CONCLUSIONS Public health professionals working at the municipal level outlined the importance of monitoring and reducing health inequalities. However, health inequality monitoring at the municipal level was considered as insufficient.
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Elhakeem A, Hardy R, Bann D, Caleyachetty R, Cosco TD, Hayhoe RP, Muthuri SG, Wilson R, Cooper R. Intergenerational social mobility and leisure-time physical activity in adulthood: a systematic review. J Epidemiol Community Health 2016; 71:673-680. [PMID: 27979970 PMCID: PMC5485757 DOI: 10.1136/jech-2016-208052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/03/2016] [Accepted: 11/24/2016] [Indexed: 01/08/2023]
Abstract
Aim To systematically review the association between intergenerational social mobility and leisure-time physical activity (LTPA) in adulthood, in order to assess all published evidence relating to the hypothesis that adults socially mobile between childhood and adulthood will have different levels of LTPA than those in the same socioeconomic group across life. Methods A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified by searching databases (MEDLINE, Embase, PsycINFO) and reference lists. Eligible studies examined associations between any indicator of social mobility, based on at least one measure of parental socioeconomic position (SEP) and one measure of own adult SEP, and LTPA in adulthood. Results 13 studies comprising a total of 44 000 participants from the UK, Finland, Sweden, Australia, USA and Brazil were included. Participants were aged 16–70 years and were from population-based surveys, occupational cohorts and primary care registries. Most studies (n=9) used occupational class measures to identify social mobility; education (n=4) and income (n=1) were also used. There was consistent evidence in nine of the 13 studies that stable high socioeconomic groups tended to report the highest levels of participation in LTPA and stable low socioeconomic groups the lowest. Upward and downwardly mobile groups participated in LTPA at levels between these stable groups. Conclusions Cumulative exposure to higher SEP in childhood and adulthood was associated with higher LTPA in adulthood. Thus, a potential outcome of policies and interventions which aim to minimise exposure to socioeconomic adversity may be increased LTPA among adults. Trial registration number CRD42016036538.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, London, UK
| | | | | | - Richard Pg Hayhoe
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Rebecca Wilson
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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