Joining the dots: The links between education and health and implications for indigenous children

Increasing health inequality among Inuit in Greenland from 1993 to 2018: Different patterns for household assets, urbanization and a sociocultural index as indicators of social position

Income inequality affects population health and wellbeing negatively. In Greenland, health inequality has been shown to exist among social groups, regionally and according to urbanization, and between Inuit and migrants from Denmark. The purpose of the study was to compare the changes in health inequality from 1993 to 2018 according to three measures of social position, i.e. a socioeconomic measure (household assets), a measure of urbanization and a composite sociocultural index. We hypothesized that social inequality in health increased parallel to the increasing economic inequality in Greenland. The sample was based on four population health surveys conducted among the Inuit in Greenland in 1993, 2005-2010, 2014 and 2018. The total number of interviews was 9024 and the total number of individuals interviewed was 5829, as participants were invited to several surveys as part of a cohort. As statistical measure of social disparity we used the slope index of inequality (SII) adjusted for age and sex. Analyses were performed with daily smoking, suicidal thoughts and obesity as health outcomes. Daily smoking was most prevalent among participants with low social position whereas obesity was most prevalent among participants with high social position. With household assets as indicator of social position, the results showed high and increasing social inequality for both daily smoking and obesity. Social inequality for daily smoking increased over time also for urbanization and the sociocultural index. The hypothesis that social inequality increased over time was thus confirmed for daily smoking and obesity but not for suicidal thoughts. With the results from the present study there is solid evidence to guide prevention and health care towards social equality in health.

Perceptions of Pacific children's academic performance at age 6 years: A multi-informant agreement study

Purpose

In New Zealand, Pacific immigrants are among the fastest growing ethnic minorities but, as a group, they are also at most risk of not realising their literacy and educational aspirations critical for achieving their human potential and wellbeing. This may be due, in part, to a misalignment in the shared understanding of academic success between students, parents and their teachers within largely non-Pacific school environments. This study aims to report levels of agreement in child-mother, child-teacher, and mother-teacher perceptions of Pacific children’s academic performance at age 6 years.

Method

A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed as part of the Pacific Islands Families study. Maternal home interviews were conducted at 6-weeks and 6-years postpartum, together with separate child and teacher elicitations at 6-years. Pairwise agreement of academic performance responses was assessed using Cohen’s weighted κ statistic, along with symmetry and marginal homogeneity tests.

Results

At 6-years, information was available for 1,001 children and their mothers, and teachers’ evaluations for 549 children. Negligible to slight agreements and significant asymmetry were found between the child-mother (κ = 0.03, 95% CI: -0.03, 0.09), child-teacher (κ = 0.04, 95% CI: 0.01, 0.08), and mother-teacher (κ = 0.07, 95% CI: 0.03, 0.11) pairwise assessments–with children and mothers more likely to rate Pacific children’s academic performance higher than their teachers. Significantly higher concordances with teacher assessments were found among mothers with post-secondary education, proficiency in English, and stronger alignment with New Zealand culture and for children who performed strongly on a standardised measure of performance relative to their peers.

Conclusion

Strategies are needed to align Pacific students’ and parental perceptions with documented educational achievement outcomes and to facilitate more effective and timely feedback on achievement results and home-school communication. The importance of removing language, cultural and socio-economic barriers to achieving shared understanding of academic performance between teachers and families is highlighted.

Integrating health, education and culture in predicting Pacific children's English receptive vocabulary at 6 years: A classification tree approach

AIM

Pacific children fare poorly on health and educational outcomes, including literacy. Early interventions are considered critical in reducing educational disparities. A prediction model was constructed to analyse the factors associated with Pacific children's English receptive vocabulary, an important component of English language development.

METHODS

A birth cohort study of Pacific children was used to construct a classification tree model and predict the proportions of Pacific children who performed strongly in a standardised test of English receptive vocabulary at 6 years of age (n = 1019). Classification trees were constructed using 10-fold cross-validation (CV) and pruned using the one-standard-error rule. Prediction errors were directly estimated using leave-one-out CV.

RESULTS

Analyses of misclassification errors from the pruned model gave false negative and positive rates of 19 and 19% from re-substitution and 54 and 21% from leave-one-out CV estimation, respectively. Of the predictors, maternal acculturation, small birthweight and performance in early developmental screening test at 4 years of age were found to have the highest goodness of split.

CONCLUSIONS

The cultural environment to which Pacific children were exposed in early childhood, indicated by the maternal acculturation, was more crucial in distinguishing children with strong English-receptive vocabulary skills than socio-economic or prenatal conditions. This highlights the importance of integrating the cultural environment into designing measures for facilitating Pacific children's language development.

Prehypertension and socioeconomic status: A cross-sectional study in Chongqing, China

BACKGROUND

A large amount of research is available on the relationship between socioeconomic status (SES) and hypertension. However, the relationship between SES and prehypertension remains complex and unclear. Prehypertension is defined as a systolic blood pressure (SBP) between 120 and 139 mmHg or diastolic blood pressure (DBP) 80 and 89 mmHg. This paper focuses on the impact of SES on the prevalence of prehypertension and provides suggestions for the prevention and control measures of prehypertension and health resource allocation.

METHOD

Using multistage random sampling, 11,773 subjects were selected. Subjects aged above 15 years old and subjects who had been living in the eight selected districts for more than 6 months were analyzed using a multivariable logistical model.

RESULTS

The prevalence of prehypertension at the present time reaches 55.17%, with it being higher among men than that among women (63.15% vs. 47.19%, p < 0.05). After adjustment for other factors such as age and gender, a logistic regression showed that a higher education level and a history of marital status were significantly associated with prehypertension.

CONCLUSIONS

People of different SES indicate different working and living conditions. They also face different risk factors for prehypertension. Lower education and a history of marital status were associated with a higher risk of prehypertension among residents in Chongqing, China.

Childhood disability in Aboriginal and Torres Strait Islander peoples: a literature review

Introduction

Aboriginal and Torres Strait Islander children have higher rates of disability than non-Indigenous children and are considered doubly disadvantaged, yet there is very little data reflecting prevalence and service access to inform design and delivery of services. Failing to address physical, social, and psychological factors can have life-long consequences and perpetuate longstanding health disparities.

Methods

A narrative literature review was undertaken to identify peer reviewed literature describing factors impacting on the prevention, recognition, and access to support and management of disability in Indigenous Australian children.

Results

Twenty-seven peer-reviewed journal articles met inclusion criteria. The majority of articles focused on the hearing loss and learning disabilities consequent of otitis media. Few articles reported data on urban or metropolitan Indigenous populations or described interventions. Individual/community-, provider-, and systems level factors were identified as impacting on recognition and management of disability in young Indigenous children.

Conclusions

Given the burden of childhood disability, the limited literature retrieved is concerning as this is a barometer of activity and investment. Solutions addressing childhood disability will require collaboration between health, social and educational disciplines as well as an increased investment in prevention, identification and promotion of access.

Viral-bacterial co-infection in Australian Indigenous children with acute otitis media

Background

Acute otitis media with perforation (AOMwiP) affects 40% of remote Indigenous children during the first 18 months of life. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the primary bacterial pathogens of otitis media and their loads predict clinical ear state. Our hypothesis is that antecedent respiratory viral infection increases bacterial density and progression to perforation.

Methods

A total of 366 nasopharyngeal swabs from 114 Indigenous children were retrospectively examined. A panel of 17 respiratory viruses was screened by PCR, and densities of S. pneumoniae, H. influenzae and M. catarrhalis were estimated by quantitative real time PCR. Data are reported by clinical ear state.

Results

M. catarrhalis (96%), H. influenzae (91%), S. pneumoniae (89%) and respiratory viruses (59%) were common; including rhinovirus (HRV) (38%), polyomavirus (HPyV) (14%), adenovirus (HAdV) (13%), bocavirus (HBoV) (8%) and coronavirus (HCoV) (4%). Geometric mean bacterial loads were significantly higher in children with acute otitis media (AOM) compared to children without evidence of otitis media. Children infected with HAdV were 3 times more likely (p < 0.001) to have AOM with or without perforation.

Conclusion

This study confirms a positive association between nasopharyngeal bacterial load and clinical ear state, exacerbated by respiratory viruses, in Indigenous children. HAdV was independently associated with acute ear states.