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Ruggiero CF, Trexberg KM, Moore AM, Savage JS. Applying the Family Stress Model to responsive feeding and early obesity prevention. Appetite 2024; 200:107515. [PMID: 38797237 PMCID: PMC11227407 DOI: 10.1016/j.appet.2024.107515] [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: 02/08/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Kaitlin M Trexberg
- Department of Human Development and Family Studies, The Pennsylvania State University, 119 Health and Human Development Building, University Park, PA, 16802, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA.
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA.
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2
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Gregory EF, Maddox AI, Tindall A, Ibarra JL, Virudachalam S. Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018. FAMILY & COMMUNITY HEALTH 2024; 47:231-238. [PMID: 38713758 DOI: 10.1097/fch.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVES We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8). METHODS This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children. RESULTS 6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82). CONCLUSIONS Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.
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Affiliation(s)
- Emily F Gregory
- Author Affiliations: Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Drs Gregory and Tindall, Mr Ibarra, and Dr Virudachalam); Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam); PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam)
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Howland MA, Glynn LM. The future of intergenerational transmission research: A prospective, three-generation approach. Dev Psychopathol 2024:1-11. [PMID: 38832544 DOI: 10.1017/s0954579424000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Dr. Dante Cicchetti's pioneering theory and research on developmental psychopathology have been fundamental to the proliferation of research on intergenerational transmission over the last 40 years. In part due to this foundation, much has been learned about continuities and discontinuities in child maltreatment, attachment, parenting, and psychopathology across generations. Looking towards the future, we propose that this field stands to benefit from a prospective, three-generation approach. Specifically, following established prospective, longitudinal cohorts of children over their transition to parenting the next generation will afford the opportunity to investigate the developmental origins of intergenerational transmission. This approach also can address key outstanding questions and methodological limitations in the extant literature related to the confounding of retrospective and prospective measures; examination of mediators and moderators; and investigation of the roles of biology, environment, and their interplay. After considering these advantages, we offer several considerations and recommendations for future research, many of which are broadly applicable to the study of two or more generations. We hope that this discussion will inspire the leveraging of existing prospective cohorts to carry forward Dr. Cicchetti's remarkable contributions, with the ultimate aim to inform the development of preventions and interventions that disrupt deleterious intergenerational cycles.
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Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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Saijo Y, Yoshioka E, Sato Y, Kunori Y, Kanaya T, Nakanishi K, Kato Y, Nagaya K, Takahashi S, Ito Y, Iwata H, Yamaguchi T, Miyashita C, Itoh S, Kishi R. Maternal pre-pregnancy body mass index and related factors: A cross-sectional analysis from the Japan Environment and Children's Study. PLoS One 2024; 19:e0304844. [PMID: 38833493 PMCID: PMC11149848 DOI: 10.1371/journal.pone.0304844] [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: 01/17/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
Socioeconomic status and smoking are reportedly associated with underweight and obesity; however, their associations among pregnant women are unknown. This study aimed to investigate whether socioeconomic factors, namely educational attainment, household income, marital status, and employment status, were associated with pre-pregnancy body mass index (BMI) categories, including severe-moderate underweight (BMI ≤ 16.9 kg/m2), mild underweight (BMI, 17.0-18.4 kg/m2), overweight (BMI, 25.0-29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2) among Japanese pregnant women using data from the Japan Environment and Children's Study (JECS). In total, pregnant women were included 96,751. Age- and parity-adjusted multivariable multinomial logistic regression analyses assessed socioeconomic factors and smoking associations with falling within abnormal BMI categories (normal BMI as the reference group). Lower education and lower household were associated with overweight and obesity, and, especially, lowest education and household income had relatively higher point estimate relative ratios (RRs) of 3.97 and 2.84, respectively. Regarding the risks for underweight, however, only junior high school education had a significantly higher RR for severely to moderately underweight. Regarding occupational status, homemakers or the unemployed had a higher RR for severe-moderate underweight, overweight, and obesity. Unmarried, divorced, or bereaved women had significantly higher RRs for mildly underweight status. Quitting smoking early in pregnancy/still smoking had higher RRs for all four not having normal BMI outcomes; however, quitting smoking before pregnancy had a higher RR only for obese individuals. Lower educational attainment and smoking are essential intervention targets for obesity and severe-moderate underweight prevention in younger women. Lower household income is also a necessary target for obesity.
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Affiliation(s)
- Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Sapporo, Hokkaido, Japan
| | - Eiji Yoshioka
- Department of Social Medicine, Asahikawa Medical University, Sapporo, Hokkaido, Japan
| | - Yukihiro Sato
- Department of Social Medicine, Asahikawa Medical University, Sapporo, Hokkaido, Japan
| | - Yuki Kunori
- Department of Social Medicine, Asahikawa Medical University, Sapporo, Hokkaido, Japan
| | - Tomoko Kanaya
- Department of Social Medicine, Asahikawa Medical University, Sapporo, Hokkaido, Japan
| | - Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Ken Nagaya
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Hokkaido, Japan
| | - Hiroyoshi Iwata
- Center for Environmental and Health Sciences, Hokkaido University Sapporo, Hokkaido, Japan
| | - Takeshi Yamaguchi
- Center for Environmental and Health Sciences, Hokkaido University Sapporo, Hokkaido, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University Sapporo, Hokkaido, Japan
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University Sapporo, Hokkaido, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University Sapporo, Hokkaido, Japan
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Bégin V, Vergunst F, Haeck C, Vitaro F, Tremblay RE, Côté SM, Fontaine NMG. Childhood behavior problems and adverse economic outcomes: a 30-year population-based study of intergenerational income mobility. J Child Psychol Psychiatry 2024. [PMID: 38659297 DOI: 10.1111/jcpp.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The objectives of this study were to (a) assess the associations between early behavioral problems and intergenerational income mobility (i.e., the degree to which income status is transmitted from one generation to the next), (b) verify whether these associations are moderated by child sex, and (c) explore indirect effects of early behavioral problems on income mobility via high school graduation. METHODS Data were drawn from the Quebec Longitudinal Study of Kindergarten Children (n = 3,020; 49.17% girls). Participants were followed from age 6 to 37 years. Measures included parents' and teachers' ratings of behavioral problems at age 6 years as well as participants' (ages 30-35 years) and their parents' (when participants were aged 10-19 years) income data obtained from tax return records. Regression models were used to predict upward and downward mobility (i.e., increased or decreased income status from one generation to the next) from attention-deficit/hyperactivity problems, conduct/opposition problems, depression/anxiety problems, prosociality, and the quality of children's relationship with their caregiver. Two-way interaction effects between behavioral problems and child sex were examined and indirect effect models including high school graduation as a mediator of these associations were conducted. RESULTS Despite their higher educational attainment, females had lower incomes and experienced lower upward (but higher downward) income mobility than males. For both females and males, higher levels of attention-deficit/hyperactivity and conduct/opposition problems were associated with decreased odds of upward mobility, whereas higher levels of attention-deficit/hyperactivity were associated with increased odds of downward mobility. Attention-deficit/hyperactivity problems, conduct/opposition problems as well as low prosociality were associated with lower educational attainment (no high school diploma), which in turn was associated with increased odds of downward mobility. CONCLUSIONS Results highlight the importance of providing intensive support to children with early behavioral problems as a means of improving educational attainment and intergenerational income mobility.
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Affiliation(s)
- Vincent Bégin
- Department of Psychoeducation, University of Sherbrooke, Sherbrooke, QC, Canada
- Group for Research and Intervention on Children's Social Adjustment, Sherbrooke, QC, Canada
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
| | - Francis Vergunst
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- Special Needs Education, University of Oslo, Oslo, Norway
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
- School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Catherine Haeck
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- Research Group on Human Capital, Montreal, QC, Canada
- Department of Economics, Université du Québec à Montréal, Montreal, QC, Canada
| | - Frank Vitaro
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
- School of Psychoeducation, University of Montreal, Montreal, QC, Canada
| | - Richard E Tremblay
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
- School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland
| | - Sylvana M Côté
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
- School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Nathalie M G Fontaine
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
- School of Criminology, University of Montreal, Montreal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage, Montreal, QC, Canada
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Elovainio M, Komulainen K, Hakulinen C, Pahkala K, Rovio S, Hutri N, Raitakari OT, Pulkki-Råback L. Intergenerational continuity of loneliness and potential mechanisms: Young Finns Multigenerational Study. Sci Rep 2024; 14:5465. [PMID: 38443584 PMCID: PMC10915156 DOI: 10.1038/s41598-024-56147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/01/2024] [Indexed: 03/07/2024] Open
Abstract
Evidence on the intergenerational continuity of loneliness and on potential mechanisms that connect loneliness across successive generations is limited. We examined the association between loneliness of (G0) parents (859 mothers and 570 fathers, mean age 74 years) and their children (G1) (433 sons and 558 daughters, mean age 47 years) producing 991 parent-offspring pairs and tested whether these associations were mediated through subjective socioeconomic position, temperament characteristics, cognitive performance, and depressive symptoms. Mean loneliness across parents had an independent effect on their adult children's experienced loneliness (OR = 1.72, 95% CI 1.23-2.42). We also found a robust effect of mothers' (OR = 1.64, 95% CI 1.17-2.29), but not of fathers' loneliness (OR = 1.47, 95% CI 0.96-2.25) on offspring's experienced loneliness in adulthood. The associations were partly mediated by offspring depressive (41-54%) and anxiety (29-31%) symptoms. The current findings emphasize the high interdependence of loneliness within families mediated partly by offspring's mental health problems.
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Affiliation(s)
- Marko Elovainio
- Research Program Unit, Faculty of Medicine (Department of Psychology), University of Helsinki, Haartmaninkatu 3, P.O.Box 63, 00014, Helsinki, Finland.
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland.
| | - Kaisla Komulainen
- Research Program Unit, Faculty of Medicine (Department of Psychology), University of Helsinki, Haartmaninkatu 3, P.O.Box 63, 00014, Helsinki, Finland
| | - Christian Hakulinen
- Research Program Unit, Faculty of Medicine (Department of Psychology), University of Helsinki, Haartmaninkatu 3, P.O.Box 63, 00014, Helsinki, Finland
| | - Katja Pahkala
- Department of Public Health, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Suvi Rovio
- Department of Public Health, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Nina Hutri
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli T Raitakari
- Department of Public Health, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Laura Pulkki-Råback
- Research Program Unit, Faculty of Medicine (Department of Psychology), University of Helsinki, Haartmaninkatu 3, P.O.Box 63, 00014, Helsinki, Finland
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7
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O'Hara HM. The Work, Play, and Worship Environments as Social Determinants of Health. Prim Care 2023; 50:621-631. [PMID: 37866835 DOI: 10.1016/j.pop.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Consideration of the definition of the social determinants of health (SDOHs) requires health care to include work, play, and worship environments because they are important to the health of patients and communities. This article attempts to discuss the issues with limited focus on these areas and the importance of using multidisciplinary health-care teams during primary care visits. The expectation from this information is to advance the ability for primary care providers to support patients and the communities they work in to effect change toward decreasing health disparities and enhancing overall health outcomes.
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Affiliation(s)
- Heather M O'Hara
- Memorial Occupational Health Clinic, 2120 North 27th Street, Decatur, IL 62526, USA.
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Berk M, Köhler-Forsberg O, Turner M, Penninx BWJH, Wrobel A, Firth J, Loughman A, Reavley NJ, McGrath JJ, Momen NC, Plana-Ripoll O, O'Neil A, Siskind D, Williams LJ, Carvalho AF, Schmaal L, Walker AJ, Dean O, Walder K, Berk L, Dodd S, Yung AR, Marx W. Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry 2023; 22:366-387. [PMID: 37713568 PMCID: PMC10503929 DOI: 10.1002/wps.21110] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.
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Affiliation(s)
- Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Megan Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Loughman
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Adam J Walker
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ken Walder
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
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9
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Nath S, Sethi S, Bastos JL, Constante HM, Mejia G, Haag D, Kapellas K, Jamieson L. The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis. Caries Res 2023; 57:485-508. [PMID: 37734332 DOI: 10.1159/000533565] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5-11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (d > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger's test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.
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Affiliation(s)
- Sonia Nath
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - João L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Helena M Constante
- Department of Sociological Studies, The University of Sheffield, Sheffield, UK
| | - Gloria Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Dandara Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Kostas Kapellas
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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10
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Cheng TL, Mistry KB. Clarity on Disparity: Who, What, When, Where, Why, and How. Pediatr Clin North Am 2023; 70:639-650. [PMID: 37422305 DOI: 10.1016/j.pcl.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
This article offers a framework of who, what, when, where, why, and how of health disparities that can serve as a systematic approach to move from description to understanding causes and taking action to ensure health equity.
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Affiliation(s)
- Tina L Cheng
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue. MLC 3016, Cincinnati, OH, USA.
| | - Kamila B Mistry
- US Department of Health and Human Services, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Room 06N03, Rockville, MD, USA; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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11
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Cheng TL, Glauser TA, Reed A. The evolving model of pediatric research. Pediatr Res 2023:10.1038/s41390-023-02677-0. [PMID: 37400540 DOI: 10.1038/s41390-023-02677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Tina L Cheng
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Tracy A Glauser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ann Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
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12
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McCabe R, Katikireddi SV, Dundas R, Craig P. The health impact of Scotland's Baby Box Scheme: a natural experiment evaluation using national linked health data. Lancet Public Health 2023; 8:e504-e510. [PMID: 37393089 PMCID: PMC10323308 DOI: 10.1016/s2468-2667(23)00121-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Scotland's Baby Box Scheme (SBBS) is a national programme offering a box of essential items to all pregnant women in Scotland intended to improve infant and maternal health. We aimed to evaluate the effect of SBBS on selected infant and maternal health outcomes at population and subgroup levels (maternal age and area deprivation). METHODS Our complete-case, intention-to-treat evaluation used national health data (from the Scottish Morbidity Record [SMR] 01, SMR02, and the Child Health Surveillance Programme-Pre School), linking birth records to postnatal hospitalisation and universal health visitor records in Scotland. We considered maternal-infant pairs of all live-singleton births 2 years either side of SBBS introduction (Aug 17, 2015, to Aug 11, 2019). We estimated step-changes and trend-changes in outcomes (hospital admission and self-reported exclusive breastfeeding, tobacco smoke exposure, and infant sleeping position) by week of birth using segmented Poisson regression, adjusting for over-dispersion and seasonality where necessary. FINDINGS The analysis comprised 182 122 maternal-infant pairs. The prevalence of tobacco smoke exposure reduced after SBBS introduction: step decrease of 10% (prevalence ratio 0·904 [95% CI 0·865-0·946]; absolute decrease of 1·6% 1 month post-introduction) for infants and 9% (0·905 [0·862-0·950]; absolute decrease of 1·9% 1 month post-introduction) for the primary carer. There was no evidence of changes in infant and maternal all-cause hospital admissions or infant sleeping position. Among mothers younger than 25 years, there was a 10% step-increase in breastfeeding prevalence (1·095 [1·004-1·195]; absolute increase of 2·2% 1 month post-introduction) at 10 days and 17% (1·174 [1·037-1·328]) at 6-8 weeks postnatal. Although associations were robust to most sensitivity analyses, for smoke exposure associations were only observed early in the postnatal period. INTERPRETATION SBBS reduced infant and primary carer tobacco smoke exposure, and increased breastfeeding among young mothers in Scotland. However, absolute effects were small. FUNDING Medical Research Council, Scottish Government Chief Scientist Office, and National Records of Scotland.
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Affiliation(s)
- Ronan McCabe
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | | | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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13
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Wagner K, Wienke A, Gröger C, Klusmann JH, Führer A. Segregated by Wealth, Health, and Development: An Analysis of Pre-School Child Health in a Medium-Sized German City. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050865. [PMID: 37238412 DOI: 10.3390/children10050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
The School Entry Examination (SEE) can be used to identify children with current health issues, developmental delays, and risk factors for later diseases. This study analyzes the health status of preschool children in a German city with considerable socio-economic differences among its quarters. We used secondary data from SEEs 2016-2019 from the entire city (8417 children), which we divided into quarters with low (LSEB), medium (MSEB), and high socioeconomic burden (HSEB). In HSEB quarters, 11.3% of children were overweight as opposed to 5.3% in LSEB quarters. In HSEB quarters, 17.2% of children had sub-par cognitive development in contrast to 1.5% in LSEB quarters. For overall sub-par development, LSEB quarters had a prevalence of 3.3%, whereas, in HSEB quarters, 35.8% of children received this result. Logistic regression was used to determine the influence of the city quarter on the outcome of overall sub-par development. Here, considerable disparities among HSEB and LSEB quarters remained after adjustment for parents' employment status and education. Pre-school children in HSEB quarters showed a higher risk for later disease than children in LSEB quarters. The city quarter had an association with child health and development that should be considered in the formulation of interventions.
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Affiliation(s)
- Karoline Wagner
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | | | | | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
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14
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Johnson LW, Diaz I. Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review. Brain Sci 2023; 13:brainsci13050707. [PMID: 37239178 DOI: 10.3390/brainsci13050707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is a global health concern, that can leave lasting physical, cognitive, and/or behavioral changes for many who sustain this type of injury. Because of the heterogeneity of this population, development of appropriate intervention tools can be difficult. Social determinants of health (SDoH) are factors that may impact TBI incidence, recovery, and outcome. The purpose of this study is to describe and analyze the existing literature regarding the prevailing SDoH and health disparities (HDs) associated with TBI in adults. A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to explore three electronic databases-PubMed, Medline, and CINAHL. Searches identified peer-reviewed empirical literature addressing aspects of SDoH and HDs related to TBI. A total of 123 records were identified and reduced to 27 studies based on inclusion criteria. Results revealed race/ethnicity was the most commonly reported SDoH impacting TBI, followed by an individual's insurance status. Health disparities were noted to occur across the continuum of TBI, including TBI risk, acute hospitalization, rehabilitation, and recovery. The most frequently reported HD was that Whites are more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities. Health disparities associated with TBI are most commonly associated with the race/ethnicity SDoH, though insurance status and socioeconomic status commonly influence health inequities as well. The additional need for evidence related to the impact of other, lesser researched, SDoH is discussed, as well as clinical implications that can be used to target intervention for at-risk groups using an individual's known SDoH.
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Affiliation(s)
- Leslie W Johnson
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
| | - Isabella Diaz
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
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15
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Developmental inflection point for the effect of maternal childhood adversity on children's mental health from childhood to adolescence: Time-varying effect of gender differences. Dev Psychopathol 2023; 35:447-458. [PMID: 35249575 PMCID: PMC9448830 DOI: 10.1017/s0954579421001486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Childhood adversities have a well-established dose-response relationship with later mental health. However, less attention has been given to intergenerational influences. Further, it is unknown how intergenerational influences intersect with children's developmental stages and gender. The current study examined whether a developmental inflection point exists when the intergenerational influences of childhood adversities gain salience and explored differences by children's gender. Data were from the Young Women and Child Development Study (n = 361). Time-varying effect models (TVEMs) and moderation TVEMs by child's gender were evaluated. Our findings reveal that ages 5-8, the period of transition into primary schools, may represent a developmental inflection point when the intergenerational influences of maternal childhood adversity start emerging substantially. The results from gender interaction TVEMs reveal that maternal childhood adversity was a statistically significant predictor of internalizing problems until age 11, regardless of child's gender, and remained statistically significant for girls' internalizing problems until age 16.7. For externalizing problems, maternal childhood adversity was a statistically significant predictor until age 13, regardless of gender.
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16
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Shah AN, Rasnick E, Bhuiyan MA, Wolfe C, Bosse D, Simmons JM, Shah SS, Brokamp C, Beck AF. Using Geomarkers and Sociodemographics to Inform Assessment of Caregiver Adversity and Resilience. Hosp Pediatr 2022; 12:689-695. [PMID: 35909177 DOI: 10.1542/hpeds.2021-006121] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A high level of caregiver adverse childhood experiences (ACEs) and/or low resilience is associated with poor outcomes for both caregivers and their children after hospital discharge. It is unknown if sociodemographic or area-based measures (ie, "geomarkers") can inform the assessment of caregiver ACEs or resilience. Our objective was to determine if caregiver ACEs or resilience can be identified by using any combinations of sociodemographic measures, geomarkers, and/or caregiver-reported household characteristics. METHODS Eligible participants for this cohort study were English-speaking caregivers of children hospitalized on a hospital medicine team. Caregivers completed the ACE questionnaire, Brief Resilience Scale, and strain surveys. Exposures included sociodemographic characteristics available in the electronic health record (EHR), geomarkers tied to a patient's geocoded home address, and household characteristics that are not present in the EHR (eg, income). Primary outcomes were a high caregiver ACE score (≥4) and/or a low BRS Score (<3). RESULTS Of the 1272 included caregivers, 543 reported high ACE or low resilience, and 63 reported both. We developed the following regression models: sociodemographic variables in EHR (Model 1), EHR sociodemographics and geomarkers (Model 2), and EHR sociodemographics, geomarkers, and additional survey-reported household characteristics (Model 3). The ability of models to identify the presence of caregiver adversity was poor (all areas under receiver operating characteristics curves were <0.65). CONCLUSIONS Models using EHR data, geomarkers, and household-level characteristics to identify caregiver adversity had limited utility. Directly asking questions to caregivers or integrating risk and strength assessments during pediatric hospitalization may be a better approach to identifying caregiver adversity.
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Affiliation(s)
- Anita N Shah
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Mohammad An Bhuiyan
- Division of Clinical Informatics, Department of Medicine, Louisiana State University Health Sciences Center
| | | | | | - Jeffrey M Simmons
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Samir S Shah
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Andrew F Beck
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine
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17
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Oh H, Nagendra A, Besecker M, Smith L, Koyanagi A, Wang JSH. Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020. Early Interv Psychiatry 2022; 16:770-781. [PMID: 34469041 DOI: 10.1111/eip.13221] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/15/2021] [Indexed: 01/14/2023]
Abstract
AIM Socioeconomic status (SES) is linked to psychosis, and much can be learned by examining how various indicators of SES-specifically economic strain and intergenerational transfer of resources-are related to sub-threshold psychotic experiences among college students. METHODS Using data from the Healthy Minds Survey (September 2020-December 2020), we used multivariable logistic regression models to examine the associations between five SES indicators and 12-month psychotic experiences, adjusting for age, gender and race/ethnicity. We also examined the count of predictors and psychotic experiences. RESULTS Each indicator of economic strain was associated with greater odds of psychotic experiences. In particular, increasing levels of financial stress (current, childhood and pandemic-related) were associated with greater odds of psychotic experiences in a dose-response fashion. Food insecurity was associated with double the odds of psychotic experiences. In terms of intergenerational transfer of resources, having either one or no parents who attended college was associated with significantly greater odds of having psychotic experiences, when compared with having both parents who attended college. Examining all predictors in the same model, only childhood and current financial stress and food insecurity were significantly associated with psychotic experiences. The count of predictors was significantly associated with greater odds of having psychotic experiences in a dose-dependent fashion. CONCLUSIONS Among college students, economic strain and intergenerational transfer of resources were associated with recent psychotic experiences, highlighting the importance of economic interventions targeting young adults to influence risk for psychosis.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Arundati Nagendra
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Julia Shu-Huah Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam Road, Hong Kong
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18
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Intergenerational Transmission of Obesity from Mothers to Their Offspring: Trends and Associated Factors Derived from the Malaysian National Health and Morbidity Survey (NHMS). Nutrients 2022; 14:nu14112186. [PMID: 35683986 PMCID: PMC9182489 DOI: 10.3390/nu14112186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Along with the increasing overweight and obesity trends among adults and children globally, numerous studies have suggested a strong association between maternal overweight and obesity among their offspring. We sought to report the prevalence and associated factors of intergenerational overweight and obesity among mother–child pairs in Malaysia from 2006 to 2015. Data were analysed from three waves of the Malaysian National Health and Morbidity Survey, a population-based cross-sectional study conducted in 2006, 2011 and 2015. A mother and the youngest child from each household formed ‘mother–child pairs’ and were grouped according to their body mass index categories. A multivariable logistic regression model was performed to determine the factors associated with overweight mother/overweight child pairs (OWM/OWC), with normal weight mother/normal weight child pairs (NWM/NWC) as the reference group. The prevalence of OWM/OWC increased from 15.3% to 21.7%, while the prevalence of NWM/NWC decreased from 28.4% to 23.8% between 2006 and 2015. Older maternal age and having primary and secondary education levels were positively associated with OWM/OWC. Conversely, older child age, Chinese ethnicity, large household size and low-income households were inversely associated with OWM/OWC. In conclusion, intergenerational weight gain is a worrisome trend in Malaysia. These findings may help in guiding priority setting for obesity prevention strategies in Malaysia.
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19
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Huizar MI, Alman R, Arena R, Laddu DR. The path forward: Highlighting social justice pearls in public health campaigns and initiatives to deliver equitable healthy living medicine. Prog Cardiovasc Dis 2022; 71:51-57. [PMID: 35490868 DOI: 10.1016/j.pcad.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
The prevalence of unhealthy living behaviors is largely driven by environments that support them and has become a key concern at global, national, and individual (patient) levels. Healthy Living Medicine offers a compelling path forward to move people towards healthy living behaviors and better health outcomes when complemented by socially just and equitable public campaigns and initiatives. Some of the concepts that are critical for these campaigns and initiatives that will be discussed in this manuscript include the social determinants of health, the communication loop, health literacy, and implicit bias and discrimination. Considering what is practical and achievable, examples of actionable, socially-just strategies will be described to inform and encourage health professionals and other stakeholders to prioritize healthy living and reverse the poor health trajectory among our most vulnerable populations.
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Affiliation(s)
- Martha I Huizar
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Rocio Alman
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Deepika R Laddu
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
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20
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Sow M, Raynault MF, De Spiegelaere M. Associations between socioeconomic status and pregnancy outcomes: a greater magnitude of inequalities in perinatal health in Montreal than in Brussels. BMC Public Health 2022; 22:829. [PMID: 35468779 PMCID: PMC9040289 DOI: 10.1186/s12889-022-13165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Comparing health inequalities between countries helps us to highlight some factors specific to each context that contribute to these inequalities, thus contributing to the identification of courses of action likely to reduce them. This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal (in general population, natives-born mothers, and immigrant mothers). Methods A population-based study examining associations between SES and pregnancy outcomes was conducted in each city, using administrative databases from Belgian and Quebec birth records (N = 97,844 and 214,620 births in Brussels and Montreal, respectively). Logistic regression models were developed in order to estimate the relationship between SES (maternal education and income quintile) and pregnancy outcomes, in each region. The analyses were first carried out for all births, then stratified according to the mother’s origin. Results For the general population, SES is associated with LBW and preterm birth in both regions, except for income and preterm birth in Brussels. The association is stronger for mothers born in Belgium and Canada than for those born abroad. The main difference between the two regions concerns the magnitude of inequalities in perintal health, which is greater in Montreal than in Brussels among the general population. For native-born mothers, the magnitude of inequalities in perinatal health is also greater for mothers born in Canada than for those born in Belgium, except for the association between income and preterm birth. The socioeconomic gradient in perinatal health is less marked among immigrant mothers than native mothers. Conclusion Significant differences in inequalities in perinatal health are observed between Brussels and Montreal. These differences can be explained by : on the one hand, the existence of greater social inequalities in Montreal than in Brussels and, on the other hand, the lower vulnerability of immigrants with low SES in Brussels. Future studies seeking to understand the mechanisms that lead to inequalities in health in different contexts should take into account a comparison of immigration and poverty contexts, as well as the public policies related to these factors.
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Affiliation(s)
- Mouctar Sow
- School of Public Health, University of Montreal, Quebec, Canada. .,Université Libre de Bruxelles, École de santé publique, Brussels, Belgium. .,Lea-Roback Research Centre on Social Inequalities in Health, CRCHUM, Quebec, Canada.
| | - Marie-France Raynault
- School of Public Health, University of Montreal, Quebec, Canada.,Lea-Roback Research Centre on Social Inequalities in Health, CRCHUM, Quebec, Canada
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21
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O'Connor M, Guo S, Letcher P, Sanson A, Goldfeld S, Olsson CA. Developmental relationships between socio-economic disadvantage and mental health across the first 30 years of life. LONGITUDINAL AND LIFE COURSE STUDIES : INTERNATIONAL JOURNAL 2022; 13:432-453. [PMID: 35920645 DOI: 10.1332/175795921x16459587898770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Understanding of how socio-economic disadvantage experienced over the life course relates to mental health outcomes in young adulthood has been limited by a lack of long-term, prospective studies. Here we address this limitation by drawing on data from a large Australian population cohort study that has followed the development of more than 2,000 Australians (and their families) from infancy to young adulthood since 1983. Associations were examined between prospective assessments of socio-economic position (SEP) from 4-8 months to 27-28 years and mental health problems (depression, anxiety, stress) and competence (civic engagement, emotional maturity, secure intimate relationship) at 27-28 years. The odds of being socio-economically disadvantaged in young adulthood were elevated eight- to tenfold in those who had experienced disadvantage in the family of origin, compared with those who had not (OR 8.1, 95% CI 4.5-14.5 to 10.1, 95% CI 5.2-19.5). Only concurrent SEP was associated with young adult mental health problems, and this effect was limited to anxiety symptoms (OR 2.0, 95% CI 1.1-3.9). In contrast, SEP had more pervasive impacts on young adult competence, particularly in the civic domain where effects were evident even from early infancy (OR 0.46, 95% CI 0.26-0.81). Findings suggest that one potentially important mechanism through which disadvantage compromises mental health is through limiting the development and consolidation of key psychosocial competencies needed for health and well-being in adulthood.
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Affiliation(s)
| | - Shuaijun Guo
- University of Melbourne and Royal Children's Hospital, Australia
| | - Primrose Letcher
- Deakin University, University of Melbourne and Royal Children's Hospital,Australia
| | | | - Sharon Goldfeld
- University of Melbourne and Royal Children's Hospital, Australia
| | - Craig A Olsson
- Deakin University and Royal Children's Hospital, Australia
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22
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Estrada LV, Resendez J, Perez GA. The Role of National Paid Family and Medical Leave Policies in Promoting Health Equity for Older Adults and Their Caregivers. J Gerontol Nurs 2022; 48:5-10. [PMID: 35201922 PMCID: PMC9017763 DOI: 10.3928/00989134-20220209-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More than 48 million unpaid family/friend caregivers in the United States provide care to older adults. This unpaid workforce provides essential support for family members or friends who have a serious, long-term illness or disability. However, family caregivers are often under supported, which contributes to negative health, economic, and psychological consequences. Despite the significant contributions of family caregivers, there are limited policy supports aimed at alleviating the hardships of care on this growing community. National paid family and medical leave policy in particular holds substantial potential to alleviate the compounding burdens faced by family caregivers and address systemic inequities that contribute to disproportionately poorer caregiving outcomes among historically marginalized older adults and their caregivers. The purpose of the current article is to provide an overview of the economic burdens and caregiving-related health disparities experienced by Black/African American and Hispanic/Latinx family caregivers and discuss the impact of paid leave policies on the overall health and well-being of older adults. We propose a "Call to Action" for gerontological nurses to work in partnership with transdisciplinary colleagues, stakeholders, and advocates to ensure all family care-givers have access to paid leave. [Journal of Gerontological Nursing, 48(3), 5-10.].
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Affiliation(s)
- Leah V. Estrada
- Center for Health Policy, Columbia University School of Nursing, 560 W. 168 Street, New York, NY
| | | | - G. Adriana Perez
- Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing, Philadelphia, PA
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23
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Johnson SB, Raghunathan RS, Li M, Nair D, Matson PA. Moving up but not getting ahead: Family socioeconomic position in pregnancy, social mobility, and child cognitive development in the first seven years of life. SSM Popul Health 2022; 17:101064. [PMID: 35313608 PMCID: PMC8933511 DOI: 10.1016/j.ssmph.2022.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Understanding when and how socioeconomic position (SEP) influences cognitive development is key to reducing population inequalities in health and achievement. The objective of this study was to determine the unique association between prenatal family SEP and child cognitive development, and to determine whether marked postnatal social mobility was associated with improvements in child cognitive performance to age 7. Methods Data were from children enrolled in the US National Collaborative Perinatal Project (NCPP) (n = 28,761) during 1959-1965, a dataset large enough to observe marked mobility, which remains uncommon. Multivariable linear regression was used to examine the relationship between SEP (i.e., parental income, education, occupation) during gestation and cognitive performance at 8 months (Bayley Scales of Infant Development Mental Development Index) and at 7 years (Wechsler Intelligence Scale for Children). Results Holding demographic and perinatal factors constant, family SEP during gestation was not associated with cognitive performance at 8 months (B = -0.03, 95% CI: -0.07-0.01) but was positively associated with performance at 7 years even after accounting for SEP at 7 years (B = 1.28, 95% CI: 1.11-1.45). Children whose families experienced the most extreme upward mobility (from the lowest to highest income quartile) showed a 12 percentile increase in cognitive performance in the first 7 years of life. Those with the most extreme downward mobility (from the highest to lowest income quartile) still experienced an 8 percentile increase in cognitive performance in this interval. Conclusions The proportion of children in poverty today is similar to 1965 and intergenerational mobility has declined markedly. Prenatal SEP may contribute to inequalities in child cognitive performance that even extraordinary social mobility cannot erase. To optimize cognitive development across generations, current means-tested programs to support families with young children should be supplemented by universal approaches to ensure access to opportunity before young people become parents.
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Affiliation(s)
- Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Division of General Pediatrics, Baltimore, MD, USA
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Radhika S. Raghunathan
- Department of Pediatrics, Johns Hopkins School of Medicine, Division of General Pediatrics, Baltimore, MD, USA
| | - Mengying Li
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Divya Nair
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Pamela A. Matson
- Department of Pediatrics, Johns Hopkins School of Medicine, Division of General Pediatrics, Baltimore, MD, USA
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Kamimura A, Higham R, Panahi S, Lee E, Griffin RJ, Sundrud J, Lucero M. How Food Insecurity and Financial Difficulty Relate to Emotional Well-Being and Social Functioning. South Med J 2021; 115:1-7. [PMID: 34964052 DOI: 10.14423/smj.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Medically uninsured individuals living in poverty experience poor health and face social barriers that negatively affect their health. The purpose of this study was to examine the association between social barriers, particularly healthy food availability and financial difficulty, and well-being among uninsured free clinic patients in the United States. METHODS Data were collected using a self-administered paper survey at a free clinic from adult patients who spoke and read English or Spanish (N = 666) from January to April 2019. RESULTS Better neighborhood healthy food availability is associated with better self-reported general health. Food security is related to better emotional well-being and social functioning. Having difficulty paying rent or a mortgage is linked to worse emotional well-being and social functioning. CONCLUSIONS Providing health education programs may not be sufficient to promote healthy eating among underserved populations because of the social barriers that they experience, such as food insecurity and financial difficulty. Future research could be performed to determine how these social factors influence those of different social and cultural backgrounds than the participants in this study.
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Affiliation(s)
- Akiko Kamimura
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Rebecca Higham
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Samin Panahi
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Edward Lee
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Rachel J Griffin
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Justine Sundrud
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
| | - Mary Lucero
- From the Department of Sociology, the Division of Public Health, the School of Medicine, and the Maliheh Free Clinic, University of Utah, Salt Lake City, and the Keck School of Medicine, University of Southern California, Los Angeles
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Bradley RH, Bryce CI. The Role of Parents in Reducing Academic, Health, and Behavioral Problems for Native American, African American, and Latinx Adolescents. J Dev Behav Pediatr 2021; 42:726-733. [PMID: 34840316 DOI: 10.1097/dbp.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine how parental modeling of thoughtful behavior and the home physical environment may reduce the number of developmental problems exhibited by Native American, African American, and Latinx adolescents. METHOD Demographic and home environmental data were collected from 54 Native American, 131 African American, and 159 Latinx families living in 4 states as part of a home visit. Parents and adolescents were administered surveys that captured adolescent health, social skills, problem behavior, self-efficacy beliefs, vocabulary attainment, and school grades. Scores from the surveys were combined to construct both an adolescent problems index and a household risk index. For each of the 3 racial/ethnic groups examined, the adolescent problems index was regressed on parental modeling and encouragement of mature behavior, the home physical environment, and the household risk index. RESULTS Modeling and encouragement of mature behavior was a significant bivariate predictor of overall problems in all 3 groups of adolescents-albeit the overall regression model was nonsignificant for Native Americans. By contrast, the other 2 predictors were nonsignificant in regression models for all 3 groups. CONCLUSION Native American, African American, and Latinx adolescents often face a multitude of risks, including poverty and discrimination. As a consequence, adolescents from these 3 racial/ethnic groups frequently display problems pertaining to health, competence, and adaptive behavior. The results from this study suggest that adolescents from such demographic groups are less likely to manifest developmental problems if their parents model mature behavior and encourage the adolescent to act in thoughtful ways.
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Affiliation(s)
- Robert H Bradley
- Center for Child and Family Success, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ
| | - Crystal I Bryce
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ
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26
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Devlin S, Ross W, Widders R, McAvoy G, Browne K, Lawrence K, MacLaren D, Massey PD, Judd JA. Tuberculosis care designed with barramarrany (family): Participatory action research that prioritised partnership, healthy housing and nutrition. Health Promot J Austr 2021; 33:724-735. [PMID: 34743380 PMCID: PMC9542773 DOI: 10.1002/hpja.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/04/2021] [Accepted: 11/02/2021] [Indexed: 01/13/2023] Open
Abstract
Issue addressed. Ongoing tuberculosis (TB) transmission in Aboriginal communities in Australia is unfair and unacceptable. Redressing the inequity in TB affecting Aboriginal peoples is a priority in Australia's Strategic Plan for Tuberculosis Control. Improving TB care needs not to just identify barriers but do something about them. Privileging the voices of Aboriginal people affected by TB is essential to identify effective and enabling strategies.
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Affiliation(s)
- Sue Devlin
- North Coast Public Health Unit, New South Wales, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Wayne Ross
- Traditional Knowledge Custodian of the Gumanyggirr Nation, New South Wales, Australia
| | | | - Gregory McAvoy
- North Coast Public Health Unit, New South Wales, Australia
| | - Kirsty Browne
- North Coast Public Health Unit, New South Wales, Australia
| | | | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Peter D Massey
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jenni A Judd
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Centre of Indigenous Health Equity Research, Central Queensland University, Bundaberg, Queensland, Australia
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Rahman MA, Halder HR, Rahman MS, Parvez M. Poverty and childhood malnutrition: Evidence-based on a nationally representative survey of Bangladesh. PLoS One 2021; 16:e0256235. [PMID: 34424928 PMCID: PMC8382176 DOI: 10.1371/journal.pone.0256235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malnutrition contributes to children's morbidity and mortality, and the situation undermines the economic growth and development of Bangladesh. Malnutrition is associated with lower levels of education that decrease economic productivity and leads to poverty. The global burden of malnutrition continues to be unacceptably high amid social and economic growth, including in Bangladesh. Therefore, identifying the factors associated with childhood malnutrition and poverty is necessary to stop the vicious cycle of malnutrition leaded poverty. METHODS The study utilized the 2017-18 Bangladesh Demographic and Health Survey (BDHS), accumulating 7,738 mother-child pairs. Associations between potential risk factors and nutritional status were determined using chi-square tests, and multivariate logistic regression models were utilized on significant risk factors to measure their odds ratio (OR) with their 95% confidence intervals (CI). RESULTS The prevalence of moderate and severe wasting was 7.0% and 1.8%, respectively, whereas the prevalence of moderate and severe stunting was 19.2% and 8.0%, while 16.4% and 3.6% of children were moderately and severely underweight. Children from the poorest and poor households were suffering from at least one form of malnutrition. Adjusted ORs were estimated by controlling socio-economic and demographic risk factors, such as poor maternal body mass index, parents' lower education level, use of unhygienic toilet, child age in months, and recent experience of diarrhea and fever. The pattern was almost similar for each malnutrition status (i.e., stunting, underweight, and wasting) in the poorest and poor households. CONCLUSION Bangladesh achieved the Millennium Development Goals, focusing primarily on health-related indicators and working to achieve the Sustainable Development Goals. Even considering this success, the prevalence of malnutrition and poverty in same household remains relatively high compared to other developing countries. Therefore, the study recommends the implementation of nationwide systematic measures to prevent poverty and malnutrition.
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Affiliation(s)
- Md. Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Henry Ratul Halder
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Md. Sazedur Rahman
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mahmood Parvez
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Inequities in Children's Reading Skills: The Role of Home Reading and Preschool Attendance. Acad Pediatr 2021; 21:1046-1054. [PMID: 33933683 DOI: 10.1016/j.acap.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children. METHODS We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0-1 year) on children's reading skills (8-9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2-5 years) and preschool attendance (4-5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. RESULTS Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%-24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%-22.7%) higher risk of poor reading outcomes in absolute terms. CONCLUSION There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.
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Nationwide evidence that education disrupts the intergenerational transmission of disadvantage. Proc Natl Acad Sci U S A 2021; 118:2103896118. [PMID: 34312230 PMCID: PMC8346897 DOI: 10.1073/pnas.2103896118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We leveraged a three-generation approach in 2.1 million Danes to measure the transmission and disruption of multiple health and social disadvantages: poor physical health, poor mental health, social welfare dependency, criminal offending, and protective services involvement. Health and social disadvantages clustered within a small segment of families: Adults who relied disproportionately on multiple, different health and social services tended to have parents who relied disproportionately on multiple, different health and social services and tended to have children who appeared in protective services records. Education disrupted these statistical associations between and within generations and between and within families. If associations are causal, investing in young people’s education potential could interrupt the multigenerational cycle of disadvantage and reduce health and social inequalities. Despite overall improvements in health and living standards in the Western world, health and social disadvantages persist across generations. Using nationwide administrative databases linked for 2.1 million Danish citizens, we leveraged a three-generation approach to test whether multiple, different health and social disadvantages—poor physical health, poor mental health, social welfare dependency, criminal offending, and Child Protective Services involvement—were transmitted within families and whether education disrupted these statistical associations. Health and social disadvantages concentrated, aggregated, and accumulated within a small, high-need segment of families: Adults who relied disproportionately on multiple, different health and social services tended to have parents who relied disproportionately on multiple, different health and social services and tended to have children who evidenced risk for disadvantage at an early age, through appearance in protective services records. Intra- and intergenerational comparisons were consistent with the possibility that education disrupted this transmission. Within families, siblings who obtained more education were at a reduced risk for later-life disadvantage compared with their cosiblings who obtained less education, despite shared family background. Supporting the education potential of the most vulnerable citizens might mitigate the multigenerational transmission of multiple disadvantages and reduce health and social disparities.
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Chakrabarti S, Scott SP, Alderman H, Menon P, Gilligan DO. Intergenerational nutrition benefits of India's national school feeding program. Nat Commun 2021; 12:4248. [PMID: 34253719 PMCID: PMC8275765 DOI: 10.1038/s41467-021-24433-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/07/2021] [Indexed: 12/25/2022] Open
Abstract
India has the world's highest number of undernourished children and the largest school feeding program, the Mid-Day Meal (MDM) scheme. As school feeding programs target children outside the highest-return "first 1000-days" window, they have not been included in the global agenda to address stunting. School meals benefit education and nutrition in participants, but no studies have examined whether benefits carry over to their children. Using nationally representative data on mothers and their children spanning 1993 to 2016, we assess whether MDM supports intergenerational improvements in child linear growth. Here we report that height-for-age z-score (HAZ) among children born to mothers with full MDM exposure was greater (+0.40 SD) than that in children born to non-exposed mothers. Associations were stronger in low socioeconomic strata and likely work through women's education, fertility, and health service utilization. MDM was associated with 13-32% of the HAZ improvement in India from 2006 to 2016.
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Affiliation(s)
- Suman Chakrabarti
- grid.419346.d0000 0004 0480 4882Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
| | - Samuel P. Scott
- grid.419346.d0000 0004 0480 4882Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
| | - Harold Alderman
- grid.419346.d0000 0004 0480 4882Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
| | - Purnima Menon
- grid.419346.d0000 0004 0480 4882Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
| | - Daniel O. Gilligan
- grid.419346.d0000 0004 0480 4882Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
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Breton CV, Landon R, Kahn LG, Enlow MB, Peterson AK, Bastain T, Braun J, Comstock SS, Duarte CS, Hipwell A, Ji H, LaSalle JM, Miller RL, Musci R, Posner J, Schmidt R, Suglia SF, Tung I, Weisenberger D, Zhu Y, Fry R. Exploring the evidence for epigenetic regulation of environmental influences on child health across generations. Commun Biol 2021; 4:769. [PMID: 34158610 PMCID: PMC8219763 DOI: 10.1038/s42003-021-02316-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/03/2021] [Indexed: 02/08/2023] Open
Abstract
Environmental exposures, psychosocial stressors and nutrition are all potentially important influences that may impact health outcomes directly or via interactions with the genome or epigenome over generations. While there have been clear successes in large-scale human genetic studies in recent decades, there is still a substantial amount of missing heritability to be elucidated for complex childhood disorders. Mounting evidence, primarily in animals, suggests environmental exposures may generate or perpetuate altered health outcomes across one or more generations. One putative mechanism for these environmental health effects is via altered epigenetic regulation. This review highlights the current epidemiologic literature and supporting animal studies that describe intergenerational and transgenerational health effects of environmental exposures. Both maternal and paternal exposures and transmission patterns are considered, with attention paid to the attendant ethical, legal and social implications.
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Affiliation(s)
- Carrie V Breton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Remy Landon
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda G Kahn
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alicia K Peterson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa Bastain
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joseph Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Sarah S Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - Cristiane S Duarte
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Alison Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hong Ji
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, MIND Institute, Genome Center, University of California, Davis, Davis, CA, USA
| | | | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan Posner
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Rebecca Schmidt
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA
| | | | - Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel Weisenberger
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California and Department of Epidemiology and Biostatistics, University of California, San Francisco, Oakland, CA, USA
| | - Rebecca Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
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Pedroso J, Herkrath FJ, Buccini G, Venancio SI, Pérez-Escamilla R, Gubert MB. Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil. Food Nutr Bull 2021; 42:77-90. [PMID: 33878902 DOI: 10.1177/0379572120987815] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal early child development (ECD) is fundamental for every child to achieve their developmental potential and thrive. Household food insecurity (HFI) is a risk factor for suboptimal development, but there is still a need to better understand the pathways that explain this relationship. OBJECTIVE To evaluate whether maternal mental health and infant's diet mediate the association between HFI and ECD using structural equation modeling. METHODS Cross-sectional study with 474 mother-infant dyads. Mothers answered a questionnaire that evaluated variables through validated instruments. Structural equation modeling analyses were conducted to obtain standardized effects (β) and bias-corrected 95% CI, enabling comparisons between the magnitude of the effects. The following observed variables were included: HFI, ECD, consumption of a healthy and diverse diet, the presence of a partner in the household, wanted pregnancy, and current breastfeeding. Latent variables were included to evaluate mental health, poverty, and neonatal health. RESULTS Poor maternal mental health mediated the relationship between HFI and ECD (β = -.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower development scores directly (β = .21) and indirectly (β = .02). Not having a partner (β = .05) and having an unwanted pregnancy (β = .02) predicted indirectly lower development scores. CONCLUSIONS Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood, and unwanted pregnancy through different pathways. Therefore, public policies and interventions that aim to promote an optimal ECD should also approach these aspects.
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Affiliation(s)
- Jéssica Pedroso
- 28127University of Brasilia, Brasilia, Distrito Federal, Brazil
| | | | - Gabriela Buccini
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, USA
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Daines CL, Hansen D, Novilla MLB, Crandall A. Effects of positive and negative childhood experiences on adult family health. BMC Public Health 2021; 21:651. [PMID: 33820532 PMCID: PMC8022401 DOI: 10.1186/s12889-021-10732-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The objective of the study was to determine the association between adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with family health in adulthood. Prior research indicates that ACEs and PCEs affect individual physical and mental health in adulthood. However, little is known about how ACEs and PCEs affect family health. Families develop and function through patterns and routines which are often intergenerational. Therefore, a person's early experiences may influence their family's health in adulthood. METHOD A survey was administered to 1030 adults through Qualtrics, with participants recruited using quota-sampling to reflect the demographic characteristics of U.S. adults. Participants completed a survey about their childhood experiences, four domains of family health (family social and emotional health processes, family healthy lifestyle, family health resources, and family external social supports), and demographic characteristics. Data were analyzed using structural equation modeling. RESULTS After controlling for marriage, education, gender, race and age, ACEs were negatively associated with family social and emotional health processes and family health resources when accounting for PCEs; PCEs were positively associated with all four family health domains irrespective of ACEs. CONCLUSION Childhood experiences affect family health in adulthood in the expected direction. Even in the presence of early adversity, positive experiences in childhood can provide a foundation for creating better family health in adulthood.
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Affiliation(s)
- Chantel L Daines
- Department of Public Health, Brigham Young University, 4103 LSB, Provo, UT, 84602, USA
| | - Dustin Hansen
- Department of Public Health, Brigham Young University, 4103 LSB, Provo, UT, 84602, USA
| | - M Lelinneth B Novilla
- Department of Public Health, Brigham Young University, 4103 LSB, Provo, UT, 84602, USA
| | - AliceAnn Crandall
- Department of Public Health, Brigham Young University, 4103 LSB, Provo, UT, 84602, USA.
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Jensen TM, Duke NN, Harris KM, Hotz VJ, Perreira KM. Like Parent, Like Child: Intergenerational Patterns of Cardiovascular Risk Factors at Midlife. J Adolesc Health 2021; 68:596-603. [PMID: 32753345 PMCID: PMC7854782 DOI: 10.1016/j.jadohealth.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/04/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to assess the prevalence of four cardiovascular risk factors (obesity, diabetes, excessive alcohol intake, and cigarette smoking) for parents and their adult children at the same approximate midlife age. We also evaluated associations of parents' cardiovascular risk factors, childhood health exposures, and social contexts (i.e., family, school, and neighborhood) during adolescence with adult children's cardiovascular health at midlife. METHODS We used data from respondents at Wave V of the National Longitudinal Study of Adolescent to Adult Health who had corresponding parent (mostly mothers) data from Wave I. The final sample included 10,466 adult children with a mean age of 37.8 years. Descriptive statistics and logistic regression models were estimated, accounting for the National Longitudinal Study of Adolescent to Adult Health sampling design. RESULTS At similar ages (i.e., 35-45 years) to their parents, adult children had higher rates of excessive drinking and obesity than their parents, lower rates of diabetes, and similar rates of smoking. Adult children's health largely converged and correlated with their parents' health at similar ages. Cardiovascular risks for adult children were also significantly associated with their childhood health exposures and social contexts during adolescence. Some associations varied with respect to the health status of parents at Wave I. CONCLUSIONS The cardiovascular risk of parents at midlife is strongly associated with the cardiovascular risk of their adult children at midlife. The status of parents' health during adolescence can also modify the significance and magnitude of associations between childhood health exposures or adolescent social contexts and adult children's cardiovascular risk factors.
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Affiliation(s)
- Todd M Jensen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Naomi N Duke
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Kathleen Mullan Harris
- Department of Sociology & Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - V Joseph Hotz
- Department of Economics, Duke University, Durham, North Carolina
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why? Int J Integr Care 2020; 20:22. [PMID: 33335463 PMCID: PMC7716786 DOI: 10.5334/ijic.5437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients’ sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.
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Barnes MD, Hanson CL, Novilla LB, Magnusson BM, Crandall AC, Bradford G. Family-Centered Health Promotion: Perspectives for Engaging Families and Achieving Better Health Outcomes. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020923537. [PMID: 32500768 PMCID: PMC7278332 DOI: 10.1177/0046958020923537] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Communities and populations are comprised of individuals and families who together affect the health of the community. The family unit is an unparalleled player for maintaining health and preventing disease for public health because members may support and nurture one another through life stages. Preliminary research confirms that family-oriented health promotion and disease prevention are promising strategies because the family unit is both a resource and a priority group needing preventative and curative services across the life course. Although there are growing numbers of successful efforts, family health systems are generally underutilized in health promotion practice. This lack of utilization in policy and practice have hampered the collection of robust evidence for family health. This paper purports that families are important actors in public health. Yet, since no one pattern for healthy families is known, public health practitioners can consider six principle-based approaches to legitimately and respectfully advance the families’ innate potential for health promotion and disease prevention. Each perspective aims to foster higher capacity for family health systems to function appropriately in public health practice. Health promotion practitioners and researchers can explore family health perspectives with the potential for systems policy and practice adjustments in public health.
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Abstract
Introduction The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Program seeks to enhance vulnerable family engagement with health and social services through a care coordination model. Besides servicing families in Sydney, HHAN has also established place-based initiatives (PBIs) in areas of disadvantage such as Redfern. The Redfern PBI co-locates HHAN with housing, drug and alcohol services, and financial and legal services. This integration aims to facilitate service access and multi-agency support for vulnerable families in Redfern. Hence, this study aims to evaluate for whom, when and why HHAN's PBI at Redfern works, or not, and what are its outcomes. Methods The project utilises critical realist methodology to undertake a qualitative evaluation of the impact of the PBI on clients, services and the community. Purposive sampling was used to identify 21 participants including HHAN clients, HHAN staff and stakeholders (HHAN partners). In-depth, semi-structured interviews were audio-recorded, transcribed, coded and analysed using a context (C), intervention (I), mechanism (M) outcome (O) (CIMO) approach to abductive analysis. Results Five key CIMO configurations of the Redfern PBI emerged - whole-of-family involvement, flexibility, trust, building connections and co-location. Whilst each theory had specific outcomes, overall client outcomes included improved access to services, better outlook, empowerment and engagement with services. Service outcomes included increased collaboration and foundation for integration between HHAN and other services. Negative outcomes included lack of full integration, the risk associated with integration and difficulty evaluating impact. Conclusion This study successfully refined the program theory for subsequent use in later implementation of critical realist evaluation studies.
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Mandelbaum J. Understanding Income and Health Inequities in the Deep South. South Med J 2020; 113:420. [PMID: 32885257 DOI: 10.14423/smj.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jennifer Mandelbaum
- Department of Health Promotion, Education and Behavior, University of South Carolina Columbia
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Baumont M, Wandasari W, Agastya NLPM, Findley S, Kusumaningrum S. Understanding childhood adversity in West Sulawesi, Indonesia. CHILD ABUSE & NEGLECT 2020; 107:104533. [PMID: 32570186 DOI: 10.1016/j.chiabu.2020.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite research indicating the long-term impact of adverse childhood experiences (ACE), few studies identify cultural variations in perceptions of ACE in low-resource settings. OBJECTIVE This study explores culturally-rooted notions of ACE and sources of vulnerability in two culturally distinct districts in West Sulawesi, Indonesia. METHODS Data from 50 stakeholders were collected from four focus group discussions and nine semi-structured key informant interviews in Mamasa and Mamuju districts in West Sulawesi. All interviews were conducted in Bahasa Indonesia, recorded, transcribed verbatim, and translated into English. Constant comparative analysis was used to identify key themes. RESULTS Primary ACE were violence, abandonment due to parents migrating for work, and malnourishment. While individual child characteristics appeared to play a minimal role in vulnerability to ACE, factors at the community and familial levels such as widespread poverty and low levels of parental education led to early transitions to adulthood through child marriage and employment. Cultural norms, particularly adherence to customary law, impacted both vulnerability and responses to violence against children. CONCLUSIONS ACE interventions should expand beyond individual and family-level interventions to address these structural and cultural barriers to resilience.
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Affiliation(s)
- Monique Baumont
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B2, New York, NY, 10032, USA.
| | - Wenny Wandasari
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
| | - Ni Luh Putu Maitra Agastya
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia; Department of Social Welfare, Faculty of Social and Political Sciences, Universitas Indonesia, Gedung Nusantara II Laintai 2 FISIP, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
| | - Sally Findley
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B2, New York, NY, 10032, USA.
| | - Santi Kusumaningrum
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
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Wertz J, Moffitt TE, Agnew‐Blais J, Arseneault L, Belsky DW, Corcoran DL, Houts R, Matthews T, Prinz JA, Richmond‐Rakerd LS, Sugden K, Williams B, Caspi A. Using DNA From Mothers and Children to Study Parental Investment in Children's Educational Attainment. Child Dev 2020; 91:1745-1761. [PMID: 31657015 PMCID: PMC7183873 DOI: 10.1111/cdev.13329] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study tested implications of new genetic discoveries for understanding the association between parental investment and children's educational attainment. A novel design matched genetic data from 860 British mothers and their children with home-visit measures of parenting: the E-Risk Study. Three findings emerged. First, both mothers' and children's education-associated genetics, summarized in a genome-wide polygenic score, were associated with parenting-a gene-environment correlation. Second, accounting for genetic influences slightly reduced associations between parenting and children's attainment-indicating some genetic confounding. Third, mothers' genetics were associated with children's attainment over and above children's own genetics, via cognitively stimulating parenting-an environmentally mediated effect. Findings imply that, when interpreting parents' effects on children, environmentalists must consider genetic transmission, but geneticists must also consider environmental transmission.
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Boat TF, Kelleher KJ. Fostering Healthy Mental, Emotional, and Behavioral Development in Child Health Care. JAMA Pediatr 2020; 174:745-746. [PMID: 32568384 DOI: 10.1001/jamapediatrics.2020.1485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas F Boat
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kelly J Kelleher
- Pediatrics and Psychiatry, The Ohio State University College of Medicine, Columbus.,Community Health, Nationwide Children's Hospital, Columbus, Ohio
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Tiberio SS, Kerr DCR, Bailey JA, Henry KL, Capaldi DM. Intergenerational associations in onset of cannabis use during adolescence: A data synthesis approach. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:877-889. [PMID: 32478533 DOI: 10.1037/adb0000625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study examined associations between parents' and their children's ages of onset of cannabis use using a data synthesis methodology to pool data from 3 similarly designed intergenerational studies. Regarding age of first use of cannabis, prospective data were collected at one or more assessments from early to late adolescence in each generation. The extent to which parent and offspring gender separately or jointly moderated intergenerational effects was examined. Data were harmonized from studies originating in the states of Washington (Bailey, Hill, Epstein, Steeger, & Hawkins, 2018), New York (Thornberry, Henry, Krohn, Lizotte, & Nadel, 2018), and Oregon (Capaldi, Kerr, & Tiberio, 2018) when the parents were in late childhood to early adolescence; analyses concerned 1,081 parents and their children from 971 unique families. Parents' and their children's age of cannabis use onset during adolescence were modeled using discrete-time survival analysis techniques. Although data were successfully synthesized across the studies, the primary hypothesis was not supported: parents' earlier age of first cannabis use during adolescence was not significantly associated with earlier onset of cannabis use in the offspring generation. Rather, parents' histories of any cannabis use in adolescence-regardless of timing-were linked with increased risk for early onset cannabis use by their children compared to parents with no history of use during adolescence. There were no significant parent, child, or parent-by-child gender moderation effects. Thus, prevention of adolescent onset of cannabis in one generation may have prevention benefits for the next. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Delgado-Angulo EK, Alshehri R, Scambler S, Bernabé E. Is grandparents' social class associated with adult grandchildren's oral health? Analysis of two British cohorts. Community Dent Oral Epidemiol 2020; 48:402-408. [PMID: 32463137 DOI: 10.1111/cdoe.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES No studies have taken a multigenerational approach to the study of oral health inequalities. This study investigated whether grandparents' social class was associated with adult grandchildren's oral health. METHODS Data from the 1958 National Child and Development Study (NCDS) and the 1970 British Cohort Study (BCS) were analysed. Cohort members' occupational social class and persistent trouble with mouth, teeth or gums in the past 12 months were reported at ages 33 years in the NCDS and 26 years in the BCS. Information on grandparents' and parents' social class was reported by the cohort members' mothers during childhood. The association between grandparents' social class and cohort members' report of persistent trouble with mouth, teeth or gums was tested in marginal structural models (MSMs). RESULTS Data from 9853 NCDS and 6487 BCS participants were analysed. Grandparents' social class was not associated with cohort members' report of persistent trouble with teeth, gums or mouth in the NCDS sample (odds ratios of 1.25 [95% Confidence Interval: 0.95-1.65] for social class IV/V and 1.12 [95% CI: 0.76-1.64] for social class IIINM-M relative to social class I/II) or the BCS sample (odds ratios of 0.98 [95% CI: 0.68-1.43] for social class IV/V and 0.88 [95% CI: 0.67-1.16] for social class IIINM-M relative to social class I/II). CONCLUSION This study provided no support for an independent association between grandparents' social class and adult grandchildren's oral health.
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Affiliation(s)
- Elsa K Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Facultad de Estomatología Roberto Beltrán Neira, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Reem Alshehri
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Cheng TL, Thornton RLJ. Family Values Means Covering Families: Parents Need to Focus on Parenting, Not Access to Care. Pediatrics 2020; 145:peds.2020-0401. [PMID: 32295818 DOI: 10.1542/peds.2020-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tina L Cheng
- Department of Pediatrics, School of Medicine; .,Departments of Population, Family, and Reproductive Health.,Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rachel L J Thornton
- Department of Pediatrics, School of Medicine.,Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Jones NL, Gilman SE, Cheng TL, Drury SS, Hill CV, Geronimus AT. Life Course Approaches to the Causes of Health Disparities. Am J Public Health 2020; 109:S48-S55. [PMID: 30699022 DOI: 10.2105/ajph.2018.304738] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Reducing health disparities requires an understanding of the mechanisms that generate disparities. Life course approaches to health disparities leverage theories that explain how socially patterned physical, environmental, and socioeconomic exposures at different stages of human development shape health within and across generations and can therefore offer substantial insight into the etiology of health disparities. Life course approaches are informed by developmental and structural perspectives. Developmental perspectives emphasize how socially patterned exposures to risk factors during sensitive life stages shift health trajectories, whereas structural perspectives emphasize how social identity and position within socially patterned environments disproportionately allocate risk factors and resources, resulting in altered health trajectories. We conclude that the science of health disparities will be advanced by integrating life course approaches into etiologic and intervention research on health disparities. The following 4 strategies are offered to guide in this process: (1) advance the understanding of multiple exposures and their interactions, (2) integrate life course approaches into the understanding of biological mechanisms, (3) explore transgenerational transmission of health disparities, and (4) integrate life course approaches into health disparities interventions.
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Affiliation(s)
- Nancy L Jones
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
| | - Stephen E Gilman
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
| | - Tina L Cheng
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
| | - Stacy S Drury
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
| | - Carl V Hill
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
| | - Arline T Geronimus
- Nancy L. Jones is with Community Health and Population Sciences, Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Stephen E. Gilman is with Social and Behavioral Sciences, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina L. Cheng is with Department of Pediatrics, Johns Hopkins University School of Medicine, Department of Population, Family & Reproductive Health, Bloomberg School of Public Health, and Johns Hopkins Children's Center, Baltimore, MD. Stacy S. Drury is with the Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Tulane University School of Medicine, Tulane Brain Institute, Tulane University, New Orleans, LA. Carl V. Hill is with the Office of Special Populations, National Institute on Aging, National Institutes of Health. Arline T. Geronimus is with the Department of Health Behavior and Health Education, School of Public Health, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor. Nancy Jones is also a Guest Editor for this supplement issue
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Kerr DCR, Tiberio SS, Capaldi DM, Owen LD. Intergenerational congruence in adolescent onset of alcohol, tobacco, and marijuana use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:839-851. [PMID: 31916782 DOI: 10.1037/adb0000546] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We examined alcohol, tobacco, and marijuana (ATM) use onset across early to late adolescence in a sample of fathers and their offspring. We tested a theory of developmental congruence in polysubstance use, or the extent to which fathers' ATM use onset in early adolescence increased risk for earlier ATM onset by their offspring. Average rates of adolescent ATM use onset were also compared across generations, which may reflect intergenerational discontinuity and secular trends. Children (n = 223, 44% boys) and their fathers (n = 113; originally recruited as boys at neighborhood risk for delinquency) contributed repeated prospective self-reports of their ATM use across adolescence (as late as age 18 years). Mothers' ATM use (retrospective) through age 18 years was available for 205 children. Data were analyzed using discrete-time survival mixture analysis. Compared with their fathers, boys and girls showed later onset for tobacco use, and girls showed later onset alcohol use. Developmental congruence was partially supported: Children showed earlier ATM use onset if their fathers were assigned to the early adolescent polysubstance use onset class, compared to the late-adolescent predominantly alcohol and tobacco onset class; mothers' ATM use in adolescence attenuated this effect. Consistent with national secular trends, rates of adolescent onset tobacco and alcohol use declined across generations, whereas marijuana use onset did not. However, there was intergenerational transmission of risk for early polysubstance use onset. Prevention that delays early substance use may have early life span effects as well as transgenerational implications. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract
The United States has developed an effective safety net of programs starting during the Great Depression, picking up steam in the War on Poverty of the 1960s, and continuing to this day. These efforts have been impactful. Child poverty rates tracked by the supplemental poverty measure have dropped by nearly 50% since the 1960s. Causal studies show that many of these programs improve child outcomes by alleviating income poverty. Some of the evidence shows that such impacts last into adulthood. Nevertheless, addressing child poverty is unfinished business for the United States. Children are still the poorest age group in our society. More robust versions of present safety net programs, as well as the possible introduction of child benefits/child allowances, which many other high-resource countries already provide to families, will need to be considered if we are going to make further progress in substantially reducing child poverty.
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Affiliation(s)
- Benard P. Dreyer
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA
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48
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The children of preterm survivors: shyness, parenting, and parental stress. J Dev Orig Health Dis 2019; 11:410-414. [PMID: 31619308 DOI: 10.1017/s2040174419000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extremely low birth weight (ELBW) survivors have higher rates of shyness, a risk factor for poorer outcomes across the life span. Due to advances in fetal and neonatal medicine, the first generation of ELBW survivors have survived to adulthood and become parents. However, no studies have investigated the transmission of their stress vulnerability to their offspring. We explored this phenomenon using a population-based cohort of ELBW survivors and normal birth weight (NBW) controls. Using data from three generations, we examined whether the shyness and parenting stress of ELBW and NBW participants (Generation 2) mediated the relation between the parenting style of their parents (Generation 1) and shyness in their offspring (Generation 3), and the extent to which exposure to perinatal adversity (Generation 2) moderated this mediating effect. We found that among ELBW survivors, parenting stress (in Generation 2) mediated the relation between overprotective parenting style in Generation 1 (grandparents) and child shyness in Generation 3. These findings suggest that perinatal adversity and stress may be transmitted to the next generation in humans, as reflected in their perceptions of their children as shy and socially anxious, a personality phenotype that may subsequently place their children at risk of later mental and physical health problems.
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Fraser KG, Pánková A, Zvolská K, Králíková E. FCTC implementation: the role of state or non-government organizations? An example of the Czech Republic. Cent Eur J Public Health 2019; 27:175-181. [PMID: 31580550 DOI: 10.21101/cejph.a5796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking is the leading cause of premature mortality and morbidity. The aim of this study was to provide the first national description of organizational capacity and involvement in tobacco control (TC) measures outlined by the WHO Framework Convention on Tobacco Control (FCTC) within the Czech Republic. METHODS Data were collected in a national cross-sectional survey of all 14 organizations engaged in TC activities within the Czech Republic. Organizational capacity (defined as skills, supports, partnerships, resources, and leadership) to implement TC activities, and level of involvement in key FCTC measures were assessed and compared across organizations. RESULTS Despite the high economic costs of tobacco use, few organizations were involved in TC activities. 50% of all organizations involved in TC activities were non-government or non-profit organizations. Less than one third of organizations reported having a sufficient number of staff or adequate funding to work effectively. Skills for chronic disease prevention (CDP) practice including assessment, identifying relevant practices, developing and implementing initiatives were rated more favourably than skills to evaluate these activities. Level of involvement was ranked highest for activities that focused on creation of smoke-free environments and lowest for activities that focused on raising taxes and sales to minors. Organizations tended to be more involved in individual, rather than population-level prevention strategies. Inadequate funding, insufficient number of staff dedicated to working on TC, and lack of political will were major barriers. CONCLUSIONS This paper provides the first national description of organizational capacity and level of involvement in FCTC measures within the Czech Republic.
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Affiliation(s)
- Keely G Fraser
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Alexandra Pánková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Centre for Tobacco-Dependent, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kamila Zvolská
- Centre for Tobacco-Dependent, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Králíková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Centre for Tobacco-Dependent, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Spencer N, Raman S, O'Hare B, Tamburlini G. Addressing inequities in child health and development: towards social justice. BMJ Paediatr Open 2019; 3:e000503. [PMID: 31423469 PMCID: PMC6688679 DOI: 10.1136/bmjpo-2019-000503] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 01/11/2023] Open
Abstract
Inequities have a profound impact on the health and development of children globally. While inequities are greatest in the world's poorest countries, even in rich nations poorer children have poorer health and developmental outcomes. From birth through childhood to adolescence, morbidity, mortality, growth and development are socially determined, resulting in the most disadvantaged having the highest risk of poor health outcomes. Inequities in childhood impact across the life course. We consider four categories of actions to promote equity: strengthening individuals, strengthening communities, improving living and working conditions, and promoting healthy macropolicies. Inequities can be reduced but action to reduce inequities requires political will. The International Society for Social Paediatrics and Child Health (ISSOP) calls on governments, policy makers, paediatricians and professionals working with children and their organisations to act to reduce child health inequity as a priority. ISSOP recommends the following: governments act to reduce child poverty; ensure rights of all children to healthcare, education and welfare are protected; basic health determinants such as adequate nutrition, clean water and sanitation are available to all children. Paediatric and child health organisations ensure that their members are informed of the impact of inequities on children's well-being and across the life course; include child health inequities in curricula for professionals in training; publish policy statements relevant to their country on child health inequities; advocate for evidence-based pro-equity interventions using a child rights perspective; advocate for affordable, accessible and quality healthcare for all children; promote research to monitor inequity as well as results of interventions in their child populations. Paediatricians and child health professionals be aware of the impact of social determinants of health on children under their care; ensure their clinical services are accessible and acceptable to all children and families within the constraints of their country's health services; engage in advocacy at community and national level.
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Affiliation(s)
- Nick Spencer
- Division of Mental Health and Wellbeing, University of Warwick Warwick Medical School, Coventry, UK
| | - Shanti Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Women’s & Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bernadette O'Hare
- School of Medicine, University of Saint Andrews, Saint Andrews, UK
- College of Medicine, University of Malawi, Zomba, Malawi
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