Who Engaged in Home-Based Arts Activities During the COVID-19 Pandemic? A Cross-Sectional Analysis of Data From 4,731 Adults in the United States

Arts engagement is a health-related behavior that may be influenced by social inequalities. While the COVID-19 pandemic provided new opportunities for some people to engage in the arts, it might have created barriers for others. We aimed to examine whether there was social patterning in home-based arts engagement during the pandemic in the United States, and whether predictors of engagement differed according to the type of arts activity. We included 4,731 adults who participated in the United States COVID-19 Social Study between April and July 2020. Three types of home-based arts engagement were considered: reading for pleasure, arts or crafts activities, and digital arts activities. Using logistic regression models, we tested cross-sectional associations between a broad range of demographic, socioeconomic, psychosocial, and health-related factors as well as adverse events and worries during lockdown and each type of arts engagement. The factors most strongly associated with all three types of arts engagement were social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems. Overall, our findings indicate that the social gradient in arts engagement was reduced in the first 4 months of the COVID-19 pandemic in the United States. Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector.

Regional Socioeconomic Deprivation in Germany and Adherence to the 24-h Movement Guidelines among Children and Adolescents

To examine the relationship between regional socioeconomic deprivation and adherence to the 24-h movement guidelines among children and adolescents, a cross-sectional study was conducted. A total of 17,433 students aged 9-17 participated in a survey in winter 2021/2022. Daily screen time (ST), moderate-to-vigorous physical activity (MVPA), and sleep behavior were outcome variables. The German Index of Socioeconomic Deprivation (GISD), a regional socioeconomic objective measure, was the exposure variable. Associations between GISD and health behaviors were examined using regression models. Models were adjusted for age, gender, school type, and individual self-reported socioeconomic status (SES). The proportions of meeting the MVPA, ST, and sleep duration guidelines were 14%, 22%, and 34%, respectively. A total of 2.3% met all guidelines. Students from the most deprived communities were half as likely to meet all three guidelines compared to students from the most affluent regions (OR = 0.49 [0.28; -0.03], p = 0.010). There was a consistent relationship between GISD and lower levels of adherence to screen time guidelines (most deprived compared to most affluent: OR = 0.49 [0.38; 0.64], p < 0.001). There was no association between GISD and adherence to sleep time guidelines. We found mixed results for the association between GISD and MVPA. Regional SES appears to be an important factor associated with screen time. Screen time should be limited through intervention programs, especially in disadvantaged areas. Parents should be made aware of their children's increased media consumption. Recommendations for screen time should be clearly communicated, as should the health disadvantages of increased media consumption in childhood and adolescence.

Vision screening outcomes of 4-5 year-olds reflect the social gradient

CLINICAL RELEVANCE

Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care.

BACKGROUND

Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia.

METHODS

The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores  .

RESULTS

Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001).

CONCLUSION

It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.

Changes in the level of health literacy in Czechia between 2015 and 2020

During the five years from 2015 to 2020, the proportion of people with limited health literacy decreased by 12%. This finding results from international research on the level of health literacy, which took place since 2019 till 2021 in 17 countries of the European region of the World Health Organization. In total, more than 42,000 respondents were interviewed, in Czechia there were 1,650 respondents. In 2020, however, we recorded a limited level of health literacy in 47% of the population over the age of 18. Respondents have the greatest problems with understanding health information from the media and with assessing different treatment options. Czechs (like Slovaks) have the biggest problem with following the instructions of a doctor or pharmacist. Health literacy is influenced by gender, age and education: women, older people and less educated people show higher levels of health literacy. The respondent's social gradient, primarily subjective social status has positive influence to health literacy while financial deprivation has negative influence. On the other hand, health literacy positively affects the physical activity of the respondent; subjectively perceived health and consumption of medical services are influenced as well. The Czech Health Literacy Institute is currently preparing monitoring in 2024-2025.

Roles of parental smoking and family structure for the explanation of socio-economic inequalities in adolescent smoking

BACKGROUND AND AIMS

Among European countries, France is particularly concerned by adolescent tobacco smoking, especially in disadvantaged socio-economic backgrounds (SES). We measured the respective contributions of parental smoking and family living arrangement to social disparities in smoking during adolescence.

DESIGN

Secondary analysis of survey data.

SETTING

A cross-sectional nation-wide exhaustive 12-day survey in March 2017 of French youth aged 17-18.5 years participating in the national mandatory civic information day.

PARTICIPANTS

A total of 13 314 adolescents answering a pen-and-paper questionnaire about their own tobacco consumption and the smoking of their parents.

MEASUREMENTS

Risk ratios (RRs) were computed using modified Poisson regressions, and population-attributable fraction (PAF) was used as a measure of the explanatory roles of the different factors as mediators of SES.

FINDINGS

Adolescents living within very privileged and privileged SES were significantly less likely to report daily tobacco smoking (20.4 and 22.7%, respectively) than those within modest and disadvantaged ones (26.0 and 28.6%, respectively). Parental smoking and family living arrangement independently explained the smoking inequalities among adolescents. After adjusting for schooling factors, the risks associated with parental smoking ranged between RR = 1.64 [95% confidence interval (CI) = 1.50-1.79] when the father only smoked and RR = 2.17 (95% CI = 1.99-2.36) when both parents smoked, compared with non-smoking parents; the risk associated with living in a non-intact family was 1.35 (95% CI = 1.26-1.43) and that of living outside the parental home was 1.20 (95% CI = 1.10-1.30). Apprentices and adolescents out of school had higher risks than those at school (RR = 1.82, 95% CI = 1.68-1.98) and RR = 2.10, 95% CI = 1.92-2.29). The contribution of parental smoking to adolescent smoking (PAF = 32%) was greater than that of SES (PAF = 9%), family living arrangement (PAF = 17%) or schooling factors (14%). The share of SES decreased from 18 to 9% when considering these mediating factors.

CONCLUSION

In France, parental smoking appears to be the factor that most influences adolescent smoking, followed by family living arrangement; the role of family socio-economic status is small in comparison.

Material Culture and Structural Violence: Reframing Evidence of the Social Gradient in Industrial Contexts

Coal mining is an industry that historically has exposed laborers to a variety of environmental and occupational health hazards that have resulted in injury, illness, and/or physical disability. These health hazards, however, did not impact all laborers involved in coal mining equally. As a coal-mining company town organized with four distinct housing areas that correlate historically with the socioeconomic statuses of the jobs held at the colliery, Eckley Miners' Village provides a case study to explore how these health disparities were lived with and treated by residents of the industrial company town. Through an analysis of health-related material culture from house lots in two different sections of Eckley Miners' Village, evidence of the social gradient can be seen in the quality and quantity of medical ephemera present in the archaeological record. By utilizing archaeology, scholars can develop a longitudinal study of health disparities in the coal-mining towns of northeastern Pennsylvania. Examining contemporary health disparities requires tracing the historical foundations of these inequities, providing a critical space for archaeologists to contribute meaningful insights into the implications of social, political, and economic factors on exposure to health hazards and access to treatment materials.

Lower Subjective Socioeconomic Status Is Associated With Increased Risk of Reporting Negative Experiences on Social Media. Findings From the "LifeOnSoMe"-Study

Objectives

To investigate the association between subjective socioeconomic status (SES) and a) frequency and daily duration of social media use, and b) self-reported negative experiences on social media platforms.

Methods

The present study is based on the cross-sectional school-based "LifeOnSoMe"-study (N = 3,415) recruiting high school students aged 16 years or more in Bergen, Norway. Subjective SES was the independent variable and measured by perceived family affluence. The dependent variables included self-reported amount of social media use, and eight different types of negative experiences on social media. Self-reported age, gender, country of birth and type study were used as covariates. Statistical analyses included multinomial logistic regression and negative binomial regression models.

Results

For amount of social media use, we only found relatively weak and inconsistent associations with SES. In contrast, the associations between SES and separate variables gauging negative experiences were robust in crude models as well as in models adjusted for age and gender. The number of different negative experiences were increased by 1.25 times for those with low and by 1.10 times for those with medium socioeconomic status, compared to those with high socioeconomic status in fully adjusted models. For composite measures of "negative acts and exclusion" and "unwanted attention from others," the difference between low and high SES was equivalent to a small-to-moderate effect size even after adjustments for age, gender, country of birth, type of study and amount of social media use.

Conclusions

In the present study, we found consistent and strong support for an association between SES and negative experiences on social media even after adjustments for age, gender, country of birth, type of study, and amount of social media use. The potential link between SES and negative experiences on social media as reported in this study is likely to have a public health impact. As the reported findings are novel, they need to be replicated in forthcoming studies based on other study populations. Future research should also focus on other aspects of SES and negative experiences, as well as endeavor to investigate potential longitudinal associations.

Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation

This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05-3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18-2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85-3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14-2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.

Professional Status of Persistent Spinal Pain Syndrome Patients after Spinal Surgery (PSPS-T2): What Really Matters? A Prospective Study Introducing the Concept of "Adapted Professional Activity" Inferred from Clinical, Psychological and Social Influence

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) represents a main cause of work disruption. Beyond its societal consequences, occupational inactivity is responsible for a major decrease in physical/mental health in individuals but remains poorly analyzed. We designed a study to prospectively examine Professional Status (PS) evolution and its association with key bio-psychological markers. Data from 151 consecutively included working-age PSPS-T2 patients were analyzed to determine the proportion of professional inactivity and the relationships between PS and Social Gradient of Health (SGH), Numeric Pain Rating Scale (NPRS), EuroQol 5-Dimensional 5-Level (EQ-5D-5L), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and Fear-Avoidance Belief Questionnaire work subscale (FABQ-W). Despite optimized medical management, 73.5% of PSPS-T2 patients remained inactive after 1 year of follow-up/p = 0.18. Inactive patients presented a low SGH/p = 0.002, higher NPRS/p = 0.048, lower EQ-5D-5L/p < 0.001, higher ODI/p = 0.018, higher HADS-D/p = 0.019 and higher FABQ-W/p < 0.001. No significant mediation effect of FABQ-W on SGH consequences regarding PS was observed in our structural model/p = 0.057. The link between unemployment and bio-psycho-social pain dimensions appears bidirectional and justifies intense collaboration with social workers. Optimizing therapeutical sequencing towards personalized professional plans implies restoring "Adapted Physical Function" as an initial goal, and tailoring an "Adapted Professional Activity", matching with patient expectations and capabilities, as a final objective.

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.

The impact of poverty and deprivation at the end of life: a critical review

This critical review interrogates what we know about how poverty and deprivation impact people at the end of life and what more we need to uncover. While we know that people in economically resource-rich countries who experience poverty and deprivation over the life course are likely to die younger, with increased co-morbidities, palliative care researchers are beginning to establish a full picture of the disproportionate impact of poverty on how, when and where we die. This is something the Covid-19 pandemic has further illustrated. Our article uses a critical social science lens to investigate an eclectic range of literature addressing health inequities and is focused on poverty and deprivation at the end of life. Our aim was to see if we could shed new light on the myriad ways in which experiences of poverty shape the end of people's lives. We start by exploring the definitions and language of poverty while acknowledging the multiple intersecting identities that produce privilege. We then discuss poverty and deprivation as a context for the nature of palliative care need and overall end-of-life circumstances. In particular, we explore: total pain; choice at the end of life; access to palliative care; and family caregiving. Overall, we argue that in addressing the effects of poverty and deprivation on end-of-life experiences, there is a need to recognise not just socio-economic injustice but also cultural and symbolic injustice. Too often, a deficit-based approach is adopted which both 'Others' those living with poverty and renders invisible the strategies and resilience they develop to support themselves, their families and communities. We conclude with some recommendations for future research, highlighting in particular the need to amplify the voices of people with lived experience of poverty regarding palliative and end-of-life care.

A unified framework to account for selective mortality in lifecycle analyses of the social gradient in health

This paper establishes a unified framework to fully account for the changing social gradient over the lifecycle in terms of a sufficient set of mobility indices characterizing the coevolution of socioeconomic status and health within each of a series of overlapping cohorts. We proceed to demonstrate the impact of selective mortality on health inequality changes, making use of a counterfactual health distribution for the start of the study period that leaves out those who are known to die before the end. Specifically, initial differences between the average health and educational attainment rank of survivors and nonsurvivors are found in our empirical study to be an increasingly important factor explaining changes in the education-health gradient in older cohorts in Great Britain. Our identification strategy has the advantage that it does not require the imputation of the "would be" health of nonsurvivors, which if carried out using inverse probability weighting procedures-as in several previous studies-is shown to bias estimates of this direct effect of selective mortality toward zero. Parallel results for the income-health gradient exhibit stronger confounding influences due to a number of other factors given that income is a less stable indicator of socioeconomic status in adulthood.

Prevalence of Parental Alcohol Problems among a General Population Sample of 28,047 Norwegian Adults: Evidence for a Socioeconomic Gradient

The aim of the study presented here was to estimate the prevalence of parental alcohol problems during childhood in a general population of Norwegian adults, and to investigate associations between parental alcohol problems during childhood and lower socioeconomic status in adulthood. This cross-sectional study recruited 28,047 adults (≥18 years) to an online health survey (Norwegian Counties Public Health Surveys). We evaluated demographic and socioeconomic measures and responses to a shortened version of the Children of Alcoholics Screening Test (CAST-6) scale to assess whether respondents perceived parental alcohol consumption during childhood as problematic. Respondents reported parental alcohol problems at a rate of 15.6%, but the experience was more prevalent among adults with a low education (20.0%), compared to those with intermediate (16.4%) or high educations (13.8%, χ2(2) = 87.486, p < 0.001), and it was more common among respondents with low economic capabilities (21.1%) compared to those with middle/high capabilities (14.2%, χ2(1) = 162.089, p < 0.001). Parental alcohol problems were most prevalent among respondents that received welfare benefits (24.5%). Multivariable logistic regression analyses revealed associations between parental alcohol problems and low socioeconomic status in adulthood; odds ratios (95% confidence intervals) ranged from 1.33 (1.25-1.42) to 1.89 (1.72-2.06). From a public health perspective, children who grow up with parental alcohol problems should be reached through both universal and selective interventions.

The Effect of Socio-Economic Status on Health Information Literacy among Urban Older Adults: Evidence from Western China

The present study aimed to observe the effect of socio-economic status on health information literacy and to identify whether there is a social gradient for health information literacy among urban older adults in Western China. This study employed a cross-sectional research design, and 812 urban participants aged 60 and older were enrolled in Western China. In the current study, only 16.7% of urban older adults reported having adequate health information literacy. Binary logistic regression analysis showed that socio-economic status factors including educational attainment, ethnicity, and financial strain were significantly and tightly associated with health information literacy. Additionally, other factors including suffering from chronic diseases, information-seeking activity, reading magazines and books, and watching television were also significantly linked to health information literacy. Consistent with existing studies, the findings indicate the health information literacy deficit and demonstrate the crucial impact of socio-economic status on health information literacy, which implies a social gradient in health information literacy. The importance of other factors related to health information literacy are discussed as well. The results suggest that reducing the health information literacy deficit and social gradient in health information literacy must be considered as an important priority when developing public health and health education strategies, programs, and actions among urban older adults in Western China.

Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt social frailty theoretical framework, we aimed to examine the association of social frailty, independently of physical frailty, with salient outcomes of mood, nutrition, physical performance, physical activity, and life–space mobility. We studied 229 community-dwelling older adults (mean age 67.22 years; 72.6% females) who were non-frail (defined by the FRAIL criteria). Using exploratory factor analysis, the resultant 8-item Social Frailty Scale (SFS-8) yielded a three-factor structure comprising social resources, social activities and financial resource, and social need fulfilment (score range: 0–8 points). Social non-frailty (SNF), social pre-frailty (SPF), and social frailty (SF) were defined based on optimal cutoffs, with corresponding prevalence of 63.8%, 28.8%, and 7.4%, respectively. In logistic regression adjusted for significant covariates and physical frailty (Modified Fried criteria), there is an association of SPF with poor physical performance and low physical activity (odds ratio, OR range: 3.10 to 6.22), and SF with depressive symptoms, malnutrition risk, poor physical performance, and low physical activity (OR range: 3.58 to 13.97) compared to SNF. There was no significant association of SPF or SF with life–space mobility. In summary, through a theory-guided approach, our study demonstrates the independent association of social frailty with a comprehensive range of intermediary health outcomes in more robust older adults. A holistic preventative approach to frailty should include upstream interventions that target social frailty to address social gradient and inequalities.

Exploring Associated Factors of Subjective Health Literacy in School-Aged Children

Low health literacy is considered to lead to worse health-related outcomes and behaviors and has therefore been recognized as a social determinant of health. While health literacy and its potential determinants have been studied in adults, little research has been conducted with children. This study aims to address this research gap by investigating factors associated with children's subjective health literacy. Cross-sectional data was collected from fourth graders at German schools with a self-report questionnaire. Sociodemographic characteristics, health-related attitudes, and motivation were analyzed. We used hierarchical multivariate linear regression to explain variance in the dependent variable "subjective health literacy". A total of n = 907 fourth graders were surveyed. Regarding health literacy, eight out of ten participants (82.2%) reported that it was "rather easy" or "very easy" to deal with health-related information. Family affluence, but not language spoken at home, was significantly related to subjective health literacy, after controlling for confounding. Moreover, parental health orientation, self-efficacy, and motivation are factors significantly associated with health literacy. Based on the results of this study, it is hypothesized that a general motivation to learn new things about health, as well as an environment promoting health-positive behavior, might foster children's health literacy.

Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality: a study of Swedish twins

BACKGROUND

Despite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935.

METHODS

Childhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding.

RESULTS

The social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association.

CONCLUSIONS

Our results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden.

Canada considers a basic income guarantee: can it achieve health for all?

There is little doubt that the implementation of a Basic Income Guarantee (BIG) in Canada and other liberal welfare states would alleviate some of the most egregious examples of absolute poverty that contribute to poor health such as lack of adequate food and shelter and inability to meet basic household and personal needs. BIG would likely improve the health of the most disadvantaged by moving them closer to the relative poverty line. Yet, advocacy for and implementation of BIG carries potential dangers. Since health improves with every step up the income ladder, simply moving people closer to the relative poverty line without providing additional universal benefits and supports common to most other developed nations would limit its health promotion potential. In addition, governing authorities in liberal political economies can use BIG to justify continuing imbalances in economic and political power that skews the distribution of the social determinants of health. In addition, implementation of BIG -- despite its more progressive advocates calls for maintaining or enhancing of existing social programs - can serve as justification for reducing or removing these programs, thereby threatening health.

Prevalence of disability among the major cities in Australia 2012 with geographical representation of distribution in Western Australia

ISSUE ADDRESSED

The aim of this study was to use a novel approach to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.

METHOD

This study used national census data and the survey of disability, ageing and carers data to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.

RESULT

The results in this study show that there were more people living in the least disadvantaged areas (wealthiest) when compared to the most disadvantaged (poorest) areas. Whereas for people with a disability as the relative socio-economic disadvantage of the area increased, the number of people reporting any disability also increased, with the highest number coming from the most disadvantaged areas. The maps show a significant distribution with fewer cases of disability in metropolitan areas and relatively higher number in the rural area along with the higher proportion of people with disability living in the relatively more disadvantaged areas.

CONCLUSION

Socio-economic profile is one of the key factors influencing the various aspects of health and hence should hold an important place during policy making. Policy should be formulated and implemented to help reduce the inequality by either directly aiming at the most disadvantaged group or by trying to bridge the gap between them. SO WHAT?: This paper provides a geographic visualisation of the distribution of people with profound and severe disability to help identify priority areas with high prevalence of disability.

Poverty as a barrier to antiretroviral therapy access for people living with HIV/AIDS in Kenya

Understanding barriers to access to essential health services is critical for devising effective strategies to improve access and align such strategies with national health and development policy objectives. However, while considerable empirical evidence exists on correlates of HIV prevalence and populations at risk of contracting HIV, there is very little such evidence on access to antiretroviral therapy. This paper addresses this gap through a cross-sectional analysis of coverage of antiretroviral therapy and its correlates across 47 counties in Kenya. It considers health-sector and social factors, and applying instrumental variables to address error-in-variables and reverse-causality issues regarding HIV prevalence. Poverty was the most robust and - statistically and substantially - significant determinant of treatment coverage. The gap in treatment coverage between the poorest and richest counties amounted to about 40 percentage points and has not narrowed between 2012 and 2015. Health sector capacities independently played a role and exacerbated the poverty gap. For Kenya, the results suggest that policies on expanding treatment access need to be differentiated across counties to greatest effect and to align the HIV/AIDS response with national health and social policy objectives. Regarding global HIV/AIDS policies, the findings suggest a need to recognise "people left behind" owing to socio-economic and specifically poverty-related barriers to access to services.

Mechanisms underlying social gradients in child and adolescent antisocial behaviour

Objective

A number of studies demonstrate a social gradient in behavioural problems, with children from low-socioeconomic backgrounds experiencing more behavioural difficulties than those from high-socioeconomic families. Antisocial behaviour is a heterogeneous concept which includes diverse behaviours such as physical fighting, vandalism, lying, disobedience and irritability. It remains unclear whether the mechanisms underlying social inequalities are similar across these different subtypes of antisocial behaviour. This study aimed to simultaneously test a range of individual, family and neighbourhood factors as mediators of the relationship between income and subtypes of antisocial behaviour.

Method

Data on a UK representative sample of 7977 children and adolescents, aged 5-16, was analysed in a series of nested structural equation models. A range of antisocial outcomes, including irritability, aggression, and callous-unemotional traits, were measured. Income quintiles were used to indicate family socioeconomic status. A range of potentially mediating or confounding variables, such as family functioning and parental mental health, were also measured.

Results

Analyses revealed that unhealthy family functioning, neighbourhood disadvantage, stressful life events and children's literacy difficulties were mediating variables contributing to the indirect effect of income on a range of antisocial behaviours.

Conclusion

As expected family functioning accounted for a substantial proportion of the association between SES and antisocial behaviour, we also found evidence that child cognitive functioning might perform an important role. Our findings emphasise the importance of addressing the mechanisms underlying the association between SES and behavioural problems.

[The role of professionals in reducing social inequalities in health]

Inequalities in health stem from social mechanisms which for the most part operate outside the health care sector. By being aware of these inequalities and understanding them from the perspective of a gradient of resources, health professionals can intervene to improve equality in this field.

[On overview of social inequalities in health in France]

Health is dependent on the living conditions and the socioeconomic environment of populations. The healthcare system tends to underestimate these aspects and thereby maintain, and even aggravate, the resulting social inequalities in health. It is essential that this situation is improved by adopting a global and interdisciplinary vision of healthcare and its social determinants.

Noncommunicable Diseases in Ghana: Does the Theory of Social Gradient in Health Hold?

The theory of social gradient in health posits that individuals with lower socioeconomic status (SES) have poorer health outcomes, compared with those in higher socioeconomic brackets. Applied to noncommunicable diseases (NCDs), this theory has largely been corroborated by studies from the West. However, evidence from sub-Saharan Africa are mixed, with those from Ghana conspicuously missing in the literature. Using data from the Study on Global Ageing and Adult Health, and applying random-effects C log-log models, this study examined the relationship between SES and the risks of living with NCDs in Ghana. Results confirmed a negative social gradient, as Ghanaians with higher SES were more likely to live with NCDs compared with those with low SES. The addition of lifestyle factors attenuated the risks of living with NCDs among Ghanaian men and women with higher SES. This study underscores the need for policies targeted at specific socioeconomic and demographic groups, such as the emerging middle and upper class Ghanaians. It is similarly important for interventions to move beyond biomedical solutions that put more emphasis on epidemiological risk factors to strategies that embrace psychosocial factors as important correlates of cardiovascular health.

From cannabis initiation to daily use: educational inequalities in consumption behaviours over three generations in France

AIMS

The diffusion of cannabis initiation has been accompanied by a reversal in the educational gradient: contrary to older generations, the less educated in recent generations are more likely to initiate than the more educated. We tested whether the educational gradient for the transition from initiation to daily use evolved in the same way.

DESIGN/SETTING

A French telephone random survey conducted in 2010 (21 818 respondents aged 15-64 years), asking interviewees about their ages at initiation to daily use, if any.

PARTICIPANTS

A total of 6824 cannabis initiators aged 18-64 years at data collection. Three birth cohort groups (generations) were compared: 1946-60 (n = 767), 1961-75 (n = 2632) and 1976-92 (n = 3425) with, respectively, 47, 42 and 45% of women.

MEASURES

Risks of transition to daily use from ages 11-34 were compared through time-discrete logistic regressions and educational gradients were quantified through a relative index of inequality (RII). Control variables include age and time-varying variables (ages at tobacco daily use, at first drunkenness and at first other use of an illicit drug in a list of 13 products).

FINDINGS

Twenty-four per cent of the initiators reported daily use before age 35, the proportions tripling from the oldest to the youngest generation (from 11.7 to 38.6% in men, from 7.7 to 22.2% in women). Whatever the generation, the less educated initiators more often shifted to daily use than the most educated: from the oldest to the youngest generation, RII = 2.13, 95% confidence interval (CI) = [0.65, 7.02]; 2.19 95% CI = [1.33, 3.63]; and 2.24, 95% CI = [1.60, 3.15] in men; RII = 3.31, 95% CI = [0.75, 14.68]; 3.17, 95% CI = [1.49, 6.76]; and 3.56, 95% CI = [2.07, 6.14] in women, respectively.

CONCLUSION

In France, the risk of transition from cannabis initiation to daily use has remained consistently higher among less educated cannabis initiators over three generations (1946-60, 1961-75, 1976-92), in contrast to what is observed for initiation.

Correlates of Mental Illness and Wellbeing in Children: Are They the Same? Results From the UK Millennium Cohort Study

OBJECTIVE

To investigate a framework of correlates of both mental illness and wellbeing in a large, current, and nationally representative sample of children in the United Kingdom.

METHOD

An ecologic framework of correlates including individual (sociodemographic and human capital), family, social, and wider environmental factors were examined in 12,347 children aged 11 years old from the UK Millennium Cohort Study. Mental illness and wellbeing scores were standardized to allow comparisons, and the variance explained by the different predictors was estimated.

RESULTS

Mental illness and wellbeing were weakly correlated in children (r = 0.2), and their correlates were similar in some instances (e.g., family structure, sibling bullying, peer problems) but differed in others (e.g., family income, perceived socioeconomic status, cognitive ability, health status, neighborhood safety). The predictors included in the study explained 47% of the variance in symptoms of mental illness, with social relationships, home environment, parent health, cognitive ability, socioeconomic status, and health factors predicting large amounts of variance. A comparatively lower 26% of the variance in wellbeing was explained by the study variables, with wider environment, social relationships, perceived socioeconomic status, and home environment predicting the most variance.

CONCLUSION

Correlates of children's mental illness and wellbeing are largely distinct, stressing the importance of considering these concepts separately and avoiding their conflation. This study highlights the relevance of these findings for understanding social gradients in mental health through the life course and the conceptualization and development of mental illness and wellbeing in childhood as precursors to lifelong development in these domains.

DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

INTRODUCTION

Although there is a documented social gradient for osteoporosis, the underlying mechanism(s) for that gradient remain unknown. We propose a conceptual model based upon the allostatic load theory, to suggest how DNA methylation (DNAm) might underpin the social gradient in osteoporosis and fracture. We hypothesise that social disadvantage is associated with priming of inflammatory pathways mediated by epigenetic modification that leads to an enhanced state of inflammatory reactivity and oxidative stress, and thus places socially disadvantaged individuals at greater risk of osteoporotic fracture.

METHODS/RESULTS

Based on a review of the literature, we present a conceptual model in which social disadvantage increases stress throughout the lifespan, and engenders a proinflammatory epigenetic signature, leading to a heightened inflammatory state that increases risk for osteoporotic fracture in disadvantaged groups that are chronically stressed.

CONCLUSIONS

Our model proposes that, in addition to the direct biological effects exerted on bone by factors such as physical activity and nutrition, the recognised socially patterned risk factors for osteoporosis also act via epigenetic-mediated dysregulation of inflammation. DNAm is a dynamic modulator of gene expression with considerable relevance to the field of osteoporosis. Elucidating the extent to which this epigenetic mechanism transduces the psycho-social environment to increase the risk of osteoporotic fracture may yield novel entry points for intervention that can be used to reduce individual and population-wide risks for osteoporotic fracture. Specifically, an epigenetic evidence-base may strengthen the importance of lifestyle modification and stress reduction programs, and help to reduce health inequities across social groups.

MINI ABSTRACT

Our conceptual model proposes how DNA methylation might underpin the social gradient in osteoporotic fracture. We suggest that social disadvantage is associated with priming of inflammatory signalling pathways, which is mediated by epigenetic modifications, leading to a chronically heightened inflammatory state that places disadvantaged individuals at greater risk of osteoporosis.

Moving forward monitoring of the social determinants of health in a country: lessons from England 5 years after the Marmot Review

Background

England has a long history of government-commissioned reviews of national inequalities. The latest review, the Marmot Review, was commissioned by a government headed by the same party (the Labour Party) that had introduced the National Health Service in 1948, but the review was implemented by a coalition of different parties (Conservatives and Liberal Democrats). At the same time, a government reform of health services took place, and the monitoring of the existing inequality strategy was changed.

Objectives

This paper examines the lessons that can be learned about indicators for monitoring social determinants of health inequalities from the Marmot Review and recent health inequality strategies in England.

Design

The paper provides a narrative review of key findings on the collection, presentation, and analysis of routine data in England in the past 5 years, comparing what has been learned from the Marmot Review and other evaluations of the first health inequality strategy in England.

Results

The emphasis on monitoring has progressively shifted from monitoring a small number of targets and supporting information to frameworks that monitor across a wide range of determinants of both the causes of ill-health and of health service performance. As these frameworks become ever larger, some consideration is being given to the key indicators.

Conclusions

Although the frameworks used in England for monitoring health inequality strategies have developed considerably since the first strategy began, lessons continue to be learned about how monitoring could be improved. Many of these are applicable to countries initiating or reviewing their strategies.

Psychosocial characteristics and predictors of health-care use in families of young children with cystic fibrosis in Western Australia

OBJECTIVE

Early childhood psychosocial experiences determine future health and health-care use. Identifying psychosocial predictors in cystic fibrosis may inform intervention strategies that can reduce health-care utilization.

DESIGN

The study was designed as a prospective cohort study.

SETTING

The study was set in the only cystic fibrosis clinic in Western Australia.

PATIENTS

The patients were children up to 6 years diagnosed with cystic fibrosis in Western Australia between 2005 and 2011.

MAIN OUTCOME MEASURES

Psychosocial data collected for each year of life were compared with Australian population data and analysed as predictors of annual hospital, emergency and outpatient visits.

RESULTS

Compared with the Australian population, cystic fibrosis families demonstrated lower socio-economic status and labour supply (P < 0.001), increased residential mobility (P < 0.001) and trends towards increased rates of parental separation (P = 0.066). Marital discord and maternal and child psychological stress significantly predicted increased hospital admissions, emergency and outpatient visits.

CONCLUSIONS

Social gradients may exist for families of young children with cystic fibrosis in Western Australia with potential implications for child health. Family psychological and relationship stress predicted increased child cystic fibrosis-related health-care use.

Perceptions of social mobility: development of a new psychosocial indicator associated with adolescent risk behaviors

Social class gradients have been explored in adults and children, but not extensively during adolescence. The first objective of this study was to examine the association between adolescent risk behaviors and a new indicator of adolescent relative social position, adolescent "perceived social mobility." Second, it investigated potential underlying demographic, socioeconomic, and psychosocial determinants of this indicator. Data were taken from the 2004 urban adolescent module of Oportunidades, a cross-sectional study of Mexican adolescents living in poverty. Perceived social mobility was calculated for each subject by taking the difference between their rankings on two 10-rung ladder scales that measured (1) projected future social status and (2) current subjective social status within Mexican society. Adolescents with higher perceived social mobility were significantly less likely to report alcohol consumption, drinking with repercussions, compensated sex, police detainment, physical fighting, consumption of junk food or soda, or watching ≥4 h of television during the last viewing. They were significantly more likely to report exercising during the past week and using a condom during last sexual intercourse. These associations remained significant with the inclusion of covariates, including parental education and household expenditures. Multiple logistic regression analyses show higher perceived social mobility to be associated with staying in school longer and having higher perceived control. The present study provides evidence for the usefulness of perceived social mobility as an indicator for understanding the social gradient in health during adolescence. This research suggests the possibility of implementing policies and interventions that provide adolescents with real reasons to be hopeful about their trajectories.

Addressing social inequality in aging by the Danish occupational social class measurement

OBJECTIVE

To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education.

METHOD

Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis.

RESULTS

The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree.

DISCUSSION

The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.

Social gradients in child and adolescent antisocial behavior: a systematic review protocol

BACKGROUND

The relationship between social position and physical health is well-established across a range of studies. The evidence base regarding social position and mental health is less well developed, particularly regarding the development of antisocial behavior. Some evidence demonstrates a social gradient in behavioral problems, with children from low-socioeconomic backgrounds experiencing more behavioral difficulties than children from high-socioeconomic families. Antisocial behavior is a heterogeneous concept that encompasses behaviors as diverse as physical fighting, vandalism, stealing, status violation and disobedience to adults. Whether all forms of antisocial behavior show identical social gradients is unclear from previous published research. The mechanisms underlying social gradients in antisocial behavior, such as neighborhood characteristics and family processes, have not been fully elucidated. This review will synthesize findings on the social gradient in antisocial behavior, considering variation across the range of antisocial behaviors and evidence regarding the mechanisms that might underlie the identified gradients.

METHODS

In this review, an extensive manual and electronic literature search will be conducted for papers published from 1960 to 2011. The review will include empirical and quantitative studies of children and adolescents (<=18 years old) recruited from the general population, which include measures of both social position and antisocial behavior. A standardized data extraction form and quality appraisal checklist will be used to retrieve essential information and critically appraise each study and the inter-rater reliability of the quality scores will be assessed. If practical, meta-analysis will be used to synthesize the data. However, it is expected that the selected studies will be heterogeneous, in which case narrative synthesis will be applied. Separate conclusions may be drawn for logically grouped studies on the basis of their quality score, scope or methodology.

DISCUSSION

This systematic review has been proposed in order to synthesize cross-disciplinary evidence of the social gradient in antisocial behavior and mechanisms underlying this effect. The results of the review will inform social policies aiming to reduce social inequalities and levels of antisocial behavior, and identify gaps in the present literature to guide further research.

Socioeconomic patterning of childhood overweight status in Europe

There is growing evidence of social disparities in overweight among European children. This paper examines whether there is an association between socioeconomic inequality and prevalence of child overweight in European countries, and if socioeconomic disparities in child overweight are increasing. We analyse cross-country comparisons of household inequality and child overweight prevalence in Europe and review within-country variations over time of childhood overweight by social grouping, drawn from a review of the literature. Data from 22 European countries suggest that greater inequality in household income is positively associated with both self-reported and measured child overweight prevalence. Moreover, seven studies from four countries reported on the influence of socioeconomic factors on the distribution of child overweight over time. Four out of seven reported widening social disparities in childhood overweight, a fifth found statistically significant disparities only in a small sub-group, one found non-statistically significant disparities, and a lack of social gradient was reported in the last study. Where there is evidence of a widening social gradient in child overweight, it is likely that the changes in lifestyles and dietary habits involved in the increase in the prevalence of overweight have had a less favourable impact in low socio-economic status groups than in the rest of the population. More profound structural changes, based on population-wide social and environmental interventions are needed to halt the increasing social gradient in child overweight in current and future generations.