Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

The relationship between anxiety and diet quality in adolescent populations: a cross-sectional analysis

Globally, more than 13 % of adolescents have clinically significant mental health problems, with anxiety and depression comprising over 40 % of cases. Despite the high prevalence of anxiety disorders among youth, dietary research has been focused on youth with depression, resulting in a significant knowledge gap regarding the impact of anxiety on adolescent diet quality. Adolescents with diagnosed anxiety disorders and healthy controls were included in this study. Anxiety symptoms were measured using the Screen for Child Anxiety-Related Disorders. Diagnosis of anxiety disorder was determined using the Kiddie Schedule for Affective Disorders and Schizophrenia interview. Five diet quality indices were scored from FFQ. Diet quality indices associated with anxiety symptoms in the correlation matrix were interrogated using multiple linear regression modelling. All models were adjusted for depression. One hundred and twenty-eight adolescents (mean age 14·8 years (sd: 2·1); 66·4 % female) were included in this cross-sectional analysis. Although healthy controls and outpatient participants had similar unhealthy dietary index subscale scores, outpatient participants had lower healthy index scores. Higher anxiety symptoms were associated with lower healthy dietary indices in univariate analysis; after adjusting for comorbid depression; however, anxiety symptoms were no longer associated with dietary indices following adjustment for multiple testing (P = 0·038 to P = 0·077). The association between anxiety symptoms and a poor diet is attenuated by depression. The results of this study support the need for an integrated approach to the assessment of mental and physical well-being and further research aimed at understanding the unique contribution of depression to healthy dietary patterns.

Geospatial Distribution of Obsessive-Compulsive Disorder Specialists: Understanding Access as a Function of Distance, Insurance Status, and Neighborhood Socioeconomic Status

Obsessive-compulsive disorder is an impairing psychiatric condition affecting 1-2% of adults and youth. Cognitive-behavioral therapy with exposure and response prevention (CBT) is an efficacious intervention but requires specialty training and access is often limited. While certain factors are associated with treatment access, one key barrier that has not been explored is the geographic availability of OCD treatment providers. Using integrated geographically-referenced data, we examined the geographic distribution of OCD CBT specialty providers across the state of Texas, with particular attention to the relationship to neighborhood socioeconomic disadvantage, insurance status, and rural versus urban status. We found that specialist providers are almost exclusively located inside the highly urbanized parts of the state, primarily in more affluent areas, and often only accept self-pay. The characteristics of the areas located the furthest away from specialty OCD care include a high proportion of persons identifying as Hispanic; a high proportion of non-English speakers, households with income below poverty; households with no vehicles; and persons with no health insurance. Average household income decreased as distances from specialist providers increased. Broadly, findings confirm that OCD CBT specialty providers are clustered in large socially advantaged areas and that economic disadvantage remains a significant barrier to care. As inadequate or inappropriate treatment of OCD is likely to result in sustained and impairing symptoms, this is of great concern.

Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation

BACKGROUND

Mortality from cervical cancer has declined steadily in the United States over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared with late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in cervical cancer diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and cervical cancer diagnosis stage.

METHODS

We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women ages 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and cervical cancer stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage.

RESULTS

Of the 9,192 women with cervical cancer, 4,720 (51.3%) had LCC at diagnosis. Compared with non-Hispanic white (NHW) women (106.13, standard deviation (SD) = 13.32), non-Hispanic Black (NHB; 111.46, SD = 9.55) and Hispanic (112.32, SD = 9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis [total effects: adjusted odds ratios (AOR) = 1.29 (95% CI, 1.11-1.46) and AOR 1.14 (95% CI, 1.03-1.25), respectively]. Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively.

CONCLUSIONS

LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women.

IMPACT

Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.

Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study

Background

Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans.

Methods

Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division.

Findings

Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific.

Interpretation

Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic.

Funding

US National Cancer Institute.

A Mixed Methods, Quasi-Experimental Evaluation Exploring the Impact of a Secondary School Universal Free School Meals Intervention Pilot

Food insecurity amongst households with children is a growing concern globally. The impacts in children include poor mental health and reduced educational attainment. Providing universal free school meals is one potential way of addressing these impacts. This paper reports findings on the impact of a universal free school meals pilot in two English secondary schools. We adopted a mixed-methods, quasi-experimental design. The intervention schools were one mainstream school (n = 414) and one school for students with special educational needs (n = 105). Two other schools were used as comparators (n = 619; n = 117). The data collection comprised a cross sectional student survey during the pilot (n = 404); qualitative interviews with students (n = 28), parents (n = 20) and school staff (n = 12); and student observations of lunchtimes (n = 57). Qualitative data were analysed using thematic analysis, and descriptive analyses and logistic regressions were conducted on the quantitative data. Self-reports of food insecurity were high at both intervention (26.6%) and comparator schools (25.8%). No effects of the intervention were seen in the quantitative findings on either hunger or food insecurity. Qualitative findings indicated that students, families and staff perceived positive impact on a range of outcomes including food insecurity, hunger, school performance, family stress and a reduction in stigma associated with means-tested free school meals. Our research provides promising evidence in support of universal free school meals in secondary schools as a strategy for addressing growing food insecurity. Future research should robustly test the impact of universal free school meals in a larger sample of secondary schools, using before and after measures as well as a comparator group.

Exploring Youth Perceptions About Cancer Prevention and Preferences for Education: a Qualitative Study

This study aimed to characterize adolescents' perspectives on cancer and cancer prevention and to explore their preferences for cancer education. A total of 188 middle and high school students participated in 25 focus groups. Focus groups were led by study team members and included five to ten participants each. Adolescents were asked to discuss their cancer and cancer prevention knowledge, sources of cancer education, and preferences for cancer prevention education. Focus groups were audio-recorded, and professionally transcribed. Transcripts were content and thematically analyzed by two study team members using NVivo qualitative data software. Six themes were identified in focus groups: knowledge about cancer, negative perceptions of cancer, awareness of cancer prevention, engagement in cancer prevention, facilitators and barriers for action, and preferences for cancer education. Adolescents described a wide range of cancer education sources, including friends, family, healthcare professionals, school, technology, and pamphlets. Participants associated cancer with negative emotions, such as sadness and fear. Participants expressed interest in learning about cancer and cancer prevention, but also identified barriers to engaging in preventative behaviors, such as discomfort, lack of knowledge, and lack of personal connection to cancer. Adolescents preferred learning through personal presentations, online videos, school, educational games, and social situations. Adolescence is a critical period for learning and developing healthy behaviors. Awareness of cancer and cancer prevention is crucial to lowering cancer risk in the future. To be effective, cancer education for adolescents should target specific areas of cancer prevention and address barriers to engagement in preventative behaviors.

Intergenerational transmission of parental risky health behaviors in Chinese children: Are there socioeconomic status differences?

Background

Risky health behaviors in childhood, including smoking, alcohol consumption, and having a poor diet, are the major sources of non-communicable diseases in adulthood. This study aimed to examine how parents affect children's risky health behaviors and whether intergenerational transmission differs based on socioeconomic status (SES).

Methods

Data were extracted from the 1991-2015 China Health and Nutrition Survey (CHNS). Smoking (n = 5,946), alcohol consumption (n = 7,821), and sugar-sweetened beverages (SSBs) consumption (n = 3,537) were used as proxies for risky health behaviors in children. A binary choice model for panel data with a random-effect specification was employed to examine whether risky health behaviors can be transmitted from parents to their children. Subsequently, we conducted a seemingly unrelated estimation test (SUEST) to explore the differences in parental transmission between the different SES groups.

Results

We found strong intergenerational persistence of smoking, alcohol drinking, and SSBs drinking behaviors, except for the mothers' smoking behavior. Mothers had a greater influence on children's alcohol drinking and SSBs drinking behaviors than fathers both in urban and rural areas and in different SES groups. The intergenerational transmission of SSBs drinking behavior exhibited a decreasing trend with increasing SES for both urban and rural families. In urban areas, mothers' alcohol drinking behavior has a decreasing trend with increasing education level, occupation, and income; however, in rural areas, the influence of mothers' alcohol drinking behavior occurred in the same direction with increasing education level and occupation type. In rural areas, the influence of fathers' drinking and smoking behaviors on children appears to mostly increase with increasing SES. Meanwhile, the influence of such behaviors among urban fathers would decrease with increasing SES.

Conclusion

Parents' behaviors and SES can influence the initiation of risky health behaviors in their offspring. Thus, to promote healthy behaviors, policymakers can introduce health education programs for parents, particularly for those living in rural areas and with a low SES.

The Portuguese economic crisis is associated with socioeconomic and sex disparities on children's health-related behaviors and obesity: A cross-sectional study

OBJECTIVES

Our objective was to examine the relationship between the 2008 and 2015 economic crisis and children's physical activity (PA) outcomes, eating behaviors and obesity prevalence, while considering sex inequalities and familial socioeconomic status.

METHOD

This is a cross-sectional study, including data collected in 2016/2017 among 5134 children aged 6-11 years (mean age: 8.11 ± 1.24; 50.0% boys). Children's height, weight, and waist circumference were objectively measured. Children's sleep- and screen-time, participation in organized sports, and specific dietary habits were reported parental-reported using a standardized questionnaire. An economic crisis impact score, with data from 10 indicators of economic needs in the family, was used to characterize the crisis' impact.

RESULTS

First, the prevalence of overweight and obesity was higher in children whose families had a higher impact of the crisis. Second, children's intake of fruit and high-fat food, screen-time, sleep-time, and participation in organized sports differed according to the level of impact of the economic crisis. Third, the association between health-related behaviors and the impact of the economic crisis was stronger for girls compared to boys.

CONCLUSION

Our findings give us an indication of how economic crises may drive changes in health outcomes.

Neighborhood Socioeconomic Deprivation in Early Childhood Mediates Racial Disparities in Blood Pressure in a College Student Sample

The influence of childhood contexts on adult blood pressure is an important yet understudied topic. Using a developmental perspective, this study examines the association between neighborhood socioeconomic disadvantage in early childhood (0-5 yrs), middle childhood (6-12 yrs) and adolescence (13-18 yrs) on subsequent blood pressure in young adulthood. Data were from 263 college students (52% Black; M_age = 19.21 years) and neighborhood socioeconomic disadvantage was measured using a tract-level Area Deprivation Index. Neighborhood disadvantage in early childhood was significantly associated with diastolic blood pressure and explained 22% of the race difference between Black and White adults. The findings are consistent with the notion that early childhood may be a sensitive period for the effects of neighborhood disadvantage on blood pressure.

Mediating Effects of Neighborhood-Level Socioeconomic Deprivation on the Association Between Race/Ethnicity and Advanced Hepatocellular Carcinoma

BACKGROUND

Racial/ethnic minorities are more likely than non-Hispanic whites (NHW) to be diagnosed with advanced stage hepatocellular carcinoma (HCC). We examined the role of neighborhood disadvantage as a mediator of the association between race/ethnicity and HCC stage at diagnosis.

METHODS

We used data from HCC cases diagnosed in Texas from 2007 to 2015. HCC cases were classified as local versus regional/advanced stage. A mediation model approach was used to estimate the average direct effect, average mediated (indirect) effect, total effect, and proportion mediated by the Area Deprivation Index (ADI), a composite measure of disadvantage.

RESULTS

7,622 had local while 6303 had regional/advanced HCC. 46.1% of cases were NHW, 15.0% non-Hispanic Black (NHB), and 38.9% Hispanic. NHBs were less likely than NHWs to be diagnosed with local stage HCC [total effect RR, 0.921; 95% confidence interval (95% CI), 0.898-0.947]; however, only 2.26% of this effect was mediated through ADI. Conversely, Hispanics were more likely than NHWs to be diagnosed with local stage HCC (total effect RR, 1.019; 95% CI, 1.001-1.037) and ADI mediated 12.56% of the effect of race/ethnicity on HCC stage. ADI was not associated with HCC stage and therefore was not a mediator of the association with HCC stage when we compared Hispanics with NHBs.

CONCLUSIONS

Neighborhood socioeconomic disadvantage may explain/mediate some of the association between race/ethnicity and HCC stage; however, the mediating effect was not uniform across populations.

IMPACT

For NHBs, other individual and neighborhood level factors, not reflected in the ADI, contribute to their lower likelihood of being diagnosed with local HCC. See related commentary by Lazo et al., p. 1254.

Self-efficacy and Unwanted Sexual Intercourse: 'Reproductive Health Education Programme for High-school Students in Vojvodina'

Introduction

Studies have shown the importance of self-efficacy in the domain of risky sexual behaviour. The aim of this study was to examine the association of unwanted sexual intercourse among secondary-school students with socio-demographic factors and perceived self-efficacy, and to assess the effectiveness of the programme on reproductive health.

Methods

The study involved 5,026 second-grade students in 72 high schools in the Province of Vojvodina, Serbia (APV). They were surveyed before and after the implementation of the extracurricular 'Reproductive health education programme for secondary-school students in APV'. A questionnaire consisting of 57 questions (socio-demographic characteristics, knowledge, attitudes, and behaviour of students regarding reproductive health, and a general self-efficacy scale) was used as the research instrument.

Results

One quarter of students had engaged in unwanted sexual intercourse on one or more occasions. Students with poor material status were twice as likely to engage in unwanted sexual intercourse (ОR=2.01; 95%CI=1.07-3.75) as students with average or good material status. Students who did not engage in unwanted sexual intercourse had a higher self-efficacy score than students who who did (t=2.903; p<0.01). After the programme was completed, there was an increase in general self-efficacy.

Conclusion

Poor material status is a predictor of unwanted sexual intercourse. Students who have a higher level of self-efficacy engaged to a lesser degree in unwanted sexual intercourse. The programme is effective in terms of increasing general self-efficacy, and can be applied to encourage responsible sexual behaviour.

Racial disparity in prostate cancer in the African American population with actionable ideas and novel immunotherapies

BACKGROUND

African Americans (AAs) in the United States are known to have a higher incidence and mortality for Prostate Cancer (PCa). The drivers of this epidemiological disparity are multifactorial, including socioeconomic factors leading to lifestyle and dietary issues, healthcare access problems, and potentially tumor biology.

RECENT FINDINGS

Although recent evidence suggests once access is equal, AA men have equal outcomes to Caucasian American (CA) men, differences in PCa incidence remain, and there is much to do to reverse disparities in mortality across the USA. A deeper understanding of these issues, both at the clinical and molecular level, can facilitate improved outcomes in the AA population. This review first discusses PCa oncogenesis in the context of its diverse hallmarks before benchmarking key molecular and genomic differences for PCa in AA men that have emerged in the recent literature. Studies have emphasized the importance of tumor microenvironment that contributes to both the unequal cancer burden and differences in clinical outcome between the races. Management of comorbidities like obesity, hypertension, and diabetes will provide an essential means of reducing prostate cancer incidence in AA men. Although requiring further AA specific research, several new treatment strategies such as immune checkpoint inhibitors used in combination PARP inhibitors and other emerging vaccines, including Sipuleucel-T, have demonstrated some proven efficacy.

CONCLUSION

Genomic profiling to integrate clinical and genomic data for diagnosis, prognosis, and treatment will allow physicians to plan a "Precision Medicine" approach to AA men. There is a pressing need for further research for risk stratification, which may allow early identification of AA men with higher risk disease based on their unique clinical, genomic, and immunological profiles, which can then be mapped to appropriate clinical trials. Treatment options are outlined, with a concise description of recent work in AA specific populations, detailing several targeted therapies, including immunotherapy. Also, a summary of current clinical trials involving AA men is presented, and it is important that policies are adopted to ensure that AA men are actively recruited. Although it is encouraging that many of these explore the lifestyle and educational initiatives and therapeutic interventions, there is much still work to be done to reduce incidence and mortality in AA men and equalize current racial disparities.

A Harvest of the Month Curriculum Increases Fruit and Vegetable Intake among 4th-6th Grade Students

BACKGROUND

Most children do not eat enough fruits and vegetables (FV). Schools are a critical setting for supporting children to consume FV. To fill a gap in available materials, a classroom curriculum was developed and evaluated to determine impacts on student FV-related knowledge, attitudes, and behaviors.

METHODS

A pre-/post-intervention survey was administered to 4th-6th grade students in 3 intervention and one comparison schools. Post-intervention student focus groups, parent/guardian surveys, and teacher surveys provided complementary information.

RESULTS

Intervention students had a significantly greater increase in total FV intake, fruit intake, and 100% juice consumption, and preference for several types of FV relative to comparison group students. Students, teachers, and parents reported overall high levels of satisfaction with the curriculum.

CONCLUSIONS

The Harvest of the Month curriculum is effective at increasing fruit intake among a low-income, diverse student population in grades 4-6, is acceptable to students, teachers, and parents, and is feasible to implement. Findings suggest this impact is the result of changes in preferences, skills, and motivation but not self-efficacy or perceived social norms. Some tailoring of the curriculum may be needed to increase its appropriateness for 6th-grade students, increase the impact on vegetable intake, and limit intake of juice.

The association of diet and depression: an analysis of dietary measures in depressed, non-depressed, and healthy youth

BACKGROUND

The association of diet quality with depression among the pediatric age group has been inconsistent. This may be due, in part, to varying dietary assessment methods. The current study sought to examine this association, and its reliability, using four dietary measures previously studied in children and adolescents.

METHODS

Dietary habits among 139 children and adolescents (10-18 years, 66% female) with major depressive disorder [MDD (n = 77)], non-MDD psychiatric conditions (PSYCH; n = 31), or without psychiatric illness (healthy controls [HC]; n = 31) were examined. Using self-reported dietary intake, diet quality was characterized using the Youth Healthy Eating Index (YHEI), Dietary Questionnaire (DQ), Health Behaviour of Teenagers (HBT), and the Healthy Eating Habits Scale (HEHS). Multivariate Analysis of Covariances examined the association between depression status and dietary habits across measures controlling for participant age.

RESULTS

The multivariate effect was significant by diet measures, F (16, 256) = 1.9, p = .02, partial η² = 0.12, with significant differences across groups on consumption of healthy dietary practices and minimal variability across measures. In subgroup analyses, MDD children had decreased consumption of healthy foods compared with PSYCH and HC children on three out of four measures. There was no difference in consumption of unhealthy foods across diagnostic groups.

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Children with MDD consume fewer healthy foods than non-MDD children, with little variation by dietary measure. Research examining the directionality of this association and specific dietary deficits among MDD youth is needed to elucidate potential preventative targets for intervention.

COVID-19 Community Incidence and Associated Neighborhood-Level Characteristics in Houston, Texas, USA

Central to developing effective control measures for the COVID-19 pandemic is understanding the epidemiology of transmission in the community. Geospatial analysis of neighborhood-level data could provide insight into drivers of infection. In the current analysis of Harris County, Texas, we used custom interpolation tools in GIS to disaggregate COVID-19 incidence estimates from the zip code to census tract estimates—a better representation of neighborhood-level estimates. We assessed the associations between 29 neighborhood-level characteristics and COVID-19 incidence using a series of aspatial and spatial models. The variables that maintained significant and positive associations with COVID-19 incidence in our final aspatial model and later represented in a geographically weighted regression model were the percentage of the Black/African American population, percentage of the foreign-born population, area derivation index (ADI), percentage of households with no vehicle, and percentage of people over 65 years old inside each census tract. Conversely, we observed negative and significant association with the percentage employed in education. Notably, the spatial models indicated that the impact of ADI was homogeneous across the study area, but other risk factors varied by neighborhood. The current findings could enhance decision making by local public health officials in responding to the COVID-19 pandemic. By understanding factors that drive community transmission, we can better target disease control measures.

Adolescents' Perceptions About Cancer and Preferences for Cancer Education

BACKGROUND

Cancer is one of the leading causes of death within the United States. Adolescence remains a critical stage of development in which new cognitive skills and lifestyle factors related to cancer are acquired. It is critical to understand adolescents' knowledge of cancer and preferences for receiving clear and easy-to-comprehend information about cancer and cancer prevention. The purpose of this study was to explore adolescents' perceptions of cancer and cancer risk factors and identify their preferences for receiving cancer prevention education.

METHODS

The survey used in this study was based on the Health Belief Model framework, the Youth Risk Behavior Survey, and the Cancer, Clear & Simple (CC&S) Curriculum. The survey evaluated adolescents' knowledge, attitudes, and health-related behaviors regarding cancer and cancer prevention among adolescents. Three Midwestern middle and high schools were recruited, and 235 students completed the survey. Survey responses were analyzed using descriptive statistics.

RESULTS

Study participants had some basic knowledge of cancer; however, only 66% recognized that individuals have control over their risk of developing cancer. Participants (95%) reported that cancer prevention was important, yet only 37.3% stated they knew how to lower their risk of getting cancer and 50% indicated that they currently try to make decisions that lower their chances of getting cancer. About 82% stated that an educational game would be a useful tool to learn about cancer and prevention.

CONCLUSION

Study findings indicate the need for an increase in adolescent knowledge of cancer, specifically how they can control their cancer risk, and prevention strategies through development of game-based education to teach adolescents about cancer-related topics.

Neighborhood deprivation index is associated with weight status among long-term survivors of childhood acute lymphoblastic leukemia

PURPOSE

Area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, has been linked to metabolic outcomes in the general population but has received limited attention in survivors of childhood acute lymphoblastic leukemia (ALL), a population with high rates of overweight and obesity.

METHODS

We retrospectively reviewed heights and weights of ≥ 5 year survivors of pediatric ALL (diagnosed 1990-2013). Residential addresses were geocoded using ArcGIS to assign quartiles of ADI, a composite of 17 measures of poverty, housing, employment, and education, with higher quartiles reflecting greater deprivation. Odds ratios (OR) and 95% confidence intervals (CI) for the association between ADI quartiles and overweight/obesity or obesity alone were calculated with logistic regression.

RESULTS

On average, participants (n = 454, 50.4% male, 45.2% Hispanic) were age 5.5 years at diagnosis and 17.4 years at follow-up. At follow-up, 26.4% were overweight and 24.4% obese. Compared to the lowest ADI quartile, survivors in the highest quartile were more likely to be overweight/obese at follow-up (OR = 2.33, 95% CI: 1.23-4.44) after adjusting for race/ethnicity, sex, age at diagnosis, and age at follow-up. The highest ADI quartile remained significantly associated with obesity (OR = 5.28, 95% CI: 1.79-15.54) after accounting for weight status at diagnosis.

CONCLUSIONS

This study provides novel insights into possible social determinants of health inequalities among survivors of childhood ALL by reporting a significant association between neighborhood deprivation and overweight/obesity.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors of childhood ALL residing in neighborhood with greater socioeconomic disadvantage may be at increased risk of overweight and obesity and candidates for targeted interventions.

Association between Socioeconomic Status and Digestive Tract Cancers: A Case-Control Study

Although socioeconomic status (SES) has been associated with cancer risk, little research on this association has been done in Japan. To evaluate the association between SES and digestive tract cancer risk, we conducted a case-control study for head and neck, esophageal, stomach, and colorectal cancers in 3188 cases and the same number of age- and sex-matched controls within the framework of the Hospital-based Epidemiological Research Program at Aichi Cancer Center III (HERPACC III). We employed the education level and areal deprivation index (ADI) as SES indicators. The association was evaluated with odds ratios (ORs) and 95% confidence intervals (CIs) by conditional logistic models adjusted for potential confounders. Even after allowance for known cancer risk factors, the education level showed linear inverse associations with head and neck, stomach, and colorectal cancers. Compared to those educated to junior high school, those with higher education showed statistically significantly lower risks of cancer (0.43 (95% CI: 0.27-0.68) for head and neck, 0.52 (0.38-0.69) for stomach, and 0.52 (0.38-0.71) for colorectum). Consistent with these results for the educational level, the ADI in quintiles showed positive associations with head and neck, esophageal, and stomach cancers (p-trend: p = 0.035 for head and neck, p = 0.02 for esophagus, and p = 0.013 for stomach). Interestingly, the positive association between ADI and stomach cancer risk disappeared in the additional adjustment for Helicobacter pylori infection and/or atrophic gastritis status. In conclusion, a lower SES was associated with an increased risk of digestive cancers in Japan and should be considered in cancer prevention policies for the target population.

The role of socio-economic factors in food consumption of Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016

This study aimed to evaluate the association between socio-economic factors and the food consumption of a young population. Participants were from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) aged from 3 to 17 years (n 1153). Food consumption was assessed using two non-consecutive days of food diaries in children and two 24-h recalls for adolescents. A latent class analysis (LCA) was used to classify children's socio-economic status (socio-economic composite classification (SCC)), categorised in low, middle or high. The associations between socio-economic variables and food consumption were evaluated through linear or logistic regression models, weighted for the Portuguese population distribution. A positive association was found between belonging to a higher level of SCC and consumption of fruits and vegetables (FV), by children (β = 2·4, 95 % CI 1·1, 3·8) and by adolescents (β = 52·4, 95 % CI 9·6, 95·3). A higher SCC, but particularly higher maternal education, was positively associated with consumption of 'white meat, fish and eggs'. Both higher SCC and parental education were positively associated with salty snack consumption in the adolescents' group. In conclusion, children and adolescents with higher educated parents and belonging to a high socio-economic level have a higher daily intake of FV and white meat, fish and eggs. Socio-economic factors play an important role in justifying differences in the food consumption of children and adolescents and must be considered in future interventions. The relationship between higher socio-economic position and salty snack consumption in adolescents needs to be further explored in other populations.

Neighborhood Socioeconomic Deprivation Associated with Fat Mass and Weight Status in Youth

(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30; 95% CI = 1.03-1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.

Are Correlates of Physical Activity in Adolescents Similar Across Ethnicity/Race and Sex: Implications for Interventions

BACKGROUND

This study tested for differences in personal, social, and environmental correlates of moderate to vigorous physical activity (MVPA) across ethnicity/race in male and female adolescents.

METHODS

Self-reported MVPA and 47 potential correlates of MVPA were measured in an ethnically/racially diverse cross-sectional sample of adolescents, in Minnesota, who participated in EAT-2010 (Eating and Activity in Teens). Interactions of potential correlates with ethnicity/race on MVPA were tested in linear hierarchical regression models in boys and girls.

RESULTS

Boys reported 1.7 more weekly hours of MVPA than girls. White adolescents reported 1.1 to 2.1 more weekly hours of MVPA than nonwhite adolescents. Among girls, neighborhood road connectivity was negatively correlated with MVPA among Hispanic and Asian participants. Among boys, sports participation was positively correlated with MVPA among all ethnicities/races, except Asians. Home media equipment was positively correlated with MVPA among Hispanic boys, but negatively correlated among white boys.

CONCLUSIONS

A few correlates of physical activity among adolescents differed intersectionally by ethnicity/race and sex. Sports participation and home media equipment may have differing impacts on physical activity across ethnicities and races in boys, whereas neighborhood features like road connectivity may have differing impacts on physical activity across ethnicities and races in girls.

Associations among Neighborhood Socioeconomic Deprivation, Physical Activity Facilities, and Physical Activity in Youth during the Transition from Childhood to Adolescence

Background: This study aims to examine the longitudinal association of neighborhood socioeconomic deprivation (SED) with physical activity in youth during the transition from elementary to middle school, and to determine if access to physical activity facilities moderates this relationship. Methods: Data were obtained from the Transitions and Activity Changes in Kids (TRACK) study, which was a multilevel, longitudinal study designed to identify the factors that influence changes in physical activity as youth transition from elementary to middle school. The analytic sample for the current study included 660 youth with complete data in grades 5 (baseline) and 7 (follow-up). A repeated measures multilevel framework was employed to examine the relationship between SED and physical activity over time and the potential moderating role of elements of the built environment. Results: Decreases in physical activity varied by the degree of neighborhood SED with youth residing in the most deprived neighborhoods experiencing the greatest declines in physical activity. Access to supportive physical activity facilities did not moderate this relationship. Conclusion: Future research studies are needed to better understand how neighborhood SED influences youth physical activity over time.

The impact of gender, socioeconomic status and locality on the development of student patterns of alcohol consumption and harm

Purpose

The consequences of problematic alcohol consumption fall heavily on Australian adolescents, with this population at increased risk of death, serious injury and other harm. Research regarding whether gender, socioeconomic status (SES) or locality play a role in young people’s alcohol consumption and related harm is limited in Australia. The purpose of this paper is to determine whether Victorian students’ patterns of alcohol uptake, consumption and related harm differed between gender, SES and locality.

Design/methodology/approach

The study involved secondary analysis of student data from the Drug Education in Victorian Schools harm minimisation drug education programme, undertaken in 21 Victorian government schools over three years The initial cohort of 1,752 students was followed during Years 8, 9 and 10, when their average age would have, respectively, been 13, 14 and 15 years.

Findings

There were no gender differences in drinking uptake, consumption or harm. Students with low SES were more likely to have consumed a full drink of alcohol and also experienced more alcohol-related harm. Students living in a regional/rural area were more likely to have engaged in high alcohol consumption.

Originality/value

The findings of this study highlighted that different student demographics have an impact on patterns of alcohol consumption, vulnerability and harm. Students with low SES, living in a regional/rural area, are more at risk than students with higher SES living in a fringe metro/major regional or metro area. Future school harm minimisation drug education programmes should consider the needs of students with demographics that make them more susceptible to higher consumption and harm.

Fruit and vegetable consumption and mental health across adolescence: evidence from a diverse urban British cohort study

BACKGROUND

Evidence on the relationship between fruit and vegetable consumption (FV) and mental health in adolescence is sparse and inconsistent. Social determinants of FV include ethnicity, family environments and economic disadvantage. We investigated the relationship between FV and mental health in the British multi-ethnic Determinants of Adolescents (now young Adult) Social well-being and Health (DASH) longitudinal study.

METHODS

A longitudinal study of 4683 adolescents living in London at age 11-13 years and followed up at 14-16 years. FV was measured using validated questions on the number of portions consumed daily. Mental health was measured by the Strengths and Difficulties Questionnaire as mean Total Difficulties Score (TDS) and by classification as a 'probable clinical case' (TDS > 17). Social measures included ethnicity, parenting and socioeconomic circumstances. Multilevel modelling was used to investigate the association between FV and mental health throughout adolescence.

RESULTS

Low FV was common among adolescents, with approximately 60-70% of adolescents reporting < 5 portions/day and 20-30% reporting < 1 portion/day. In late adolescence, most ethnic minority groups reported lower FV than their White peers. In fully adjusted models, < 1 portion/day remained a significant correlate with mean TDS (Coef: 0.55, 0.29-0.81, P < 0.001) and TDS > 17 (Odds Ratio: 1.43, 1.11-1.85, P = 0.007). Gender- or ethnic-specific effects were not observed. Low parental care partly attenuated the association between FV and mental health.

CONCLUSIONS

Low FV is a longitudinal correlate of poor mental health across adolescence. A focus on FV in parenting interventions could yield interrelated benefits across developmental outcomes given its importance to both physical and socioemotional health.

Disparities in mortality among 25-44-year-olds in England: a longitudinal, population-based study

BACKGROUND

Since the mid-1990s, excess mortality has increased markedly for adults aged 25-44 years in the north compared with the south of England. We examined the underlying causes of this excess mortality and the contribution of socioeconomic deprivation.

METHODS

Mortality data from the Office of National Statistics for adults aged 25-44 years were aggregated and compared between England's five most northern versus five most southern government office regions between Jan 1, 1981, and Dec 31, 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the north compared with the south by underlying cause of death (accidents, alcohol related, cardiovascular disease and diabetes, drug related, suicide, cancer, and other causes). The role of socioeconomic deprivation, as measured by the 2015 Index of Multiple Deprivation, in explaining the excess and regional variability was also explored.

FINDINGS

A mortality divide between the north and south appeared in the mid-1990s and rapidly expanded thereafter for deaths attributed to accidents, alcohol misuse, and drug misuse. In the 2014-16 period, the northern excess was incidence rate ratio (IRR) 1·47 (95% CI 1·39-1·54) for cardiovascular reasons, 2·09 (1·94-2·25) for alcohol misuse, and 1·60 (1·51-1·70) for drug misuse, across both men and women aged 25-44 years. National mortality rates for cardiovascular deaths declined over the study period but a longstanding gap between north and south persisted (from 33·3 [95% CI 31·8-34·8] in 1981 to 15·0 [14·0-15·9] in 2016 in the north vs from 23·5 [22·3-24·8] to 9·9 [9·2-10·5] in the south). Between 2014 and 2016, estimated excess numbers of death in the north versus the south for those aged 25-44 years were 1881 (95% CI 726-2627) for women and 3530 (2216-4511) for men. Socioeconomic deprivation explained up to two-thirds of the excess mortality in the north (IRR for northern effect reduced from 1·15 [95% CI 1·14-1·15; unadjusted] to 1·05 [1·04-1·05; adjusted for Index of Multiple Deprivation]). By 2016, in addition to the persistent north-south gap, mortality rates in London were lower than in all other regions, with IRRs ranging from IRR 1·13 (95% CI 1·12-1·15) for the East England to 1·22 (1·20-1·24) for the North East, even after adjusting for deprivation.

INTERPRETATION

Sharp relative rises in deaths from cardiovascular reasons, alcohol misuse and drug misuse in the north compared with the south seem to have created new health divisions between England's regions. This gap might be due to exacerbation of existing social and health inequalities that have been experienced for many years. These divisions might suggest increasing psychological distress, despair, and risk taking among young and middle-aged adults, particularly outside of London.

FUNDING

Medical Research Council and Wellcome Trust.

Prostate Cancer Disparities by Race and Ethnicity: From Nucleotide to Neighborhood

Prostate cancer (CaP) incidence, morbidity, and mortality rates vary substantially by race and ethnicity, with African American men experiencing among the highest CaP rates in the world. The causes of these disparities are multifactorial and complex, and likely involve differences in access to screening and treatment, exposure to CaP risk factors, variation in genomic susceptibility, and other biological factors. To date, the proportion of CaP that can be explained by environmental exposures is small and differences in the role factors play by race or ethnicity is poorly understood. In the absence of additional data, it is likely that environmental factors do not contribute greatly to CaP disparities. In contrast, CaP has one of the highest heritabilities of all major cancers and many CaP susceptibility genes have been identified. Some CaP loci, including the risk loci found at chromosome 8q24, have consistent effects in all racial/ethnic groups studied to date. However, replication of many susceptibility loci across race or ethnicity remains limited. It is likely that inequities in health care access strongly influences CaP disparities. CaP is a disease with a complex multifactorial etiology, and therefore any approach attempting to address racial/ethnic disparities in CaP must consider the many sources that influence risk, outcomes, and disparities.

Health behaviours of young mothers: Implications for health promotion and cancer prevention

OBJECTIVE

Evidence suggests that younger mothers engage in poorer health behaviours, resulting in increased cancer risk. We aimed to better understand the health behaviours of younger mothers and the factors that influence their lifestyle choices, in order to improve cancer prevention within this population.

METHODS

A multiple focus group, photo-elicitation-aided approach was used, in which young mothers (n = 27; aged 16-24 years) were provided with cameras and asked to capture 'a week in your life'. Photographs were developed and participants invited to an initial focus group where photographs were used to elicit discussion, exploring participants' health behaviours. Data were thematically analysed particularly identifying themes relating to barriers and facilitators of positive health behaviours. Participants were later invited to participate in a second focus group, to explore and validate identified themes further.

RESULTS

Themes emerged from the data relating to (1) the mothers' personal perceptions of health, (2) health-related behaviours and (3) beliefs about cancer and its causes. Barriers to positive health behaviours included a lack of money, childcare and cookery skills; facilitators included the social media, commercial weight loss programmes and local community organisations.

CONCLUSION

Study findings provide insight into the health behaviours and life choices of young mothers. They help illustrate health perceptions in relation to cancer risk, providing an understanding of how their daily routine and circumstance influence young women's decisions and lifestyle behaviour choices and highlighting barriers to, and facilitators of, positive health behaviours. Data hold potential to inform future health-related research among young mothers, particularly relating to cancer prevention intervention.

Race/Ethnicity, Smoking Status, and Self-Generated Expected Outcomes from Smoking among Adolescents

Racial/ethnic differences in adolescent smoking suggest that different factors may motivate smoking among various racial/ethnic groups. This study examined relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status. Our findings noted that current smoking was highest among Hispanics, whereas African Americans and Asians were least likely to ever smoke. African Americans were most likely to experiment but least likely to smoke currently. Five expectancies differed significantly by race/ethnicity: reduce tension, image, negative aesthetics, addiction, and cost. However, none were significant mediators or moderators. Racial/ethnic groups most susceptible to smoking initiation and with the highest rates of current smoking should be targeted for prevention and cessation. Research is needed to examine more thoroughly racial/ethnic differences in expectancies.

A School-Level Proxy Measure for Individual-Level Poverty Using School-Level Eligibility for Free and Reduced-Price Meals

BACKGROUND

Socioeconomic status (SES) impacts health outcomes. The Youth Risk Behavior Survey (YRBS), like many school-based data sources, lacks individual-level poverty information. We propose using school-level percentages of student eligibility for free/reduced-price meals (%FRPM) as a proxy for individual-level poverty.

METHODS

Using the New York City (NYC) 2009 YRBS, we created school-level poverty quartiles to append to individual YRBS records by ranking schools by %FRPM. We compared this with 2 other school-level poverty measures using students' home and school neighborhood-level poverty and measured the association of these 3 school-level proxies with individual's household income. Last, we evaluated health outcomes by race/ethnicity and poverty to demonstrate the importance of accounting for poverty.

RESULTS

The school-level measure that used %FRPM had the strongest association with household income. When the school-level individual poverty proxy was included in illustrative analyses using YRBS data, patterns by poverty within race/ethnicity emerged that were not seen when looking at race/ethnicity alone.

CONCLUSIONS

Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.

Longitudinal Rates of Colon Cancer Screening Use in Winnipeg, Canada: The Experience of a Universal Health-Care System with an Organized Colon Screening Program

OBJECTIVES

We examined trends in colorectal cancer (CRC) screening (fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy (FS)) and differences in CRC screening by income in a population with an organized CRC screening program and universal health-care coverage.

METHODS

Individuals who had an FOBT, colonoscopy, or FS were identified from the provincial Physician Claims database and the population-based colon cancer screening registry. Trends in age-standardized rates were determined. Logistic regression was performed to explore the association between CRC screening and income quintiles by year.

RESULTS

Up-to-date CRC screening (FOBT, colonoscopy, or FS) increased over time for men and women, all age groups, and all income quintiles. Up-to-date CRC screening was very high among 65- to 69- and 70- to 74-year-olds (70% and 73%, respectively). There was a shift toward the use of an FOBT for CRC screening for individuals in the lower income quintiles. The disparity in colonoscopy/FS coverage by income quintile was greater in 2012 than in 1995. Overall, there was no reduction in disparities by income in up-to-date CRC screening nor did the rate of increase in up-to-date CRC screening or FOBT use change after the introduction of the organized provincial CRC screening program.

CONCLUSIONS

CRC screening is increasing over time for both men and women and all age groups. However, a disparity in up-to-date CRC screening by income persisted even with an organized CRC screening program in a universal health-care setting.

Individual- and neighborhood-level education influences the effect of obesity on prostate cancer treatment failure after prostatectomy

Purpose

The relationship between obesity and prostate cancer (CaP) treatment failure is complex and may vary by patient- and neighborhood-level educational attainment. We evaluated whether patient- and neighborhood-level education is associated with the effect of obesity on biochemical recurrence.

Methods

Seven hundred and forty-six CaP cases were classified into four groups: Concordant Low–Low: less educated cases (<4 years college) living in a less educated neighborhood (below-median proportion of college-educated residents; n = 164); Concordant High–High: highly educated cases (≥4 years college) living in a highly educated neighborhood (above-median proportion of college-educated residents; n = 326); Discordant Low–High: less educated cases living in a highly educated neighborhood (n = 69); and Discordant High–Low: highly educated cases living in a less educated neighborhood (n = 187). Cox regression models were used to examine associations between obesity and biochemical (PSA) failure after prostatectomy stratified by the concordant/discordant groups.

Results

The association of obesity with biochemical failure varied significantly by educational concordance/discordance (p = 0.007). Obesity was associated with risk of biochemical failure for less educated cases residing in less educated neighborhoods (HR 3.72, 95 % CI 1.30–10.65). The relationship was not significant for other concordant/discordant groups.

Conclusions

Obesity effects on CaP outcomes vary by multilevel educational discordance/concordance. Strategies to decrease prostate cancer risk of progression may focus on reduction in obesity, particularly for less educated cases residing in less educated neighborhoods.

Socio-economic position as an intervention against overweight and obesity in children: a systematic review and meta-analysis

Studies that investigated the association between socio-economic position (SEP) and obesity in children suggest inconsistent results. The aim of this study is to summarize and quantify the current evidence on SEP and risks of overweight and obesity in children aged 0–15 years. Relevant studies published between 1990 to Sep 4, 2014 were searched in Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Risk estimates from individual studies were pooled using random-effects models, according to lowest vs the highest SEP category. A total of 62 articles were included in the meta-analysis. The odds of both overweight risk and obesity risk were higher in the children with lowest SEP than in those with highest SEP (OR, 1.10, 95% CI: 1.03–1.17, and OR, 1.41, 95% CI: 1.29–1.55, respectively). Sub-group analyses showed that the inverse relationships between SEP and childhood overweight and obesity were only found in high-income countries and in more economic developed areas. In conclusion, our study suggests that children with lower SEP had higher risks of overweight and obesity, and the increased risks were independent of the income levels of countries.

Design and methods for "Commit to Get Fit" - a pilot study of a school-based mindfulness intervention to promote healthy diet and physical activity among adolescents

INTRODUCTION

Cardiovascular prevention is more effective if started early in life, but available interventions to promote healthy lifestyle habits among youth have been ineffective. Impulsivity in particular has proven to be an important barrier to the adoption of healthy behaviors in youth. Observational evidence suggests that mindfulness interventions may reduce impulsivity and improve diet and physical activity. We hypothesize that mindfulness training in adjunct to traditional health education will improve dietary habits and physical activity among teenagers by reducing impulsive behavior and improving planning skills.

METHODS/DESIGN

The Commit to Get Fit study is a pilot cluster randomized controlled trial examining the feasibility, acceptability and preliminary efficacy of school-based mindfulness training in adjunct to traditional health education for promotion of a healthy diet and physical activity among adolescents. Two schools in central Massachusetts (30 students per school) will be randomized to receive mindfulness training plus standard health education (HE-M) or an attention-control intervention plus standard health education (HE-AC). Assessments will be conducted at baseline, intervention completion (2 months), and 8 months. Primary outcomes are feasibility and acceptability. Secondary outcomes include physical activity, diet, impulsivity, mood, body mass index, and quality of life.

CONCLUSIONS

This study will provide important information about feasibility and preliminary estimates of efficacy of a school-delivered mindfulness and health education intervention to promote healthy dietary and physical activity behaviors among adolescents. Our findings will provide important insights about the possible mechanisms by which mindfulness training may contribute to behavioral change and inform future research in this important area.

Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

DESIGN

Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

SETTING

Australian secondary schools across all states/territories.

SUBJECTS

Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188).

RESULTS

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

CONCLUSIONS

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Socio-economic disparities in Australian adolescents' eating behaviours

OBJECTIVE

To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.

DESIGN

Cross-sectional survey of students' vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.

SETTING

Secondary schools across all Australian states and territories.

SUBJECTS

Secondary-school students (n 12 188; response rate: 54 %) aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey.

RESULTS

Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1-2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).

CONCLUSIONS

Results suggest that socio-economic disparities in Australian adolescents' eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

Reducing inequities in colorectal cancer screening in North America

Colorectal cancer (CRC) is an important cause of mortality and morbidity in North America. Screening using a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy reduces CRC mortality through the detection and treatment of precancerous polyps and early stage CRC. Although CRC screening participation has increased in recent years, large inequities still exist. Minorities, new immigrants, and those with lower levels of education or income are much less likely to be screened. This review provides an overview of the commonly used tests for CRC screening, disparities in CRC screening, and promising methods at the individual, provider, and system levels to reduce these disparities. Overall, to achieve high CRC participation rates and reduce the burden of CRC in the population, a multi-faceted approach that uses strategies at all levels to reduce CRC screening disparities is urgently required.

Financial strain and cancer risk behaviors among African Americans

BACKGROUND

African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1,278 African American adults (age, 46.5 ± 12.6 years; 77% female) and explored potential mediators (stress and depressive symptoms) of those associations.

METHODS

Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation.

RESULTS

Greater financial strain was associated with greater odds of insufficient physical activity (P < 0.003) and smoking (P = 0.005) and was positively associated with the total number of cancer risk factors (P < 0.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively.

CONCLUSIONS

Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms.

IMPACT

Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans.

Witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents

Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95% confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95% CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95% CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95% CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95% CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95% CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.

Socioeconomic inequalities in youth smoking in Brazil

OBJECTIVE

The contribution of smoking to socioeconomic inequalities in health is increasing worldwide, including in Brazil. Youth smoking may play an important role in the increasing social inequalities related to smoking. This study investigates social determinants of smoking among 15-year-old to 19-year-old individuals.

DESIGN

Cross-sectional study.

SETTING

The study uses data of 3536 participants aged 15-19 years of age of the Global Adult Tobacco Survey (GATS) and the National Household Sample Survey (Pesquisa Nacional por Amostragem de Domicilio, PNAD) obtained from household interviews. Smoking was defined as currently smoking tobacco products, regardless of frequency. Household socioeconomic indicators included per capita income, the educational level and sex of the head of the household, the presence of smoking restrictions and the number of smokers (excluding adolescents). Adolescent social factors included years of delaying school and social status (full-time student, working, and neither working nor studying). The hierarchical logistic regression analysis considered the effect of the complex sampling design.

RESULTS

From 3536 participants, 6.2% were smokers (95% CI 5.4 to 7.1). More men than women had the habit of smoking (7.2%; 5.9 to 8.6 vs 3.6%; 2.7 to 4.6). The likelihood of smoking was significantly greater for men and older teens. There was an upward trend in the OR of smoking according to the number of smokers in the house. Adolescents living in households with no smoking restrictions had a greater likelihood of being smokers. OR of smoking rose as the number of years of delaying school increased, being about three times greater among adolescents who were working and five times greater among those who were neither studying nor working.

CONCLUSIONS

Results demonstrate that socioeconomic inequality in smoking is established at younger ages and that school delay as well as school abandonment may contribute to increased smoking-related inequalities. Smoking restrictions at home were protective against adolescents becoming smokers. Living with other smokers was a strong predictor of adolescents becoming smokers.

Gender- and ethnic-specific associations with obesity: individual and neighborhood-level factors

OBJECTIVES

Gender- and ethnicity-specific groups face different risks for obesity, but little is understood about the factors that predict group-specific risks. We evaluated individual and neighborhood factors in relation to obesity.

DESIGN

Cross-sectional surveys of adults (ages 18-100 years) from southeastern Pennsylvania were analyzed. Individual- and neighborhood-level factors were included in fully-adjusted regression models to estimate relationships with obesity for specific gender-ethnic groups. The study included 679 Asian women, 655 Asian men, 4190 African-American women, 1568 African-American men, 1248 Hispanic women, 586 Hispanic men, 11791 European American women, and 6547 European American men.

RESULTS

There were significant differences in the predictors of obesity by gender-ethnic groups. Obesity was differentially associated with age (p < 0.001, positively associated with middle age in African-American men and in all women except Asian; positively associated with older age in European American women but inversely in African-American men and European American men), employment (p < 0.01, positively associated in African-American men and European American men) and poverty (p < 0.001, positively associated in Asian men, African-American women, and European American women). Reporting good/excellent health was differentially associated with less obesity (p < 0.01, no association for African-American men and Asians). Interestingly, neighborhood-level effects, however, did not differ significantly by gender-ethnic group. Inverse neighborhood effects on obesity prevalence were observed in most groups for higher neighborhood education and family income. Direct associations with obesity were observed for neighborhood poverty and neighborhood smoking.

CONCLUSIONS

We observed that individual- and neighborhood-level variables are associated with obesity. Several individual-level effects differ by gender-ethnic group.

Adolescents' awareness of cancer risk factors and associations with health-related behaviours

Increasing adolescents' awareness of the contribution of modifiable lifestyle factors to cancer risk may influence life-long patterns of healthy behaviour. However, little is known about adolescents' awareness of cancer risk factors and the effectiveness of awareness-raising interventions. This study assessed adolescents' cancer awareness and the effectiveness of an existing cancer-specific school-based intervention delivered by Teenage Cancer Trust. The Cancer Awareness Measure was completed by 478 adolescents (male: 250, 52.3%) aged 11-17 years (mean: 13.8, standard deviation: 1.24) in four UK schools; 422 adolescents provided paired data 2 weeks before and 2 weeks after the intervention delivered in 3 schools, and twice 4 weeks apart in the fourth (control) school. Adolescents recognized on average 4.4 (of 11) cancer risk factors. With the exception of smoking, adolescents' awareness of cancer risk factors was low. Awareness significantly increased after the intervention (4.6-5.7, P < 0.001). There was no significant change in the control school. Intervention effect was greater among females. This educational intervention is an effective way to raise adolescents' awareness of cancer risk factors. However, further cross-sectional and experimental studies are required to definitively assess adolescents' awareness of cancer risk factors and the effectiveness of this educational intervention.

Young smokers' narratives: public health, disadvantage and structural violence

This research article on youth smoking in disadvantaged communities is the product of a qualitative study to understand the issues faced by young smokers--and those trying not to be smokers--in such communities. Environmental factors and peer influence are widely recognised influences on adolescents' take-up and continuation of smoking but less is known about whether, what, how and why circumstances in disadvantaged communities affect young people's pathways towards and away from smoking. Focusing on a youth club in a disadvantaged neighbourhood in the North East of England, narratives about young people's relationships with tobacco provide an ethnographically rich, thick description of the experiences of a group that is too often easily ignored. We argue that young people are caught between competing domains that together exert a form of structural violence. These are, first, the economic and political structures that have overseen de-industrialisation; second, the media structures that create desire for what they cannot afford; third the structures of international organised crime that conspire to provide them with the means to consume from which 'legitimate' structures effectively exclude them. Rather than expecting young people to comply with the health imperative, interventions need to bridge issues of agency and critical consciousness, which structural violence otherwise insidiously erodes.

Preventing cancer: a community-based program for youths in public housing

PURPOSE

This article describes a feasibility study of a program that mentors boys aged 14-18 living in inner city public housing, engages them in a basketball league, and provides educational sessions on life skills and ways to resolve conflicts without violence. Such programs have the potential to engage adolescent males living in public housing in activities that reduce cancer-related behaviors and increase protective behaviors.

METHODS

We conducted a feasibility evaluation of the program, which included a survey of participants, interviews with coaches, and observations of games and practices.

RESULTS

Lifetime and previous-30-day substance use was common among participants, and many were exposed to and had experienced various forms of violence. Keeping youths active helps prevent their joining gangs and using drugs.

CONCLUSIONS

Youths from disadvantaged backgrounds are at a high risk for cancer because they are at greater risk for obesity and other adverse health-related conditions than are more affluent youths. Implementing and sustaining community programs for youths in public housing can reduce the effects of exposure to factors that put them at risk for cancer during adulthood: chronic poverty, lack of safe areas for recreation, easy access to alcohol and drugs, and exposure to violence. In addition, workshops to prevent substance use and violence and to teach leadership, sportsmanship, conflict resolution, and healthy youth development are needed for youths, coaches, and parents or guardians.

In search of the cancer candidate: can lay epidemiology help?

First published in 1991, the ideas embedded in 'Lay epidemiology and the prevention paradox' offered a novel and rational explanation for the lay public's failure to fully engage with the lifestyle messages offered by health educators. During the course of a large ethnographic study in South Wales, Davison and colleagues described the emergence of what they termed the coronary candidate. Candidacy provides a 'cultural mechanism' that facilitates the estimation of risk for coronary heart disease. The model has rarely been applied to other major illnesses. This article presents findings from a study that sought to explore the lay epidemiology model, candidacy and cancer. In a series of in-depth individual interviews, members of the lay public discussed their ideas about cancer, and what emerged was an explanatory hierarchy to account for cancer events. Yet the random and unpredictable nature of cancer was emphasised as well as a general reluctance to accept the idea of cancer candidacy.

Socioeconomic differences in adolescent health-related behavior differ by gender

BACKGROUND

Many studies of adolescent health-related behaviors have assessed the effects of gender and parental socioeconomic position (SEP) but not their mutual modification. We investigated socioeconomic differences in health-related behaviors among Slovak adolescents and the potential modification of those differences by gender.

METHODS

Data were collected in 2006 (n = 3547; 49.4% boys; mean [SD] age, 14.3 [0.6] years; response rate, 93.5%). The sample comprised students in the eighth and ninth grades of randomly selected elementary schools in Slovakia. Gender-specific prevalence rates for 9 types of health-related behaviors, including nutritional behavior, physical activity and substance use, were calculated for 3 socioeconomic groups, which were defined by the highest educational level attained by both parents. Gender differences in socioeconomic gradients for health-related behaviors were tested.

RESULTS

Socioeconomic differences were found in nutritional behavior, physical activity, and smoking. Adolescents with lower parental education behaved less healthily. The largest relative socioeconomic difference was no daily vegetable consumption among girls (90.3% of those with high SEP vs 95.2% of those with middle SEP; odds ratio, 2.33). Regarding no daily fruit consumption, differences among girls were 1.51 times and 1.92 times as large as those among boys for children with medium and low SEP, respectively, as compared with those with high SEP.

CONCLUSIONS

Socioeconomic differences in health-related behavior were small, especially for nutritional behavior and physical activity. Interventions that aim to improve health-related behaviors among adolescents with lower SEP should focus on these 2 behaviors, particularly on healthy nutrition in girls with low SEP.

Trends in educational differences in adolescent daily smoking across Europe, 2002-10

BACKGROUND

Across Europe, tobacco use is more prevalent among secondary school students attending vocational tracks compared with students attending academic tracks. The purpose of the present study is to describe trends in social inequality in daily smoking among adolescents between 2002 and 2010 by addressing both absolute social inequality (prevalence difference between vocational and academic tracks) and relative social inequality (prevalence ratio) in seven European countries.

METHODS

Analyses were based on data from 15-year-olds who participated in the Health Behaviour in School-aged Children study in 2002, 2006 and 2010 in Belgium, Croatia, France, Germany, Hungary, Italy and The Netherlands (total N = 32 867).

RESULTS

Overall, daily smoking decreased between 2002 and 2010 in Belgium, France, Germany and The Netherlands, increased in Croatia and remained stable in Hungary and Italy. Considerable differences in daily smoking according to educational track existed in all countries. Absolute educational inequalities increased dramatically in Croatia and Italy, while relative inequalities showed a tendency to increase in all countries (significant in Belgium and The Netherlands).

CONCLUSIONS

Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. Especially the large increase in absolute educational inequalities in daily smoking in Croatia and Italy are worrisome and warrant attention from the public health domain. The findings underline the need for appropriate smoking policies and interventions in vocational schools across Europe.

Is socioeconomic status associated with dietary sodium intake in Australian children? A cross-sectional study

OBJECTIVE

To assess the association between socioeconomic status (SES) and dietary sodium intake, and to identify if the major dietary sources of sodium differ by socioeconomic group in a nationally representative sample of Australian children.

DESIGN

Cross-sectional survey.

SETTING

2007 Australian National Children's Nutrition and Physical Activity Survey.

PARTICIPANTS

A total of 4487 children aged 2-16 years completed all components of the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sodium intake was determined via one 24 h dietary recall. The population proportion formula was used to identify the major sources of dietary salt. SES was defined by the level of education attained by the primary carer. In addition, parental income was used as a secondary indicator of SES.

RESULTS

Dietary sodium intake of children of low SES background was 2576 (SEM 42) mg/day (salt equivalent 6.6 (0.1) g/day), which was greater than that of children of high SES background 2370 (35) mg/day (salt 6.1 (0.1) g/day; p<0.001). After adjustment for age, gender, energy intake and body mass index, low SES children consumed 195 mg/day (salt 0.5 g/day) more sodium than high SES children (p<0.001). Low SES children had a greater intake of sodium from processed meat, gravies/sauces, pastries, breakfast cereals, potatoes and potato snacks (all p<0.05).

CONCLUSIONS

Australian children from a low SES background have on average a 9% greater intake of sodium from food sources compared with those from a high SES background. Understanding the socioeconomic patterning of salt intake during childhood should be considered in interventions to reduce cardiovascular disease.