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de Menezes MC, Duran AC, Langellier B, Pérez-Ferrer C, Barnoya J, Mayén AL. Socioeconomic Position, Pre-Obesity and Obesity in Latin American Cities: A Systematic Review. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241238677. [PMID: 38489831 DOI: 10.1177/27551938241238677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Currently the socioeconomic gradient of obesity it is not well understood in the urban population in Latin American. This study reviewed the literature assessing associations between pre-obesity, obesity, and socioeconomic position (SEP) in adults living in urban areas in Latin American countries. PubMed and SciELO databases were used. Data extraction was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted data on the association between SEP (e.g., education, income), pre-obesity (body mass index [BMI] ≥ 25 and < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2). Relative differences between low and high SEP groups were assessed and defined a priori as significant at p < 0.05. Thirty-one studies met our inclusion criteria and most were conducted in Brazil and Mexico (22 and 3 studies, respectively). One study presented nonsignificant associations. Forty-seven percent of associations between education or income and pre-obesity were negative. Regarding obesity, 80 percent were negative and 20 percent positive. Most negative associations were found in women while in men they varied depending on the indicator used. Pre-obesity and obesity by SEP did not follow the same pattern, revealing a reversal of the obesity social gradient by SEP, especially for women in Latin America, highlighting the need for articulated policies that target structural and agentic interventions.
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Affiliation(s)
- Mariana Carvalho de Menezes
- Department of Social and Clinical Nutrition, Federal University of Ouro Preto, Campus Morro do Cruzeiro, Escola de Nutrição - Ouro Preto, Rua Dois, Brazil, CEP 35.400-000
| | - Ana C Duran
- Center for Food Studies, University of Campinas, Av. Albert Einstein, 291, Campinas, Sao Paulo, Brazil
| | - Brent Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolina Pérez-Ferrer
- National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Joaquin Barnoya
- Unit of Cardiovascular Surgery, UNICAR, 9A Avenida 8, 01011 Guatemala, GT, Guatemala
| | - Ana-Lucia Mayén
- Department of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala city, Guatemala
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Addey T, Alegre-Díaz J, Bragg F, Trichia E, Wade R, Santacruz-Benitez R, Ramirez-Reyes R, Garcilazo-Ávila A, Gonzáles-Carballo C, Bello-Chavolla OY, Antonio-Villa NE, Aguilar-Ramirez D, Friedrichs LG, Lewington S, Peto R, Collins R, Berumen J, Emberson JR, Kuri-Morales P, Tapia-Conyer R. Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study. Lancet Public Health 2023; 8:e670-e679. [PMID: 37633676 PMCID: PMC7615266 DOI: 10.1016/s2468-2667(23)00153-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City. METHODS The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors. FINDINGS Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality. INTERPRETATION In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality. FUNDING Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
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Affiliation(s)
- Thomas Addey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Díaz
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rogelio Santacruz-Benitez
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Raúl Ramirez-Reyes
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos Gonzáles-Carballo
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Diego Aguilar-Ramirez
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc Friedrichs
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jaime Berumen
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jonathan R Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pablo Kuri-Morales
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Roberto Tapia-Conyer
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
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Witkam R, Gwinnutt JM, Humphreys J, Gandrup J, Cooper R, Verstappen SM. Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis. SSM Popul Health 2021; 15:100884. [PMID: 34401462 PMCID: PMC8350379 DOI: 10.1016/j.ssmph.2021.100884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m2) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region. Methods Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants). Results 86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men. Conclusions Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries.
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Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - James M. Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Julie Gandrup
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, UK
| | - Suzanne M.M. Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
- Corresponding author. Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Beltrán-Sánchez H, Goldman N, Pebley AR, Morales JF. Calloused hands, shorter life? Occupation and older-age survival in Mexico. DEMOGRAPHIC RESEARCH 2020; 42:875-900. [PMID: 36777478 PMCID: PMC9917739 DOI: 10.4054/demres.2020.42.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Inequalities in mortality are often attributed to socioeconomic differences in education level, income, and wealth. Low socioeconomic status (SES) is generally related to worse health and survival across the life course. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards. OBJECTIVE We examine the link between primary lifetime occupation, together with education and net worth, on survival among older adults in Mexico. METHODS We use data from four waves (2001, 2003, 2012, and 2015) of the Mexican Health and Aging Study (MHAS). We estimate age-specific mortality rates for ages 50 and over using a hazards model based on a two-parameter Gompertz function. RESULTS Primary lifetime occupations have a stronger association with survival for women than men. Women with higher socioeconomic status have significantly lower mortality rates than lower status women, whether SES is assessed in terms of schooling, wealth, or occupation. Occupational categories are not jointly related to survival among men, even without controls for education and wealth. There are significant survival differences by wealth among men, but no disparities in mortality by education. CONCLUSIONS Consistent with recent studies of the Mexican population, we fail to find the expected gradient in the association between some measures of SES and better survival among men. CONTRIBUTION Our estimates extend this anomalous pattern among Mexican men to another dimension of SES, occupation. SES differentials in mortality are substantially larger for Mexican women, highlighting an important gender disparity.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Fielding School of Public Health, California Center for Population Research, University of California at Los Angeles, USA
| | - Noreen Goldman
- Office of Population Research, Princeton University, USA
| | - Anne R Pebley
- Fielding School of Public Health, California Center for Population Research, University of California at Los Angeles, USA
| | - Josefina Flores Morales
- Department of Sociology, California Center for Population Research, University of California at Los Angeles, USA
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The nutrition transition in Mexico 1988–2016: the role of wealth in the social patterning of obesity by education. Public Health Nutr 2018; 21:2394-2401. [DOI: 10.1017/s1368980018001167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico.DesignCross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988–2016. Effect modification of the education–obesity association by household wealth was tested.SettingMexico.SubjectsWomen (n 54 816) and men (n 20 589) aged 20–49 years.ResultsIn both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity.ConclusionThe reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.
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Lozano P, Thrasher JF, Forthofer M, Hardin J, Shigematsu LMR, Arillo Santillán E, Fleischer NL. The role of social norms and socioeconomic status in smoking-related stigma among smokers in Mexico and Uruguay. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1440070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paula Lozano
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James F. Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Melinda Forthofer
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina, Charlotte, NC,USA
| | - James Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Edna Arillo Santillán
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, USA
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Torres JM, Rizzo S, Wong R. Lifetime Socioeconomic Status and Late-life Health Trajectories: Longitudinal Results From the Mexican Health and Aging Study. J Gerontol B Psychol Sci Soc Sci 2018; 73:349-360. [PMID: 27140821 PMCID: PMC5927147 DOI: 10.1093/geronb/gbw048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/11/2016] [Indexed: 02/05/2023] Open
Abstract
Objective This article examines the association between childhood and adult socioeconomic status (SES) and late-life health trajectories for older adults in Mexico. Method Data are from the Mexican Health and Aging Study, a panel survey that began with a nationally representative sample of Mexican adults 50 years and older at baseline (2001), with follow-up in 2003 and 2012. We use a hierarchical repeated measures model to estimate the relationship between SES and depressive symptoms, functional limitations, and self-rated health, respectively. We tested both discrete measures of SES in childhood and adulthood, as well as a combined indicator of lifetime SES. Results Childhood SES was significantly associated with later-life health trajectories net of adulthood SES indicators. Adult SES was significantly associated with late-life health trajectories, with some differences by gender and outcome. There were significant SES disparities in health outcomes over the 11-year study period. However, there were no significant multiplicative interactions between SES and age, which would have indicated either diminishing or widening SES health disparities with age. Discussion Socioeconomic disparities in health appear to persist into old age in the Mexican context. Efforts to reduce late-life health disparities in Mexico should target socioeconomic and material conditions across the life course.
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Affiliation(s)
| | - Shemra Rizzo
- Department of Statistics, University of California, Riverside
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, Sealy Center on Aging, University of Texas Medical Branch, Galveston
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Basto-Abreu A, Barrientos-Gutiérrez T, Zepeda-Tello R, Camacho V, Gimeno Ruiz de Porras D, Hernández-Ávila M. The Relationship of Socioeconomic Status with Body Mass Index Depends on the Socioeconomic Measure Used. Obesity (Silver Spring) 2018; 26:176-184. [PMID: 29152913 DOI: 10.1002/oby.22042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/14/2017] [Accepted: 09/17/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The association between socioeconomic status (SES) and body mass index (BMI) in middle-income countries is mixed. Heterogeneity in SES indicators used could explain some differences. This study aimed to identify SES indicators consistently associated with BMI in Mexican adults in 2006, 2012, and 2016. METHODS Data were obtained from the Mexican National Health and Nutrition Surveys of 2006, 2012, and 2016, including adults 20 to 59 years old. Given expected differences by sex, sex-stratified linear regression models were fitted for each survey. Age-adjusted and multivariate models were fit by using seven noncollinear SES indicators. RESULTS In age-adjusted models, most SES indicators were associated with a higher BMI in men; mixed associations were found for women. In multivariate models, living in urban areas was associated with a higher BMI for both men and women in 2006 and 2012. Across all surveys, education was associated with a lower BMI in women, while household assets were associated with a higher BMI in men. CONCLUSIONS The association between SES indicators and BMI is complex. Differences by sex need to be explicitly recognized when modeling this association. Approaches that rely on a single indicator could be confounded by other SES indicators. Adjusted models show the specific SES attributes that may influence BMI.
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Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | | | - Rodrigo Zepeda-Tello
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - Vanessa Camacho
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, San Antonio, Texas, USA
- Center for Research in Occupational Health (CISAL), Pompeu Fabra University, Barcelona, Catalonia, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
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Kollath-Cattano C, Osman A, Thrasher JF. Evaluating the perceived effectiveness of pregnancy-related cigarette package health warning labels among different gender/age groups. Addict Behav 2017; 66:33-40. [PMID: 27871043 PMCID: PMC5177510 DOI: 10.1016/j.addbeh.2016.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The impact of pregnancy-related health warning labels (HWLs) appearing on cigarette packages on women of reproductive age and other socio-demographic groups is not well understood. The current study analyzes how different age/gender groups respond to pregnancy-related HWLs as compared to non-pregnancy HWLs. METHODS Data were analyzed from four waves of an online longitudinal study with adult smokers aged 18-64 in Australia, Canada, Mexico, and the US. Participants were classified into four age\gender groups: women 40 and under; men 40 and under; women over 40; men over 40. Participants rated one pregnancy-related and several non-pregnancy related labels on worry, believability, and motivation to quit. Country-specific adjusted linear GEE were estimated regressing ratings for each of the three key outcomes for 1) pregnancy-related HWLs and 2) a rating difference score that subtracted the average ratings of the non-pregnancy warning from the rating of the pregnancy warning. All models adjusted for socio-demographics and smoking related variables. RESULTS In Mexico and Australia, where graphic pregnancy-related HWL imagery is used (i.e., premature infant), women of reproductive age reported stronger believability, worry, and quit motivation than all other groups. Results were similar in the US, where text only HWLs are used. In contrast in Canada, where the pregnancy-related HWL imagery features a pregnant woman, ratings were unassociated with gender/age groups. Stronger effects among women of reproductive age were limited to pregnancy HWLs in each country, except Canada. CONCLUSIONS HWLs that depict graphic effects to illustrate smoking-related pregnancy risks appear to be perceived as particularly effective among women of reproductive age.
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Affiliation(s)
- Christy Kollath-Cattano
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA.
| | - Amira Osman
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA
| | - James F Thrasher
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA
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Perez Ferrer C, McMunn A, Rivera Dommarco JA, Brunner EJ. Educational inequalities in obesity among Mexican women: time-trends from 1988 to 2012. PLoS One 2014; 9:e90195. [PMID: 24599098 PMCID: PMC3943903 DOI: 10.1371/journal.pone.0090195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obesity is one of the leading causes of global morbidity and mortality. Trends in educational inequalities in obesity prevalence among Mexican women have not been analysed systematically to date. METHODS Data came from four nationally representative surveys (1988, 1999, 2006, and 2012) of a total of 51 220 non-pregnant women aged 20 to 49. Weight and height were measured during home visits. Education level (higher education, high school, secondary, primary or less) was self-reported. We analysed trends in relative and absolute educational inequalities in obesity prevalence separately for urban and rural areas. RESULTS Nationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over 25 years to 2012. Obesity prevalence was inversely associated with education level in urban areas at all survey waves. In rural areas, obesity prevalence increased markedly but there was no gradient with education level at any survey. The relative index of inequality in urban areas declined over the period (2.87 (95%CI: 1.94, 4.25) in 1988, 1.55 (95%CI: 1.33, 1.80) in 2012, trend p<0.001). Obesity increased 5.92 fold (95%CI: 4.03, 8.70) among urban women with higher education in the period 1988-2012 compared to 3.23 fold (95%CI: 2.88, 3.63) for urban women with primary or no education. The slope index of inequality increased in urban areas from 1988 to 2012. Over 0.5 M cases would be avoided if the obesity prevalence of women with primary or less education was the same as for women with higher education. CONCLUSIONS The expected inverse association between education and obesity was observed in urban areas of Mexico. The declining trend in relative educational inequalities in obesity was due to a greater increase in obesity prevalence among higher educated women. In rural areas there was no social gradient in the association between education level and obesity across the four surveys.
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Affiliation(s)
- Carolina Perez Ferrer
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anne McMunn
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Juan A. Rivera Dommarco
- Centro de investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Eric J. Brunner
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev 2013; 14:989-1005. [PMID: 23889851 PMCID: PMC3902051 DOI: 10.1111/obr.12062] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023]
Abstract
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
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Affiliation(s)
- A K Cohen
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
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Beltrán-Sánchez H, Thomas D, Teruel G, Wheaton F, Crimmins EM. Links between socio-economic circumstances and changes in smoking behavior in the Mexican population: 2002-2010. J Cross Cult Gerontol 2013; 28:339-58. [PMID: 23888371 PMCID: PMC3777536 DOI: 10.1007/s10823-013-9203-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While deleterious consequences of smoking on health have been widely publicized, in many developing countries, smoking prevalence is high and increasing. Little is known about the dynamics underlying changes in smoking behavior. This paper examines socio-economic and demographic characteristics associated with smoking initiation and quitting in Mexico between 2002 and 2010. In addition to the influences of age, gender, education, household economic resources and location of residence, changes in marital status, living arrangements and health status are examined. Drawing data from the Mexican Family Life Survey, a rich population-based longitudinal study of individuals, smoking behavior of individuals in 2002 is compared with their behavior in 2010. Logistic models are used to examine socio-demographic and health factors that are associated with initiating and quitting smoking. There are three main findings. First, part of the relationship between education and smoking reflects the role of economic resources. Second, associations of smoking with education and economic resources differ for females and males. Third, there is considerable heterogeneity in the factors linked to smoking behavior in Mexico indicating that the smoking epidemic may be at different stages in different population subgroups. Mexico has recently implemented fiscal policies and public health campaigns aimed at reducing smoking prevalence and discouraging smoking initiation. These programs are likely to be more effective if they target particular socio-economic and demographic sub-groups.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Center for Population & Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA,
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Incidence of non-small-cell lung cancer among California Hispanics according to neighborhood socioeconomic status. J Thorac Oncol 2013; 8:287-94. [PMID: 23399956 DOI: 10.1097/jto.0b013e31827bd7f5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Lung cancer incidence is associated with markers of lower socioeconomic status (SES) in whites, blacks, and Asians but with markers of higher SES in Hispanics. The magnitude and etiology of this positive gradient in Hispanics remain undefined. We examined non-small-cell lung cancer (NSCLC) incidence and ever-smoking rates among California Hispanics according to measures of SES. METHODS We computed neighborhood (n)SES-specific incidence rates by sex and race or ethnicity for 74,179 NSCLC cases in the California Cancer Registry, 1998-2002. Associations between nSES and NSCLC incidence were examined, using incidence rate ratios and linear trend tests, and stratified by age, stage, and histology. Ever-smoking rates among Hispanics were obtained from California Health Interview Survey 2001 data, and odds ratios for ever-smoking were calculated for measures of SES and acculturation. RESULTS Compared with the lowest nSES quintile, the NSCLC incidence in the highest quintile was 1.86 and 1.18 times higher for Hispanic women and men, respectively. The positive nSES gradients remained significant for all ages, stages, and nonsquamous histologies in women, and only for older age, local or regional stages, and adenocarcinoma histology in men. Ever-smoking rates were associated with English-speaking households and U.S.-born status for Hispanic women and low education and U.S.-born status for Hispanic men. CONCLUSIONS For California Hispanics, higher nSES was strongly associated with increased NSCLC incidence in women, but weakly associated in men, and ever-smoking rates were strongly correlated with increased acculturation. This finding may portend an increasing burden of NSCLC in Hispanic women, given future trends in acculturation and SES.
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Macías F, Malmusi D, Borrell C. Different patterns by age-group and gender of socioeconomic inequalities in smoking in Colombia. Nicotine Tob Res 2013; 15:1745-55. [PMID: 23645609 DOI: 10.1093/ntr/ntt055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Evidence on socioeconomic inequalities in smoking from low- and middle-income countries has shown some inconsistency between countries. We have studied the socioeconomic inequalities in current smoking, ever smoking, and smoking cessation in Colombia by age-group and gender. METHODS Sixty thousand, three hundred and forty-nine Colombian men and women aged 12-69 years were selected at random from the results of a national survey. We used Pearson's chi-square and Robust Poisson regression analyses to estimate adjusted prevalence ratios between smoking behaviors and 2 indicators of socioeconomic position; individuals' educational level and household socioeconomic stratum. RESULTS In men aged 45-69 years, higher socioeconomic stratum and higher education were associated with a lower rate of current smoking (PR = 0.49 [95% CI, 0.32-0.73] and PR = 0.64 [95% CI, 0.47-0.86], respectively), a history of smoking (PR = 0.67 [95% CI, 0.53-0.85] and PR = 0.75 [95% CI, 0.63-0.90], respectively), or a higher rate of smoking cessation (PR = 1.37 [95% CI, 1.09-1.72] and PR = 0.18 [95% CI, 0.99-1.72], respectively). In men aged 18-44 years, higher education was associated with lower odds of current and history of smoking (PR = 0.75 [95% CI, 0.61-0.92 and PR = 0.81 [95% CI, 0.67-0.98], respectively). Results in women and adolescents were mixed. CONCLUSIONS In Colombia, the overall declining prevalence of smoking in men seems to be accompanied by a narrowing of smoking inequalities in successive birth cohorts, suggesting a favorable evolution of the tobacco epidemic. Further research will be required to identify factors that have contributed these optimal circumstances in tobacco control.
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Affiliation(s)
- Felipe Macías
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
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15
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Buttenheim AM, Pebley AR, Hsih K, Chung CY, Goldman N. The shape of things to come? Obesity prevalence among foreign-born vs. US-born Mexican youth in California. Soc Sci Med 2013; 78:1-8. [PMID: 23273875 PMCID: PMC3888820 DOI: 10.1016/j.socscimed.2012.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 09/16/2012] [Accepted: 10/27/2012] [Indexed: 01/29/2023]
Abstract
Obesity among the Mexican-origin adult population in the US has been associated with longer stays in the US and with being US- vs. Mexican-born, two proxies for acculturation. This pattern is less clear for Mexican-origin children and young adults: recent evidence suggests that it may be reversed, with foreign-born Mexican youth in the US at higher risk of obesity than their US-born Mexican-American counterparts. The objective of this study is to evaluate the hypothesis that the immigrant advantage in obesity prevalence for Mexican-origin populations in the US does not hold for children and young adults. We use data from the Los Angeles Family and Neighborhood Survey (N = 1143) and the California Health Interview Survey (N = 25,487) for respondents ages 4-24 to calculate the odds of overweight/obesity by ethnicity and nativity. We find support for the hypothesis that overweight/obesity prevalence is not significantly lower for first-generation compared to second- and third-generation Mexican-origin youth. Significantly higher obesity prevalence among the first generation was observed for young adult males (ages 18-24) and adolescent females (ages 12-17). The previously-observed protective effect against obesity risk among recent adult immigrants does not hold for Mexican-origin youth.
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Affiliation(s)
- Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Wheaton FV, Crimmins EM. In hindsight: urban exposure explains the association between prior migration and current health of older adults in Mexico. J Aging Health 2013; 25:422-38. [PMID: 23349513 DOI: 10.1177/0898264312472537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines sex differences in the association between migration and exposure to an urban environment and overweight, hypertension and diabetes in later life. METHODS Interviews were conducted with 3,604 adults aged 50 and older in the Mexican Family Life Survey (MxFLS). Logistic regression analyses were used to examine the association between previous migration, urban exposure, and risk of overweight, hypertension, and diabetes. RESULTS Migration itself was not associated with health outcomes after controlling for urban exposure. The risk of overweight and diabetes associated with urban exposure appeared to be greater for men. Sex differences were found in the covariates that helped explain differences in health between those with high and low urban exposure. DISCUSSION These findings underscore the need to consider heterogeneity in health by urban exposure and by sex.
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Affiliation(s)
- Felicia V Wheaton
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089-0191, USA.
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Schmeer KK. Union transitions and changes in BMI among adults in Mexico. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2012; 53:263-275. [PMID: 22660828 PMCID: PMC3638789 DOI: 10.1177/0022146512445898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study utilizes nationally representative, longitudinal data from the Mexico Family Life Survey to examine the associations between union transitions and changes in body mass index (BMI) among adults in Mexico. Results from change score regression models (N = 11,339) indicate larger BMI gains for those entering a union than for those remaining single, net of baseline weight status and socioeconomic controls. Further, a significant moderating effect of baseline weight status suggests that overweight individuals entering a union gain almost two BMI points more than overweight single individuals during this three-year period. Individuals experiencing a union dissolution gain less BMI than those entering a union, but are predicted to lose BMI (as found in the United States) only if they are overweight before the transition.
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Affiliation(s)
- Kammi K Schmeer
- Department of Sociology,The Ohio State University, 1885 Neil Ave. Mall, Columbus, OH 43210, USA.
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Beltrán-Sánchez H, Crimmins EM, Teruel GM, Thomas D. Links between childhood and adult social circumstances and obesity and hypertension in the Mexican population. J Aging Health 2011; 23:1141-65. [PMID: 21948773 PMCID: PMC3187563 DOI: 10.1177/0898264311422255] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study examines links between early life circumstances and adult socioeconomic status and obesity and hypertension in the adult Mexican population. METHOD We use data from the Mexican Family Life Survey (MxFLS) collected in 2002 for people aged 20 or older (N = 14,280). RESULTS We found that men with low education and women with more education have significantly lower obesity. Women with higher education also have significantly less hypertension. Obesity triples the likelihood of hypertension among both men and women. Better childhood experiences are associated with less hypertension among women, but more hypertension among men in rural areas. DISCUSSION Recent changes in income, nutrition, and infection in Mexico may be responsible for the observed high prevalence of overweight and obesity and the extremely high odds of hypertension among obese young adults.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Ethel Percy Andrus Gerontology Center, University of Southern California, 3715 McClintock Ave, Los Angeles, CA 90089-0191, USA.
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The influence of indigenous status and community indigenous composition on obesity and diabetes among Mexican adults. Soc Sci Med 2011; 73:1635-43. [PMID: 22033376 DOI: 10.1016/j.socscimed.2011.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 05/01/2011] [Accepted: 09/06/2011] [Indexed: 01/20/2023]
Abstract
In many high-income countries, indigenous populations bear a higher burden of obesity and diabetes than non-indigenous populations. Less is known about these patterns in lower- and middle-income countries. We assessed the hypothesis that obesity and diabetes were less prevalent among indigenous than non-indigenous adults in Mexico, home to the largest indigenous population in Latin America. We investigated socioeconomic explanations for differences. In a related line of inquiry, we examine whether adults in communities with higher versus lower percentages of indigenous residents were buffered against these conditions. We assessed whether differences were partially explained by lower development in higher-indigenous communities. Obesity was based on measured height and weight, and diabetes on a diagnosis from a healthcare professional. The analysis for obesity included 19 577 adults aged 20 and older from the Mexican Family Life Survey (2002), a nationally representative survey of Mexican households and communities; for diabetes, we restricted analysis to adults with health insurance. We used multilevel logistic regression to estimate the odds of obesity and diabetes by indigenous status and community percent indigenous. Results suggest that indigenous adults had significantly lower odds of obesity and diabetes than non-indigenous adults. This advantage was not explained by the lower socioeconomic status of indigenous individuals. A higher percentage of indigenous individuals in communities provided protection against obesity, although not for diabetes. Differences for obesity were not accounted for by community development. Findings suggest that an opportunity may exist to prevent disparities in obesity and diabetes from developing by indigenous characteristics in Mexico. Identifying the sources of protective effects of individual and community indigenous characteristics relative to these health conditions should be a priority, given global implications for prevention.
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Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana. Public Health Nutr 2011; 14:2260-7. [PMID: 21806869 DOI: 10.1017/s1368980011001339] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. DESIGN A nationwide cross-sectional survey. SETTING Secondary schools in cities, towns and villages in Botswana, Africa. SUBJECTS A total of 746 adolescent schoolchildren. RESULTS OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES. CONCLUSIONS These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.
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Ullmann SH, Goldman N, Massey DS. Healthier before they migrate, less healthy when they return? The health of returned migrants in Mexico. Soc Sci Med 2011; 73:421-8. [PMID: 21729820 DOI: 10.1016/j.socscimed.2011.05.037] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 05/06/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
Abstract
Over the course of the 20th century, Mexico-U.S. migration has emerged as an important facet of both countries, with far reaching economic and social impacts. The health of Mexican immigrants in the U.S. has been well studied, but relatively less is known about the health of returned migrants to Mexico. The objectives of this paper are twofold. Relying on health data pertaining to two stages of the life course, early life health (pre-migration) and adult health (post-migration) from the Mexican Migration Project gathered between 2007 and 2009, we aim to assess disparities in adult health status between male returned migrants and male non-migrants in Mexico, accounting for their potentially different early life health profiles. While we find evidence that returned migrants had more favorable early life health, the results for adult health are more complex. Returned migrants have a higher prevalence of heart disease, emotional/psychiatric disorders, obesity, and smoking than non-migrants but no differences are found in self-rated health, diabetes, or hypertension.
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Affiliation(s)
- S Heidi Ullmann
- Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08544, USA.
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Heidi Ullmann S, Buttenheim AM, Goldman N, Pebley AR, Wong R. Socioeconomic differences in obesity among Mexican adolescents. ACTA ACUST UNITED AC 2010; 6:e373-80. [PMID: 20883181 DOI: 10.3109/17477166.2010.498520] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigate socioeconomic disparities in adolescent obesity in Mexico. Three questions are addressed. First, what is the social patterning of obesity among Mexican adolescents? Second, what are the separate and joint associations of maternal and paternal education with adolescent obesity net of household wealth? Third, are there differences in socioeconomic status (SES) gradients among Mexican boys and girls, rural residents and non-rural residents? METHODS Using data from the Mexican National Health Survey 2000 we examined the slope and direction of the association between SES and adolescent obesity. We also estimated models for sub-populations to examine differences in the social gradients in obesity by sex and non-rural residence. RESULTS We find that household economic status (asset ownership and housing quality) is positively associated with adolescent obesity. High paternal education is related to lower obesity risk, whereas the association between maternal education and obesity is positive, but not always significant. CONCLUSION The household wealth components of SES appear to predispose Mexican adolescents to higher obesity risk. The effects of parental education are more complex. These findings have important policy implications in Mexico and the United States.
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Affiliation(s)
- S Heidi Ullmann
- Princeton University, Office of Population Research, Princeton, NJ, USA.
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Buttenheim A, Goldman N, Pebley AR, Wong R, Chung C. Do Mexican immigrants "import" social gradients in health to the US? Soc Sci Med 2010; 71:1268-1276. [PMID: 20692753 DOI: 10.1016/j.socscimed.2010.06.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 11/20/2009] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
Abstract
Greater educational attainment is consistently associated with lower mortality and better health, a pattern known as the social gradient. However, recent research suggests that Mexican-origin adults in the US have weak or flat gradients, in contrast to steep gradients for non-Hispanic whites. In this study we evaluate one hypothesis for this finding: Is the relative weakness of education gradients in health behaviors observed among Mexican-origin adults in the US due to weak gradients in the sending population? We test this "imported gradients" hypothesis with data from two nationally-representative datasets: the US National Health Interview Survey (NHIS) and the Mexican National Health Survey (ENSA 2000). We compare education gradients in smoking and obesity for recently-arrived Mexican immigrants in the US to the corresponding gradients in high-migration regions of Mexico. Results partially support the imported gradients hypothesis and have implications for health education and promotion programs targeted to immigrant populations to reduce racial and ethnic disparities in health in the US.
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Affiliation(s)
- Alison Buttenheim
- Robert Wood Johnson Foundation Health & Society Scholars Program, University of Pennsylvania, 3641 Locust Walk #308, Philadelphia, PA 19130, USA.
| | - Noreen Goldman
- Office of Population Research, Princeton University, 243 Wallace Hall, Princeton NJ 08540, USA
| | - Anne R Pebley
- Community Health Sciences, School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Chang Chung
- Office of Population Research, Princeton University, 243 Wallace Hall, Princeton NJ 08540, USA
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