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Geddes-Barton D, Ramakrishnan R, Knight M, Goldacre R. Associations between neighbourhood deprivation, ethnicity and maternal health outcomes in England: a nationwide cohort study using routinely collected healthcare data. J Epidemiol Community Health 2024:jech-2024-222060. [PMID: 38834232 DOI: 10.1136/jech-2024-222060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND In the United Kingdom, pregnant women who live in the most deprived areas have two times the risk of dying than those who live in the least deprived areas. There are even greater disparities between women from different ethnic groups. The aim of this study was to investigate the role of area-based deprivation and ethnicity in the increased risk of severe maternal morbidity (SMM), in primiparous women in England. METHODS A retrospective nationwide population study was conducted using English National Hospital Episode Statistics Admitted Patient Care database. All primiparous women were included if they gave birth in an National Healthcare Service (NHS) hospital in England between 1 January 2016 and 31 December 2021. Logistic regression was used to examine the relative odds of SMM by Index of Multiple Deprivation and ethnicity, adjusting for age and health behaviours, medical and psychological factors. RESULTS The study population comprised 1 178 756 primiparous women. Neighbourhood deprivation increased the risk of SMM at the time of childbirth. In the fully adjusted model, there was a linear trend (p=0.001) between deprivation quintile and the odds of SMM. Being from a minoritised ethnic group also independently increased the risk of SMM, with black or black British African women having the highest risk, adjusted OR 1.84 (95% CI 1.70 to 2.00) compared with white women. There was no interaction between deprivation and ethnicity (p=0.49). CONCLUSION This study has highlighted that neighbourhood deprivation and ethnicity are important, independently associated risk factors for SMM.
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Affiliation(s)
| | - Rema Ramakrishnan
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Raph Goldacre
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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2
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Alur P, Holla I, Hussain N. Impact of sex, race, and social determinants of health on neonatal outcomes. Front Pediatr 2024; 12:1377195. [PMID: 38655274 PMCID: PMC11035752 DOI: 10.3389/fped.2024.1377195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.
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Affiliation(s)
- Pradeep Alur
- Penn State College of Medicine, Hampden Medical Center, Enola, PA, United States
| | - Ira Holla
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Naveed Hussain
- Department of Pediatrics, Connecticut Children’s, Hartford, CT, United States
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3
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Mariko H, Uban KA. The implications of socioeconomic factors on salivary bioscience methodological variables in a large pediatric multi-site study. Front Public Health 2023; 11:1088043. [PMID: 37427258 PMCID: PMC10327643 DOI: 10.3389/fpubh.2023.1088043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Salivary bioscience has found increased utilization within pediatric research, given the non-invasive nature of self-collecting saliva for measuring biological markers. With this growth in pediatric utility, more understanding is needed of how social-contextual factors, such as socioeconomic factors or status (SES), influence salivary bioscience in large multi-site studies. Socioeconomic factors have been shown to influence non-salivary analyte levels across childhood and adolescent development. However, less is understood about relationships between these socioeconomic factors and salivary collection methodological variables (e.g., time of saliva collection from waking, time of day of saliva collection, physical activity prior to saliva collection, and caffeine intake prior to saliva collection). Variability in salivary methodological variables between participants may impact the levels of analytes measured in a salivary sample, thus serving as a potential mechanism for non-random systematic biases in analytes. Methods Our objective is to examine relationships between socioeconomic factors and salivary bioscience methodological variables within the Adolescent Brain Cognitive Development Study© cohort of children aged 9-10 years old (n = 10,567 participants with saliva samples). Results We observed significant associations between household socioeconomic factors (poverty status, education) and salivary collection methodological variables (time since waking, time of day of sampling, physical activity, and caffeine intake). Moreover, lower levels of household poverty and education were significantly associated with more sources of potential bias in salivary collection methodological variables (e.g., longer times since waking, collections later in the day, higher odds of caffeine consumption, and lower odds of physical activity). Consistent associations were not observed with neighborhood socioeconomic factors and salivary methodological variables. Discussion Previous literature demonstrates associations between collection methodological variables and measurements of salivary analyte levels, particularly with analytes that are more sensitive to circadian rhythms, pH levels, or rigorous physical activity. Our novel findings suggest that unintended distortions in measured salivary analyte values, potentially resulting from the non-random systematic biases in salivary methodology, need to be intentionally incorporated into analyses and interpretation of results. This is particularly salient for future studies interested in examining underlying mechanisms of childhood socioeconomic health inequities in future analyses.
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Affiliation(s)
- Hawa Mariko
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
| | - Kristina A. Uban
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
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4
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A new era: improving use of sociodemographic constructs in the analysis of pediatric cohort study data. Pediatr Res 2021; 90:1132-1138. [PMID: 33603207 PMCID: PMC8371054 DOI: 10.1038/s41390-021-01386-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/30/2020] [Indexed: 01/31/2023]
Abstract
Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the United States, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach of "convenience" in how data related to these constructs are collected, categorized, and included in models; the field needs to be more systematic and thoughtful in its approach to understand how sociodemographics affect child health. We offer suggestions for improving the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses, without the automatic "adjusting for" all sociodemographic constructs. We propose to leverage newly available data from large multi-cohort consortia as unique opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs. Improving the characterization and interpretation of child health studies with regards to core sociodemographic constructs is critical for optimizing child health and reducing inequities in the health and well-being of all children across the United States. IMPACT: Current child health research often utilizes an approach of "convenience" in how data related to sex, race/ethnicity, and SEP are collected, categorized, and included in models. We offer suggestions for how scholars can improve the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses. We propose to leverage newly available large cohort consortia of child health studies as opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs.
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5
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Lee H, Tranby E, Shi L. Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012-2015. JDR Clin Trans Res 2021; 7:379-388. [PMID: 34323108 DOI: 10.1177/23800844211028541] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. METHODS This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. RESULTS Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80-0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52-0.58). CONCLUSION FOR PRACTICE Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. KNOWLEDGE TRANSFER STATEMENT The current study updated the previous findings with more recent multiyear PRAMS data (2012-2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.
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Affiliation(s)
- H Lee
- Mount Sinai Hospital, Department of Dentistry, New York, NY, USA
| | - E Tranby
- Data and Impact Analytics and Evaluation, DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - L Shi
- Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
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6
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Preston EV, Chan M, Nozhenko K, Bellavia A, Grenon MC, Cantonwine DE, McElrath TF, James-Todd T. Socioeconomic and racial/ethnic differences in use of endocrine-disrupting chemical-associated personal care product categories among pregnant women. ENVIRONMENTAL RESEARCH 2021; 198:111212. [PMID: 33957140 PMCID: PMC8886956 DOI: 10.1016/j.envres.2021.111212] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 05/20/2023]
Abstract
Personal care products (PCPs) are important and modifiable sources of exposure to endocrine disrupting chemicals (EDCs). Research is limited on how EDC-associated PCP use differs by race/ethnicity and socioeconomic status (SES), particularly during the sensitive period of pregnancy. We investigated differences in PCP use by race/ethnicity and SES among 497 participants in the LIFECODES pregnancy cohort (Boston, Massachusetts). Participants self-reported race/ethnicity, SES indicators (maternal education; insurance status), and recent PCP use via questionnaire at ≤4 prenatal visits. We evaluated trimester-specific differences in use of individual PCP categories by race/ethnicity and SES indicators. We used Poisson regression to estimate trimester-specific mean total product categories used by race/ethnicity and SES indicators. In the first trimester, compared to non-Hispanic White women, Hispanic women reported higher use of hair gel (45% vs. 28%), perfume (75% vs. 39%), and "other" hair products (37% vs. 19%). Compared to women with a college degree, women without a college degree reported higher use of perfume (79% vs. 41%) and bar soap (74% vs. 56%); patterns were similar for insurance status. The estimated mean total product categories used was significantly lower in Asian compared to non-Hispanic White women in all trimesters (e.g., Trimester 1: 4.8 vs. 6.7 categories; p<0.001). Patterns of PCP use differed by race/ethnicity and SES, with implications for potentially modifiable differential EDC exposure and associated pregnancy outcomes.
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Affiliation(s)
- Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Marissa Chan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Katerina Nozhenko
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Marissa C Grenon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - David E Cantonwine
- Department of Maternal Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Thomas F McElrath
- Department of Maternal Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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7
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Social and ethnic disparities in stillbirth and infant death in Denmark, 2005-2016. Sci Rep 2021; 11:8001. [PMID: 33846451 PMCID: PMC8041838 DOI: 10.1038/s41598-021-87084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Ethnic disparity in stillbirth and infant death has been demonstrated in Europe. As the relation between migration and health change over time, this population based register study investigated the recent figures and explored if potential differences could be explained by the well-known educational and income inequalities in stillbirth and infant death using a novel approach. Stillbirth and infant mortality varied considerably according to country of origin, with only immigrants from China, Norway, and Poland having an overall lower risk than Danish women. Women of Pakistani, Turkish, and Somali origin had a particularly high risk of both outcomes. Women from recent high conflict areas displayed a pattern with increased stillbirth risk. An observed excess risks across generations was found, which is disturbing and rule out factors related to language barriers or newness. Differences in educational level and household income explained only part of the observed inequalities. Strengthening of the maternity care system to better understand and meet the needs of immigrant women seems needed to mitigate the disparities.
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8
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Pelletier-Baldelli A, Strauss GP, Kuhney FS, Chun C, Gupta T, Ellman LM, Schiffman J, Mittal VA. Perceived stress influences anhedonia and social functioning in a community sample enriched for psychosis-risk. J Psychiatr Res 2021; 135:96-103. [PMID: 33460840 PMCID: PMC7914219 DOI: 10.1016/j.jpsychires.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Existing animal and human research support the causal role of stress in the emergence of anhedonia, and in turn, the influence of anhedonia in social functioning. However, this model has not been tested in relation to psychosis-risk; this literature gap is notable given that both anhedonia and declining social functioning represent key markers of risk of developing a psychotic disorder such as schizophrenia. The current research tested the evidence for this model using structural equation modeling in 240 individuals selected based on a range of psychosis-risk symptomatology from the general community. Results supported this model in comparison with alternative models, and additionally emphasized the direct role of perceived stress in social functioning outcomes. Findings suggest the clinical relevance of targeting early perceptions of stress in individuals meeting psychosis-risk self-report criteria in an effort to prevent subsequent anhedonia and declines in social functioning.
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Affiliation(s)
| | | | - Franchesca S Kuhney
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA
| | - Charlotte Chun
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Tina Gupta
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | - Lauren M Ellman
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry, Evanston, IL, USA; Northwestern University, Institute for Policy Research, Evanston, IL, USA; Northwestern University, Department of Medical Social Science, Evanston, IL, USA
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9
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Szeszulski J, Lorenzo E, O'Connor T, Hill JL, Shaibi GQ, Buman MP, Vega-López S, Hooker SP, Lee RE. Exploring Correlates of Preschool-Aged Children's Locomotor Skills: Individual and Parent Demographics and Home Environment. Percept Mot Skills 2020; 128:649-671. [PMID: 33342342 DOI: 10.1177/0031512520980938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents' physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child's age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children's PACER score. In addition, higher parent concern for children's safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children's locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17).
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Affiliation(s)
- Jacob Szeszulski
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, United States.,Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin Campus, United States.,Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Jennie L Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, United States
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, United States.,Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, United States
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, United States
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
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10
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Language Disparities Related to Maternal Education Emerge by Two Years in a Low-Income Sample. Matern Child Health J 2020; 24:1419-1427. [PMID: 32632843 DOI: 10.1007/s10995-020-02973-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Young children living in low-income households experience disparities in language development compared to their advantaged peers, with large differences in language skill by kindergarten entry. In this study, we sought to determine whether there were disparities in early language trajectories within a low-income sample of children from 9 to 36 months as a function of maternal education. We hypothesized that children with more highly educated mothers would show accelerated language trajectories compared to children with less educated mothers. METHODS Using observational data collected from a longitudinal birth-cohort sample of 192 low-income mother-infant dyads in Ohio from 2014 to 2018, children's language skills were assessed at three time-points (ages 9-13 months, 20-24 months, and 32-36 months). Multi-level growth curve models were used to examine early language trajectories through three years of age as a function of maternal education. RESULTS Multilevel growth curve models showed distinct language trajectories: young low-income children have significantly better language skills at 15 months if their mother had a college education compared to not, and this gap remained significant to almost 3 years of age. CONCLUSIONS FOR PRACTICE Among young low-income children, disparities emerge in early language trajectories that differentiate children with less- versus more-educated mothers. Given that these disparities are apparent near the child's first birthday, it is necessary that pediatric care providers monitor children's early language trajectories and guide families to resources when lags are apparent.
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11
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Wang YJ, Chen XP, Chen WJ, Zhang ZL, Zhou YP, Jia Z. Ethnicity and health inequalities: an empirical study based on the 2010 China survey of social change (CSSC) in Western China. BMC Public Health 2020; 20:637. [PMID: 32380963 PMCID: PMC7204236 DOI: 10.1186/s12889-020-08579-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In China, ethnic minorities often live in frontier areas and have a relatively small population size, and tremendous social transitions have enlarged the gap between eastern and western China, with western China being home to 44 ethnic minority groups. These three disadvantages have health impacts. Examining ethnicity and health inequality in the context of western China is therefore essential. METHODS This paper is based on data from the 2010 China Survey of Social Change (CSSC2010), which was conducted in 12 provinces, autonomous regions and province-level municipalities in western China and had a sample size of 10,819. We examined self-rated health and disparities in self-rated health between ethnic minorities and Han Chinese in the context of western China. Self-rated health was coded as poor or good, and ethnicity was coded as ethnic minority or Han Chinese. Ethnic differences in self-rated health was examined by using binary logistic regression. Associations among sociodemographic variables, SES variable, health behaviour variable, health problem variables and self-rated health were also explored. RESULTS Fourteen percent of respondents reported their health to be poor. A total of 15.75% of ethnic minorities and 13.43% of Han Chinese respondents reported their health to be poor, indicating a difference in self-rated health between ethnic minorities and Han Chinese. Age, gender, marital status, education, alcohol, and health problems were the main factors that affected differences in self-rated health. CONCLUSION In western China, there were obvious ethnic disparities in self-rated health. Elderly ethnic minorities, non-partnered ethnic minorities, ethnic minorities with an educational level lower than middle school, and ethnic minorities with chronic disease had higher odds of poor self-rated health.
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Affiliation(s)
- Y J Wang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 730000, China
- Research Center for Circular Economy in Western China, Lanzhou University, Lanzhou, 730000, China
| | - X P Chen
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 730000, China
- Research Center for Circular Economy in Western China, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Western China's Environmental Systems (Ministry of Education), Lanzhou University, Lanzhou, 730000, China
| | - W J Chen
- Philosophy and Sociology School of Lanzhou University, Lanzhou, 730000, China
| | - Z L Zhang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 730000, China.
- Research Center for Circular Economy in Western China, Lanzhou University, Lanzhou, 730000, China.
- Key Laboratory of Western China's Environmental Systems (Ministry of Education), Lanzhou University, Lanzhou, 730000, China.
| | - Y P Zhou
- Philosophy and Sociology School of Lanzhou University, Lanzhou, 730000, China
| | - Z Jia
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 730000, China
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12
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Holliday CN, Kahn G, Thorpe RJ, Shah R, Hameeduddin Z, Decker MR. Racial/Ethnic Disparities in Police Reporting for Partner Violence in the National Crime Victimization Survey and Survivor-Led Interpretation. J Racial Ethn Health Disparities 2019; 7:468-480. [PMID: 31828687 DOI: 10.1007/s40615-019-00675-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022]
Abstract
Despite compromising women's health and safety, intimate partner violence (IPV) is among the most underreported crimes, and our understanding of factors that drive police reporting by race/ethnicity is underdeveloped. The purpose of this study is to examine racial/ethnic differences in self-reporting IPV to police. Race/ethnicity-stratified models identified predictors of reporting IPV to police among recent, female survivors (n = 898) in the National Crime Victimization Survey (NCVS; 2011-15). Focus groups (n = 3) with recent survivors (n = 19) in Baltimore, MD (2018), contextualized results. Black women in the NCVS were twice as likely to report IPV to police relative to White women (AOR = 2.05, 95% CI: 1.01-4.15). In race/ethnicity-stratified models, police reporting significantly increased with increasing age between 18 and < 35 years (AOR = 1.18, 95% CI: 1.05-1.33) for Black women, and with IPV-related injury for Black (AOR = 2.51, 95% CI: 1.10-5.71) and Hispanic women (AOR = 2.87, 95% CI: 1.22-6.71); Hispanics with less than a high school education were least likely to report (AOR = 0.24, 95% CI: 0.07-0.91). Focus groups explained racial/ethnic influences on reporting including a culture of silence and discrimination, socioeconomic status, and social desirability. We identified influences on reporting IPV to police that vary by race/ethnicity using national data in context to an urban environment. Results demonstrate the need to enhance equity in survivors' health and public safety through training and organizational change.
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Affiliation(s)
- Charvonne N Holliday
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. .,Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Geoffrey Kahn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roma Shah
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,University of Maryland School of Social Work, Baltimore, MD, USA
| | - Zaynab Hameeduddin
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Ash T, Davison KK, Haneuse S, Horan C, Kitos N, Redline S, Taveras EM. Emergence of racial/ethnic differences in infant sleep duration in the first six months of life. Sleep Med X 2019; 1:100003. [PMID: 33870162 PMCID: PMC8041110 DOI: 10.1016/j.sleepx.2019.100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Examine the emergence of differences in sleep duration between infants from different racial/ethnic backgrounds and extent to which differences are explained by socioeconomic status (SES) and sleep continuity. Methods Sleep duration and continuity (number of night wakings and longest nighttime stretch of sleep) were assessed for 394 infants in the Rise & Sleep Health in Infancy & Early Childhood (SHINE) birth cohort at one- and six-months using the Brief Infant Sleep Questionnaire (BISQ). Multivariable regression was used to estimate associations of race/ethnicity with sleep duration adjusting for individual-level covariates, SES, and sleep continuity. Results The sample was 40% non-Hispanic white, 33% Hispanic, 11% Black, and 15% Asian. Mean (SD) durations for daytime, nighttime, and total sleep at one-month were 6.3 (2.0), 8.9 (1.5), and 15.2 (2.7) hours, respectively. Corresponding durations at six-months were 3.0 (1.4), 9.9 (1.3), and 13.0 (1.9) hours. At one-month, Hispanic infants had shorter nighttime sleep than white infants [β: −0.44 h (95% CI: −0.80, −0.08)]. At six-months, Hispanic [β: −0.96 h (−1.28, −0.63)] and Black [β: −0.60 h (−1.07, −0.12)] infants had shorter nighttime sleep than white infants. The near 1-h differential in night sleep among Hispanics resulted in shorter total sleep [β: −0.66 h (−1.16, −0.15)]. Associations across all racial/ethnic groups were attenuated after adjustment for SES at one- and six months. Sleep continuity attenuated associations with nighttime and total sleep duration by 20–60% for Hispanic infants at six-months. Conclusions Differences in sleep duration emerge early in life among racial/ethnic groups and are in part explained by SES and sleep continuity. At one-month, Hispanic infants slept significantly less at night than white infants. At six-months, Hispanic and Black infants slept less at night than white infants. The near 1-h differential among Hispanics resulted in shorter total sleep. Adjusting for SES attenuated associations across all racial/ethnic groups. Sleep continuity attenuated associations for Hispanic infants at six-months.
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Affiliation(s)
- Tayla Ash
- Department of Behavioral & Social Sciences, Brown School of Public Health, 121 S. Main St., Providence, RI, 02903, USA.,Center for Health Equity Research, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02903, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.,Department of Social & Behavioral Sciences, Harvard Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, 125 Nashua St., Boston, MA, 02114, USA
| | - Nicole Kitos
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA, 02108, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, 221 Longwood Ave., Boston, MA, 02115, USA
| | - Elsie M Taveras
- Department of Nutrition, Harvard Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.,Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, 125 Nashua St., Boston, MA, 02114, USA
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Hartanto A, Lee STH, Yong JC. Dispositional Gratitude Moderates the Association between Socioeconomic Status and Interleukin-6. Sci Rep 2019; 9:802. [PMID: 30692578 PMCID: PMC6349864 DOI: 10.1038/s41598-018-37109-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023] Open
Abstract
Socioeconomic disparities in health are prevalent and growing in importance as a concern among academics, policymakers, and the general public. However, psychological resources that can narrow such disparities have not been well-examined. The current study examined the moderating role of dispositional gratitude in the relationship between socioeconomic status (SES) and inflammation risk as an index of health. Participants consisted of 1,054 midlife adults from the biomarker project of the Midlife in the United States. Inflammation risk was measured by interleukin-6 biomarker and SES was operationalized by education attainment and income. We found that dispositional gratitude significantly moderated the relationships between SES and interleukin-6. Among individuals with low dispositional gratitude, higher SES was significantly associated with lower levels of interleukin-6. However, the association between SES and interleukin-6 was not significant among individuals with high dispositional gratitude. More importantly, the findings remained robust after controlling for demographic characteristics, health status, health behaviours, and personality traits. Our findings suggest that gratitude may serve as an important psychological resource in attenuating health-related risk from socioeconomic stressors.
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Affiliation(s)
| | - Sean T H Lee
- Singapore Management University, Singapore, Singapore
| | - Jose C Yong
- Singapore Management University, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
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15
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Breathett K, Filley J, Pandey M, Rai N, Peterson PN. Trends in Early Prenatal Care Among Women with Pre-Existing Diabetes: Have Income Disparities Changed? J Womens Health (Larchmt) 2018; 27:93-98. [PMID: 29023180 PMCID: PMC5771526 DOI: 10.1089/jwh.2016.6031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with pre-existing diabetes are at high maternal risk for comorbidities and death, particularly when early prenatal care is not received. Low income is a known barrier to early prenatal care. It is unknown whether recent policies to expand access to prenatal care have reduced income disparities. We hypothesized that income disparities would be minimized and that the odds of receipt of first trimester prenatal care among women with pre-existing diabetes would become similar across income strata over time. MATERIAL AND METHODS Using the Colorado birth certificate registry from 2007 to 2014, receipt of prenatal care was assessed retrospectively in 2,497 women with pre-existing diabetes. Logistic regression was used to examine the association between high (>$50,000), medium ($25,000-50,000), and low (<$25,000) income strata and receipt of first trimester prenatal care by birth year, adjusted for demographics. RESULTS High, medium, and low income represented 29.5%, 19.0%, and 51.5% of the cohort, respectively. Women with high income were more likely to receive first trimester care than women with low income from 2007 [adjusted odds ratio, 95% confidence interval: 2.16 (1.18, 3.96)] through 2013 [1.66 (1.01, 2.73)], but significant differences were no longer observed in 2014 [1.59 (0.89, 2.84)]. The likelihood of receiving first trimester prenatal care was not significantly different between medium- and low-income strata from 2007 [1.07 (0.66, 1.74)] through 2014 [0.77 (0.48, 1.23)]. CONCLUSIONS From 2007 to 2013, women in Colorado with diabetes were more likely to receive early prenatal care if they were in the highest income stratum than in the lowest stratum. In 2014, receipt of first trimester care became equitable across all income strata. Future work should examine national patterns of income with receipt of prenatal care and outcomes among women with pre-existing diabetes.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Division of Cardiology, Sarver Heart Center, University of Arizona-Tucson, Tucson, Arizona
| | - Jessica Filley
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Madhaba Pandey
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Nayanjot Rai
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Pamela N. Peterson
- Division of Cardiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Denver Health Medical Center, Denver, Colorado
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16
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Isong IA, Rao SR, Bind MA, Avendaño M, Kawachi I, Richmond TK. Racial and Ethnic Disparities in Early Childhood Obesity. Pediatrics 2018; 141:peds.2017-0865. [PMID: 29269386 PMCID: PMC5744272 DOI: 10.1542/peds.2017-0865] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The prevalence of childhood obesity is significantly higher among racial and/or ethnic minority children in the United States. It is unclear to what extent well-established obesity risk factors in infancy and preschool explain these disparities. Our objective was to decompose racial and/or ethnic disparities in children's weight status according to contributing socioeconomic and behavioral risk factors. METHODS We used nationally representative data from ∼10 700 children in the Early Childhood Longitudinal Study Birth Cohort who were followed from age 9 months through kindergarten entry. We assessed the contribution of socioeconomic factors and maternal, infancy, and early childhood obesity risk factors to racial and/or ethnic disparities in children's BMI z scores by using Blinder-Oaxaca decomposition analyses. RESULTS The prevalence of risk factors varied significantly by race and/or ethnicity. African American children had the highest prevalence of risk factors, whereas Asian children had the lowest prevalence. The major contributor to the BMI z score gap was the rate of infant weight gain during the first 9 months of life, which was a strong predictor of BMI z score at kindergarten entry. The rate of infant weight gain accounted for between 14.9% and 70.5% of explained disparities between white children and their racial and/or ethnic minority peers. Gaps in socioeconomic status were another important contributor that explained disparities, especially those between white and Hispanic children. Early childhood risk factors, such as fruit and vegetable consumption and television viewing, played less important roles in explaining racial and/or ethnic differences in children's BMI z scores. CONCLUSIONS Differences in rapid infant weight gain contribute substantially to racial and/or ethnic disparities in obesity during early childhood. Interventions implemented early in life to target this risk factor could help curb widening racial and/or ethnic disparities in early childhood obesity.
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Affiliation(s)
- Inyang A. Isong
- Boston Children’s Hospital, Boston, Massachusetts;,Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health and
| | - Sowmya R. Rao
- Department of Surgery, Boston University, Boston, Massachusetts; and
| | - Marie-Abèle Bind
- Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Mauricio Avendaño
- Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health and,Department of Social Science, Health and Medicine, King’s College London, London, United Kingdom
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health and
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17
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A Qualitative Study to Understand Nativity Differences in Breastfeeding Behaviors Among Middle-Class African American and African-Born Women. Matern Child Health J 2017; 20:2100-11. [PMID: 27334637 DOI: 10.1007/s10995-016-2029-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To explore nativity differences and the role of attitudes, social norms, and behavioral control perceptions surrounding breastfeeding initiation and duration among middle-class African-American (AA) and African-born (AB) mothers in the US. Methods Semi-structured individual interviews were conducted with 20 middle-class AA and AB mothers in central Ohio from December 2012 to February 2013. Interview questions were developed based on the Theory of Planned Behavior (TPB). Interviews were analyzed for salient themes by TPB constructs. Differences in themes were examined by nativity status. Results All study participants had initiated breastfeeding or bottle-feeding with expressed breast milk, noting the benefits it conferred as well as the persuasive encouragement they received from others. Persistent encouragement was often cited as a factor for sustaining breastfeeding. More AA mothers had discontinued breastfeeding by the time of the interview, which was often attributed to health, lactation, and work challenges. Inconsistent support from health providers, dissuasive remarks from others, ambivalent breastfeeding attitudes, and diminished family support led some mothers to begin formula supplementation. Analysis of maternal narratives revealed nativity differences across sources of encouragement. Specifically, important sources of encouragement were health providers for AA mothers and family, friends, partners and culture for AB mothers. Only AB mothers expressed concerns about difficulty they encountered with breastfeeding due to the lack of proximal family support. Conclusions Findings reveal that both groups of mothers may be susceptible to unsupportive breastfeeding norms in the US and also highlight the need for intervention in health care settings and workplaces to improve AA women's breastfeeding rates.
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18
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Tehranifar P, Cohn BA, Flom JD, Protacio A, Cirillo P, Lumey LH, Michels KB, Terry MB. Early life socioeconomic environment and mammographic breast density. BMC Cancer 2017; 17:41. [PMID: 28068940 PMCID: PMC5223475 DOI: 10.1186/s12885-016-3010-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Early life social environment may influence breast cancer through shaping risk factors operating in early life, adolescence and adulthood, or may be associated with breast cancer risk independent of known risk factors. We investigated the associations between early life socioeconomic status (SES) and mammographic density, a strong risk factor for breast cancer, and the extent to which these associations were independent of risk factors across the lifecourse. Methods We used data from an adult follow-up study of two U.S. birth cohorts of women (average age = 43 years) with prospectively collected data starting during the pregnancy of the mother and continuing through early childhood of the offspring. We collected data on factors in later life periods through computer-assisted interviews with the offspring as adults, and obtained routine clinical mammograms for measurement of percent density and dense and nondense breast areas using a computer assisted method. We used generalized estimating equation models for multivariable analysis to account for correlated data for sibling sets within the study sample (n = 700 composed of 441 individuals and 127 sibling sets). Results Highest vs. lowest family income level around the time of birth was associated with smaller dense breast area after adjustment for early life factors (e.g., birthweight, maternal smoking during pregnancy) and risk factors in later life periods, including adult body mass index (BMI) and adult SES (β = −8.2 cm2, 95% confidence interval [CI]: −13.3, −3.2). Highest vs. lowest parental educational attainment was associated with higher percent density in models that adjusted for age at mammogram and adult BMI (e.g., β = 4.8, 95% CI = 0.6, 9.1 for maternal education of college or higher degree vs. less than high school), but the association was attenuated and no longer statistically significant after further adjustment for early life factors. There were no associations between early life SES indicators and non-dense area after adjustment for adult BMI. Neither adult education nor adult income was statistically significantly associated with any measure of mammographic density after adjusting for age and adult BMI. Conclusions We did not observe consistent associations between different measures of early life SES and mammographic density in adulthood.
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Affiliation(s)
- Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Barbara A Cohn
- The Center for Research on Women and Children's Health, The Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Julie D Flom
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Angeline Protacio
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Piera Cirillo
- The Center for Research on Women and Children's Health, The Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - L H Lumey
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.,The Imprints Center for Genetic and Environmental Lifecourse Studies, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Karin B Michels
- Department of Epidemiology, University of California (UCLA) Fielding School of Public Health, Los Angeles, CA, USA.,Institute for Prevention and Cancer Epidemiology, Freiburg University Medical Center, Freiburg, Germany
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,The Imprints Center for Genetic and Environmental Lifecourse Studies, Columbia University Mailman School of Public Health, New York, NY, USA
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19
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Link-Gelles R, Westreich D, Aiello AE, Shang N, Weber DJ, Holtzman C, Scherzinger K, Reingold A, Schaffner W, Harrison LH, Rosen JB, Petit S, Farley M, Thomas A, Eason J, Wigen C, Barnes M, Thomas O, Zansky S, Beall B, Whitney CG, Moore MR. Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM Popul Health 2016; 2:587-594. [PMID: 27668279 PMCID: PMC5033249 DOI: 10.1016/j.ssmph.2016.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the US for prevention of invasive pneumococcal disease in children. Individual-level socioeconomic status (SES) is a potential confounder of the estimated effectiveness of PCV13 and is often controlled for in observational studies using zip code as a proxy. We assessed the utility of zip code matching for control of SES in a post-licensure evaluation of the effectiveness of PCV13 (calculated as [1-matched odds ratio]*100). We used a directed acyclic graph to identify subsets of confounders and collected SES variables from birth certificates, geocoding, a parent interview, and follow-up with medical providers. Cases tended to be more affluent than eligible controls (for example, 48.3% of cases had private insurance vs. 44.6% of eligible controls), but less affluent than enrolled controls (52.9% of whom had private insurance). Control of confounding subsets, however, did not result in a meaningful change in estimated vaccine effectiveness (original estimate: 85.1%, 95% CI 74.8–91.9%; adjusted estimate: 82.5%, 95% CI 65.6–91.1%). In the context of a post-licensure vaccine effectiveness study, zip code appears to be an adequate, though not perfect, proxy for individual SES. Socioeconomic status (SES) may impact enrollment in vaccine effectiveness studies. We assessed zip code matching as a proxy for SES in a pneumococcal vaccine study. After zip code matching, we found differences in SES between cases and controls. Differences did not appear to substantially bias estimated vaccine effectiveness.
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Affiliation(s)
- Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Nong Shang
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - David J Weber
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Corinne Holtzman
- Minnesota Department of Health, P.O. Box 64975, St. Paul, MN 55164, USA
| | - Karen Scherzinger
- Institute for Public Health, University of New Mexico, Emerging Infections Program, 1601 Randolph SE, Suite 1005, Albuquerque, NM 87106, USA
| | - Arthur Reingold
- California Emerging Infections Program, 360 22nd Street, Suite 750, Oakland, CA 94612, USA
| | - William Schaffner
- Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Avenue South, Suite 2600, Nashville, TN 37212, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 201 W. Preston Street, Baltimore, MD 21201, USA
| | - Jennifer B Rosen
- New York City Department of Health and Mental Hygiene, 125 Worth St, New York, NY 10013, USA
| | - Susan Petit
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134, USA
| | - Monica Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Infection Disease Section, Medical Specialty Care Service Line, Atlanta VA Medical Center, 1670 Clairmont Road, Station 152, Decatur, GA 30033, USA
| | - Ann Thomas
- Oregon Public Health Division and Oregon Emerging Infections Program, 800 NE Oregon Street, Suite 772, Portland, OR 97232, USA
| | - Jeffrey Eason
- Bureau of Epidemiology, Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, USA
| | - Christine Wigen
- County of Los Angeles Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA
| | - Meghan Barnes
- Colorado Emerging Infections Program, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
| | - Ola Thomas
- County of Los Angeles Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA
| | - Shelley Zansky
- New York State Department of Health, Corning Tower, Room 651, Empire State Plaza, Albany, NY 12237, USA
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
| | - Matthew R Moore
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
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20
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Hidaka BH, Kerling EH, Thodosoff JM, Sullivan DK, Colombo J, Carlson SE. Dietary patterns of early childhood and maternal socioeconomic status in a unique prospective sample from a randomized controlled trial of Prenatal DHA Supplementation. BMC Pediatr 2016; 16:191. [PMID: 27884184 PMCID: PMC5123236 DOI: 10.1186/s12887-016-0729-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/08/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Dietary habits established in early childhood and maternal socioeconomic status (SES) are important, complex, interrelated factors that influence a child's growth and development. The aim of this study was to define the major dietary patterns in a cohort of young US children, construct a maternal SES index, and evaluate their associations. METHODS The diets of 190 children from a randomized, controlled trial of prenatal supplementation of docosahexaenoic acid (DHA) were recorded at 6-mo intervals from 2-4.5 years by 24-h dietary recall. Hierarchical cluster analysis of age-adjusted, average daily intake of 24 food and beverage groups was used to categorize diet. Unrotated factor analysis generated an SES score from maternal race, ethnicity, age, education, and neighborhood income. RESULTS We identified two major dietary patterns: "Prudent" and "Western." The 85 (45%) children with a Prudent diet consumed more whole grains, fruit, yogurt and low-fat milk, green and non-starchy vegetables, and nuts and seeds. Conversely, those with a Western diet had greater intake of red meat, discretionary fat and condiments, sweet beverages, refined grains, French fries and potato chips, eggs, starchy vegetables, processed meats, chicken and seafood, and whole-fat milk. Compared to a Western diet, a Prudent diet was associated with one standard deviation higher maternal SES (95% CI: 0.80 to 1.30). CONCLUSIONS We found two major dietary patterns of young US children and defined a single, continuous axis of maternal SES that differed strongly between groups. This is an important first step to investigate how child diet, SES, and prenatal DHA supplementation interact to influence health outcomes. TRIAL REGISTRATION NCT00266825 . Prospectively registered on December 15, 2005.
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Affiliation(s)
- Brandon H Hidaka
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Elizabeth H Kerling
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Jocelynn M Thodosoff
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - John Colombo
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., Lawrence, KS, 66045, USA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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21
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Peña MM, Rifas-Shiman SL, Gillman MW, Redline S, Taveras EM. Racial/Ethnic and Socio-Contextual Correlates of Chronic Sleep Curtailment in Childhood. Sleep 2016; 39:1653-61. [PMID: 27306269 DOI: 10.5665/sleep.6086] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine the association between race/ethnicity and sleep curtailment from infancy to mid-childhood, and to determine the extent to which socioeconomic and contextual factors both explain racial/ethnic differences and are independently associated with sleep curtailment. METHODS We studied 1,288 children longitudinally in Project Viva, a pre-birth cohort study, from 6 months to 7 years of age. The main exposure was the child's race/ethnicity. The main outcome was a sleep curtailment score from 6 months to 7 years. The score ranged from 0-13, where 0 indicated maximal sleep curtailment and 13 indicated never having curtailed sleep. RESULTS The mean (standard deviation) sleep curtailment score was 10.2 (2.7) points. In adjusted models (β [95% CI]), black (-1.92, [-2.39, -1.45] points), Hispanic (-1.58, [-2.43, -0.72] points), and Asian (-1.71, [-2.55, -0.86] points) children had lower sleep scores than white children. Adjustment for sociodemographic covariates attenuated racial/ethnic differences in sleep scores for black (by 24%) and Hispanic children (by 32%) but strengthened the differences for Asian children by 14%. Further adjustment for environmental and behavioral variables did not substantially change these differences. Independently, low maternal education, living in households with incomes < $70,000, viewing more TV, and having a TV in the child's bedroom were associated with lower sleep scores. CONCLUSIONS Chronic sleep curtailment from infancy to mid-childhood was more prevalent among black, Hispanic, and Asian children. These differences were partially but not entirely explained by socio-contextual variables. Independently, children from lower socioeconomic status and those with greater exposures to TV also had greater sleep curtailment.
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Affiliation(s)
- Michelle-Marie Peña
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Department of Nutrition, Harvard School of Public Health, Boston, MA
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22
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Winkleby MA, Cubbin C. Changing Patterns in Health Behaviors and Risk Factors Related to Chronic Diseases, 1990–2000. Am J Health Promot 2016; 19:19-27. [PMID: 15460097 DOI: 10.4278/0890-1171-19.1.19] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose. Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. Design. Stratified cross-sectional design. Setting. United States. Subjects. 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. Measures. Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. Results. Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%–36% current smokers among white women and men), the largest increases in smoking (10%–12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%–9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%–30%) and low vegetable or fruit intake (approximately 35%–50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). Conclusion. The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.
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Affiliation(s)
- Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University School of Medicine, 211 Quarry Road, Room N229, Stanford, CA 94305-5705, USA.
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Abstract
Using a person-centered approach, we examine phenomenological variations in exposure to violence for Black males and describe risk and protective factors associated with patterns of violence exposure. We ran K-means iterative cluster analysis to determine patterns of violence exposure and conducted analysis of variance to test whether clusters differed. Data are from 287 Black males ( M = 18.9) who participated in the Black Youth Project–Youth Culture Survey. Participants in the current study self-identified as Black or African American and male, and completed the political participation, health, and demographic portions of the survey questionnaire. We found four clusters of violence exposure that were related to demographic characteristics, maternal closeness, neighborhood condition, and sociopolitical inequity. Our findings highlight the heterogeneity of exposure to violence among young Black males and the individual and environmental risk and protective factors that are related to types and levels of exposure. This examination of quality of violence exposure in the context of available risks and protective factors may help clinicians and researchers improve their intervention efforts.
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Affiliation(s)
| | - Elan C. Hope
- North Carolina State Univeristy, Raleigh, NC, USA
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24
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Choe SA, Min HS, Cho SI. The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013. SPRINGERPLUS 2016; 5:895. [PMID: 27386343 PMCID: PMC4923012 DOI: 10.1186/s40064-016-2620-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/17/2016] [Indexed: 02/07/2023]
Abstract
There is limited evidence on the effects of relatively low socioeconomic status on maternal health. Additionally, the global economic recession that began in 2008 could have worsened disparities in maternal complications. To explore disparities in maternal health, we analyzed the occurrence of preeclampsia and postpartum hemorrhage according to level of household income. A population-based cohort data set from the Korean National Health Insurance was used to calculate the age-adjusted incidence, slope index of inequality, and Kunst and Mackenbach relative index of inequality (RIIKM) for preeclampsia and postpartum hemorrhage from 2002 to 2013. In the aggregated data of 65,479 live births, women with lower household income showed a higher risk of developing preeclampsia and postpartum hemorrhage than those with higherhigher incomes after adjusting for conventional risk factors. The absolute and relative inequalities for both complications showed no significant change over the period from 2002 to 2013. Considering the difference in the trends and risks of major obstetric complications according to level of household income, policies to monitor and reduce disparities in maternal health across different economic levels need to be implemented.
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Affiliation(s)
- Seung-Ah Choe
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Hye-Sook Min
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742 Republic of Korea
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25
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Assari S. Race and Ethnic Differences in Additive and Multiplicative Effects of Depression and Anxiety on Cardiovascular Risk. Int J Prev Med 2016; 7:22. [PMID: 26941923 PMCID: PMC4755257 DOI: 10.4103/2008-7802.173931] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/03/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shervin Assari
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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26
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Ilori TO, Adedinsewo DA, Odewole O, Enofe N, Ojo AO, McClellan W, Patzer RE. Racial and Ethnic Disparities in Graft and Recipient Survival in Elderly Kidney Transplant Recipients. J Am Geriatr Soc 2015; 63:2485-2493. [PMID: 26660200 DOI: 10.1111/jgs.13845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate racial and ethnic differences in graft and recipient survival in elderly kidney transplant recipients. DESIGN Retrospective cohort. SETTING First-time, kidney-only transplant recipients aged 60 and older of age at transplantation transplanted between July 1996 and October 2010 (N = 44,013). PARTICIPANTS United Network for Organ Sharing (UNOS) database. MEASUREMENTS Time to graft failure and death obtained from the UNOS database and linkage to the Social Security Death Index. Neighborhood poverty from 2000 U.S. Census geographic data. RESULTS Of the 44,013 recipients in the sample, 20% were black, 63% non-Hispanic white, 11% Hispanic, 5% Asian, and the rest "other racial groups." In adjusted Cox models, blacks were more likely than whites to experience graft failure (hazard ratio (HR) = 1.23, 95% confidence interval (CI) = 1.15-1.32), whereas Hispanics (HR = 0.77, 95% CI = 0.70-0.85) and Asians (HR = 0.70, 95% CI = 0.61-0.81) were less likely to experience graft failure. Blacks (HR = 0.84, 95% CI = 0.80-0.88), Hispanics (HR = 0.68, 95% CI = 0.64-0.72), and Asians (HR = 0.62, 95% CI = 0.57-0.68) were less likely than whites to die after renal transplantation. CONCLUSION Elderly blacks are at greater risk of graft failure than white transplant recipients but survive longer after transplantation. Asians have the highest recipient and graft survival, followed by Hispanics. Further studies are needed to assess additional factors affecting graft and recipient survival in elderly adults and to investigate outcomes such as quality of life.
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Affiliation(s)
| | | | | | - Nosayaba Enofe
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Akinlolu O Ojo
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - William McClellan
- Department of Medicine, Emory University, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rachel E Patzer
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia
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27
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Wijtzes AI, Jansen W, Jaddoe VWV, Franco OH, Hofman A, van Lenthe FJ, Raat H. Social Inequalities in Young Children's Meal Skipping Behaviors: The Generation R Study. PLoS One 2015. [PMID: 26225757 PMCID: PMC4520523 DOI: 10.1371/journal.pone.0134487] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Regular meal consumption is considered an important aspect of a healthy diet. While ample evidence shows social inequalities in breakfast skipping among adolescents, little is known about social inequalities in breakfast skipping and skipping of other meals among young school-aged children. Such information is crucial in targeting interventions aimed to promote a healthy diet in children. Methods We examined data from 4704 ethnically diverse children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, the Netherlands. Information on family socioeconomic position (SEP), ethnic background, and meal skipping behaviors was assessed by parent-reported questionnaire when the child was 6 years old. Multiple logistic regression analyses were performed to assess the associations of family SEP (educational level, household income, employment status, family composition) and ethnic background with meal skipping behaviors, using high SEP children and native Dutch children as reference groups. Results Meal skipping prevalence ranged from 3% (dinner) to 11% (lunch). The prevalence of meal skipping was higher among low SEP children and ethnic minority children. Maternal educational level was independently associated with breakfast skipping ([low maternal educational level] OR: 2.21; 95% CI: 1.24,3.94). Paternal educational level was independently associated with lunch skipping ([low paternal educational level] OR: 1.53; 95% CI: 1.06,2.20) and dinner skipping ([mid-high paternal educational level] OR: 0.39; 95% CI: 0.20,0.76). Household income was independently associated with breakfast skipping ([low income] OR: 2.43, 95% CI: 1.40,4.22) and dinner skipping ([low income] OR: 2.44; 95% CI: 1.22,4.91). In general, ethnic minority children were more likely to skip breakfast, lunch, and dinner compared with native Dutch children. Adjustment for family SEP attenuated the associations of ethnic minority background with meal skipping behaviors considerably. Conclusion Low SEP children and ethnic minority children are at an increased risk of breakfast, lunch, and dinner skipping compared with high SEP children and native Dutch children, respectively. Given these inequalities, interventions aimed to promote regular meal consumption, breakfast consumption in particular, should target children from low socioeconomic groups and ethnic minority children. More qualitative research to investigate the pathways underlying social inequalities in children’s meal skipping behaviors is warranted.
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Affiliation(s)
- Anne I. Wijtzes
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Wilma Jansen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Social Development, City of Rotterdam, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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28
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Akinyemiju TF, Genkinger JM, Farhat M, Wilson A, Gary-Webb TL, Tehranifar P. Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis. BMC Cancer 2015; 15:191. [PMID: 25885593 PMCID: PMC4396806 DOI: 10.1186/s12885-015-1098-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/20/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. METHODS Using PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable. RESULTS We reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality. CONCLUSIONS The findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Maggie Farhat
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Adrienne Wilson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Departments of Community and Behavioral Sciences and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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29
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Daoud N, O'Campo P, Minh A, Urquia ML, Dzakpasu S, Heaman M, Kaczorowski J, Levitt C, Smylie J, Chalmers B. Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures. BMC Pregnancy Childbirth 2015; 14:393. [PMID: 25494970 PMCID: PMC4369885 DOI: 10.1186/s12884-014-0393-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 11/17/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants. METHODS Using cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups. RESULTS We observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months. Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping. CONCLUSION By examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.
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Affiliation(s)
- Nihaya Daoud
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada.
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel.
| | - Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada. O'
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. O'
| | - Anita Minh
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada.
| | - Marcelo L Urquia
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Susie Dzakpasu
- Maternal and Infant Health Section, Surveillance and Analysis Division, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Maureen Heaman
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Janusz Kaczorowski
- Département de médecine de famille et de médecine d'urgence and CRCHUM, Université de Montréal, Hôtel-Dieu Hospital, Montréal, Québec, Canada.
| | - Cheryl Levitt
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Janet Smylie
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael Hospital, 209 Victoria Street, third floor, Toronto, ON, M5C 1 N8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, Saint Michael's Hospital, Toronto, ON, Canada.
| | - Beverley Chalmers
- Department of Obstetrics and Gynaecology, Ottawa Hospital Research Unit, University of Ottawa, Ottawa, Canada.
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Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: a cross-sectional population based study. Soc Sci Med 2015; 128:178-87. [PMID: 25618607 DOI: 10.1016/j.socscimed.2015.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aboriginal and Torres Strait Islander adults in the Australian state of Victoria have a higher prevalence of psychological distress than their non-Aboriginal and Torres Strait Islander counterparts. We sought to explain this inequality, focussing on the social determinants of health. We used population-based survey data from the 2008 Victorian Population Health Survey; a cross-sectional landline computer-assisted telephone survey of 34,168 randomly selected adults. We defined psychological distress as a score of 22 or more on the Kessler 10 Psychological Distress scale. We used logistic regression to identify socio-demographic characteristics and social capital indicators that were associated with psychological distress. We then created multivariable models to explore the association between psychological distress and Aboriginal and Torres Strait Islander status that incorporated all significant socioeconomic status (SES) and social capital variables, adjusting for all non-SES socio-demographic characteristics. Aboriginal and Torres Strait Islander Victorians (24.5%) were more than twice as likely than their non-Aboriginal and Torres Strait Islander counterparts (11.3%) to have psychological distress (odds ratio (OR) = 2.56, 95% confidence interval; 1.67-3.93). Controlling for SES, negative perceptions of the residential neighbourhood, lack of social support from family, social and civic distrust, and all non-SES socio-demographic variables (age, sex, marital status, household composition, and rurality), rendered the previously statistically significant inequality in the prevalence of psychological distress, between Aboriginal and Torres Strait Islander Victorians and their non-Aboriginal and Torres Strait Islander counterparts, insignificant at the p = 0.05 level (OR = 1.50; 0.97-2.32). Psychological distress is an important health risk factor for Aboriginal and Torres Strait Islander adults that has yet to be widely acknowledged and addressed. Addressing the underlying inequalities in SES and social capital may be the key to addressing the inequality in psychological distress.
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Johnson A, Kirk R, Rosenblum KL, Muzik M. Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions. Breastfeed Med 2015; 10:45-62. [PMID: 25423601 PMCID: PMC4307211 DOI: 10.1089/bfm.2014.0023] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.
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Affiliation(s)
- Angela Johnson
- Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
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Wijtzes AI, Jansen W, Bouthoorn SH, Pot N, Hofman A, Jaddoe VWV, Raat H. Social inequalities in young children's sports participation and outdoor play. Int J Behav Nutr Phys Act 2014; 11:155. [PMID: 25510552 PMCID: PMC4272790 DOI: 10.1186/s12966-014-0155-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Research on social inequalities in sports participation and unstructured physical activity among young children is scarce. This study aimed to assess the associations of family socioeconomic position (SEP) and ethnic background with children’s sports participation and outdoor play. Methods We analyzed data from 4726 ethnically diverse 6-year-old children participating in the Generation R Study. Variables were assessed by parent-reported questionnaires when the child was 6 years old. Low level of outdoor play was defined as outdoor play <1 hour per day. Series of multiple logistic regression analyses were performed to assess associations of family SEP and ethnic background with children’s sports participation and outdoor play. Results Socioeconomic inequalities in children’s sports participation were found when using maternal educational level (p < 0.05), paternal educational level (p < 0.05), maternal employment status (p < 0.05), and household income (p < 0.05) as family SEP indicator (less sports participation among low SEP children). Socioeconomic inequalities in children’s outdoor play were found when using household income only (p < 0.05) (more often outdoor play <1 hour per day among children from low income household). All ethnic minority children were significantly more likely to not to participate in sports and play outdoor <1 hour per day compared with native Dutch children. Adjustment for family SEP attenuated associations considerably, especially with respect to sports participation. Conclusion Low SEP children and ethnic minority children are more likely not to participate in sports and more likely to display low levels of outdoor play compared with high SEP children and native Dutch children, respectively. In order to design effective interventions, further research, including qualitative studies, is needed to explore more in detail the pathways relating family SEP and ethnic background to children’s sports participation and outdoor play. Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0155-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne I Wijtzes
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center, P.O.Box 2040, Rotterdam, CA, 3000, The Netherlands.
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, University Medical Center, P.O.Box 2040, Rotterdam, CA, 3000, The Netherlands. .,Department of Social Development, Rotterdam, The Netherlands.
| | - Selma H Bouthoorn
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center, P.O.Box 2040, Rotterdam, CA, 3000, The Netherlands.
| | - Niek Pot
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands. .,School of Human Movement & Sports, Windesheim University of Applied Sciences, Zwolle, the Netherlands.
| | - Albert Hofman
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center, P.O.Box 2040, Rotterdam, CA, 3000, The Netherlands.
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Riley ED, Cohen J, Knight KR, Decker A, Marson K, Shumway M. Recent violence in a community-based sample of homeless and unstably housed women with high levels of psychiatric comorbidity. Am J Public Health 2014; 104:1657-63. [PMID: 25033127 PMCID: PMC4151936 DOI: 10.2105/ajph.2014.301958] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined associations between co-occurring psychiatric conditions and violence against homeless and unstably housed women. METHODS Between 2008 and 2010, we interviewed homeless and unstably housed women recruited from community venues about violence, socioeconomic factors, and psychiatric conditions. We used multivariable logistic regression to determine independent correlates of violence. RESULTS Among 291 women, 97% screened positive for 1 or more psychiatric conditions. Types of violence perpetrated by primary partners and persons who were not primary partners (non-primary partners) included emotional violence (24% vs 50%; P < .01), physical violence (11% vs 19%; P < .01), and sexual violence (7% vs 22%; P < .01). The odds of primary partner and non-primary partner violence increased with each additional psychiatric diagnosis and decreasing levels of social isolation. CONCLUSIONS All types of violence were more commonly perpetrated by non-primary partners, suggesting that an exclusive focus on domestic violence screening in health care or social service settings will miss most of the violence in this population. Contrary to some previous studies, the odds of violence decreased as social isolation increased, suggesting that social isolation may be protective in homeless and unstably housed communities with high levels of comorbidity and limited options.
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Affiliation(s)
- Elise D Riley
- Elise D. Riley, Jennifer Cohen, and Kara Marson are with the School of Medicine, Department of Medicine, University of California, San Francisco. Kelly R. Knight is with the School of Medicine, Department of Anthropology, History and Social Medicine, University of California, San Francisco. Alyson Decker is with the School of Nursing, University of California, San Francisco. Martha Shumway is with the School of Medicine, Department of Psychiatry, University of California, San Francisco
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Markwick A, Ansari Z, Sullivan M, McNeil J. Social determinants and lifestyle risk factors only partially explain the higher prevalence of food insecurity among Aboriginal and Torres Strait Islanders in the Australian state of Victoria: a cross-sectional study. BMC Public Health 2014; 14:598. [PMID: 24924598 PMCID: PMC4076758 DOI: 10.1186/1471-2458-14-598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/03/2014] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of food insecurity is substantially higher among Australians of Aboriginal or Torres Strait Islander descent. The purpose of this study is to explain the relationship between food insecurity and Aboriginal and Torres Islander status in the state of Victoria. Methods Data were obtained from the 2008 Victorian Population Health Survey; a cross-sectional landline computer-assisted telephone interview survey of 34,168 randomly selected Victorians aged 18 years and older; including 339 Aboriginal and Torres Strait Islanders. We categorised a respondent as food insecure, if in the previous 12 months, they reported having run out of food and not being able to afford to buy more. We used multivariable logistic regression to adjust for age, sex, socioeconomic status (household income), lifestyle risk factors (smoking, alcohol consumption and obesity), social support (ability to get help from family, friends or neighbours), household composition (lone parent status, household with a child, and household size), and geographic location (rurality). Results Aboriginal and Torres Strait Islanders (20.3%) were more likely than their non-Aboriginal and Torres Strait Islander counterparts (5.4%) to have experienced food insecurity; odds ratio (OR) = 4.5 (95% CI; 2.7-7.4). Controlling for age, SES, smoking, obesity and inability to get help from family or friends reduced the odds ratio by 38%; ORadjusted = 2.8 (1.6-5.0). Conclusions Social determinants and lifestyle risk factors only partially explained the higher prevalence of food insecurity among Aboriginal and Torres Strait Islanders in Victoria. Further research is needed to explain the disparity in food insecurity between the two populations in order to inform and guide corrective action.
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Affiliation(s)
- Alison Markwick
- Department of Health, Health Intelligence Unit, Prevention and Population Health Branch, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia.
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Azad G, Blacher J, Marcoulides G. Longitudinal models of socio-economic status. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2014. [DOI: 10.1177/0165025414532172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parenting research is frequently conducted without a thorough examination of socio-economic characteristics. In this study, longitudinal observations of positive parenting were conducted across six time points. Participants were 219 mothers of children with and without developmental delays. Mothers’ positive parenting increased during early and middle childhood in children with and without developmental delays. Mothers who reported more education had significantly higher levels of positive parenting when their children were 3 years old. Mothers who reported more family income grew at a significantly faster rate in positive parenting. There was preliminary support that mothers with more income were more likely to be members of a class that started off and remained at a higher level of positive parenting over time. Implications are discussed.
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Psaki SR, Seidman JC, Miller M, Gottlieb M, Bhutta ZA, Ahmed T, Ahmed AS, Bessong P, John SM, Kang G, Kosek M, Lima A, Shrestha P, Svensen E, Checkley W. Measuring socioeconomic status in multicountry studies: results from the eight-country MAL-ED study. Popul Health Metr 2014; 12:8. [PMID: 24656134 PMCID: PMC4234146 DOI: 10.1186/1478-7954-12-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/14/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is no standardized approach to comparing socioeconomic status (SES) across multiple sites in epidemiological studies. This is particularly problematic when cross-country comparisons are of interest. We sought to develop a simple measure of SES that would perform well across diverse, resource-limited settings. METHODS A cross-sectional study was conducted with 800 children aged 24 to 60 months across eight resource-limited settings. Parents were asked to respond to a household SES questionnaire, and the height of each child was measured. A statistical analysis was done in two phases. First, the best approach for selecting and weighting household assets as a proxy for wealth was identified. We compared four approaches to measuring wealth: maternal education, principal components analysis, Multidimensional Poverty Index, and a novel variable selection approach based on the use of random forests. Second, the selected wealth measure was combined with other relevant variables to form a more complete measure of household SES. We used child height-for-age Z-score (HAZ) as the outcome of interest. RESULTS Mean age of study children was 41 months, 52% were boys, and 42% were stunted. Using cross-validation, we found that random forests yielded the lowest prediction error when selecting assets as a measure of household wealth. The final SES index included access to improved water and sanitation, eight selected assets, maternal education, and household income (the WAMI index). A 25% difference in the WAMI index was positively associated with a difference of 0.38 standard deviations in HAZ (95% CI 0.22 to 0.55). CONCLUSIONS Statistical learning methods such as random forests provide an alternative to principal components analysis in the development of SES scores. Results from this multicountry study demonstrate the validity of a simplified SES index. With further validation, this simplified index may provide a standard approach for SES adjustment across resource-limited settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - William Checkley
- Fogarty International Center, National Institutes of Health, Bethesda, USA.
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Mutambudzi M, Meyer JD. Construction of early and midlife work trajectories in women and their association with birth weight. Am J Public Health 2013; 104 Suppl 1:S58-64. [PMID: 24354827 DOI: 10.2105/ajph.2013.301401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We derived trajectories of the substantive complexity (SC) of work across mid-adult life in women and determined their association with term birth weight. SC is a concept that encompasses decision latitude, active learning, and ability to use and expand one's abilities at work. METHODS Using occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables, we used growth mixture modeling (GMM) to construct longitudinal trajectories of work SC from the ages of 18 to 34 years. The association between work trajectories and birth weight of infants born to study participants was modeled using generalized estimating equations, adjusting for education, income, and relevant covariates. RESULTS GMM yielded a 5-class solution for work trajectories in women. Higher work trajectories were associated with higher term birth weight and were robust to the inclusion of both education and income. A work trajectory that showed a sharp rise after age 24 years was associated with marked improvement in birth weight. CONCLUSIONS Longitudinal modeling of work characteristics might improve capacity to integrate occupation into a life-course model that examines antecedents and consequences for maternal and child health.
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Affiliation(s)
- Miriam Mutambudzi
- Miriam Mutambudzi is with the Johns Hopkins Lupus Center, Johns Hopkins School of Medicine, Baltimore, MD. John D. Meyer is with the Department of Environmental and Occupational Health Sciences, SUNY-Downstate School of Public Health, Brooklyn, NY, and the Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Shimotsu ST, Jones-Webb RJ, Lytle LA, MacLehose RF, Nelson TF, Forster JL. The relationships among socioeconomic status, fruit and vegetable intake, and alcohol consumption. Am J Health Promot 2013; 27:21-8. [PMID: 22950922 DOI: 10.4278/ajhp.110311-quan-108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE We examined the relationships among fruit and vegetable intake, alcohol consumption, and socioeconomic status (SES). We hypothesized that fruit and vegetable consumption would be inversely associated with alcohol consumption and the relationship would differ by SES. DESIGN A cross-sectional analysis. SETTING Large, urban Midwestern county. SUBJECTS A unique, racially/ethnically diverse sample of 9959 adults (response rate: 66.3%). MEASURES Fruit and vegetable intake was measured using two items that assessed servings per day. Alcohol consumption was measured in terms of volume of alcohol consumed and binge drinking. Individual measures of SES included education and household income. ANALYSIS Weighted multivariate linear and Poisson regression were used to estimate effects. RESULTS The relationship between fruit and vegetable intake and alcohol consumption varied by SES. Those with lower household incomes who consumed five or more servings of fruits and vegetables per day were less likely to engage in binge drinking relative to those consuming zero to one servings of fruits and vegetables per day (risk ratio = .66; 95% confidence interval: .46, .95). No association was observed for higher-household-income individuals. CONCLUSION We observed an inverse relationship between fruit and vegetable consumption and alcohol intake in those with lower household incomes but not in those with higher household incomes. Results suggest that the relationship between diet and alcohol consumption may be more relevant in populations with more restricted economic choices. Results are, however, based on cross-sectional data.
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Affiliation(s)
- Scott T Shimotsu
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55415, USA
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Nielsen SS, Hempler NF, Krasnik A. Issues to consider when measuring and applying socioeconomic position quantitatively in immigrant health research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6354-65. [PMID: 24287857 PMCID: PMC3881118 DOI: 10.3390/ijerph10126354] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 01/02/2023]
Abstract
The relationship between migration and health is complex, yet, immigrant-related inequalities in health are largely influenced by socioeconomic position. Drawing upon previous findings, this paper discusses issues to consider when measuring and applying socioeconomic position in quantitative immigrant health research. When measuring socioeconomic position, it is important to be aware of four aspects: (1) there is a lack of clarity about how socioeconomic position should be measured; (2) different types of socioeconomic position may be relevant to immigrants compared with the native-born population; (3) choices of measures of socioeconomic position in quantitative analyses often rely on data availability; and (4) different measures of socioeconomic position have different effects in population groups. Therefore, caution should be used in the collection, presentation, analyses, and interpretation of data and researchers need to display their proposed conceptual models and data limitations as well as apply different approaches for analyses.
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Affiliation(s)
- Signe Smith Nielsen
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1014 Copenhagen K, Denmark; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +45-3532-7991; Fax: +45-3532-7629
| | - Nana Folmann Hempler
- Steno Diabetes Center, Steno Health Promotion Center, Niels Steensensvej 8, 2820 Gentofte, Denmark; E-Mail:
| | - Allan Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1014 Copenhagen K, Denmark; E-Mail:
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Bell ML, Zanobetti A, Dominici F. Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis. Am J Epidemiol 2013; 178:865-76. [PMID: 23887042 DOI: 10.1093/aje/kwt090] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Although there is strong evidence that short-term exposure to particulate matter is associated with health risks, less is known about whether some subpopulations face higher risks. We identified 108 papers published after 1995 and summarized the scientific evidence regarding effect modification of associations between short-term exposure to particulate matter and the risk of death or hospitalization. We performed a meta-analysis of estimated mortality associations by age and sex. We found strong, consistent evidence that the elderly experience higher risk of particular matter--associated hospitalization and death, weak evidence that women have higher risks of hospitalization and death, and suggestive evidence that those with lower education, income, or employment status have higher risk of death. Meta-analysis showed a statistically higher risk of death of 0.64% (95% confidence interval (CI): 0.50, 0.78) for older populations compared with 0.34% (95% CI: 0.25, 0.42) for younger populations per 10 μg/m3 increase of particulate matter with aerodynamic diameter ≤10 μm. Women had a slightly higher risk of death of 0.55% (95% CI: 0.41, 0.70) compared with 0.50% (95% CI: 0.34, 0.54) for men, but these 2 risks were not statistically different. Our synthesis on modifiers for risks associated with particulate matter can aid the design of air quality policies and suggest directions for future research. Studies of biological mechanisms could be informed by evidence of differential risks by population, such as by sex and preexisting conditions.
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Osborn CY, de Groot M, Wagner JA. Racial and ethnic disparities in diabetes complications in the northeastern United States: the role of socioeconomic status. J Natl Med Assoc 2013; 105:51-8. [PMID: 23862296 DOI: 10.1016/s0027-9684(15)30085-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of socioeconomic status (SES) in explaining racial/ ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications and the role of macro (eg, income, education) and micro (eg, owning a home or having a checking account) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were aged, on average, 55 years, and 55.6% non-Hispanic white, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic white, African American, and Hispanic participants, with Hispanic participants having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (eg, income) mediated racial differences (ie, non-Hispanic whites vs African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (eg, education, income, and ownirg a home or having a checking account) mediated racial/ethnic differences (ie, non-Hispanic white vs Hispanic participants) in self-reported cardiovascular disease, and only micro SES indicators (eg, owning a home or having a checking account) mediated differences between lower-income SES racial/ethnic minority groups (ie, African American vs Hispanic participants) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.
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Affiliation(s)
- Chandra Y Osborn
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Silvestrin S, Silva CHD, Hirakata VN, Goldani AAS, Silveira PP, Goldani MZ. Maternal education level and low birth weight: a meta-analysis. J Pediatr (Rio J) 2013; 89:339-45. [PMID: 23809705 DOI: 10.1016/j.jped.2013.01.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/09/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the association between maternal education level and birth weight, considering the circumstances in which the excess use of technology in healthcare, as well as the scarcity of these resources, may result in similar outcomes. METHODS A meta-analysis of cohort and cross-sectional studies was performed; the studies were selected by systematic review in the MEDLINE database using the following Key**words socioeconomic factors, infant, low birth weight, cohort studies, cross-sectional studies. The summary measures of effect were obtained by random effect model, and its results were obtained through forest plot graphs. The publication bias was assessed by Egger's test, and the Newcastle-Ottawa scale was used to assess study quality. RESULTS The initial search found 729 articles. Of these, 594 were excluded after reading the title and abstract; 21, after consensus meetings among the three reviewers; 102, after reading the full text; and three for not having the proper outcome. Of the nine final articles, 88.8% had quality ≥ six stars (Newcastle-Ottawa Scale), showing good quality studies. The heterogeneity of the articles was considered moderate. High maternal education showed a 33% protective effect against low birth weight, whereas medium degree of education showed no significant protection when compared to low maternal education. CONCLUSIONS The hypothesis of similarity between the extreme degrees of social distribution, translated by maternal education level in relation to the proportion of low birth weight, was not confirmed.
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Affiliation(s)
- Sonia Silvestrin
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Maternal education level and low birth weight: A meta-analysis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim D, Saada A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2296-335. [PMID: 23739649 PMCID: PMC3717738 DOI: 10.3390/ijerph10062296] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Abstract
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.
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Affiliation(s)
- Daniel Kim
- Behavioural and Policy Sciences Department, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, USA
- Department of Social and Behavioural Sciences, Ecole des Hautes Etudes en Santé Publique, Rennes 35043, France
| | - Adrianna Saada
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA; E-Mail:
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Pollack CE, Cubbin C, Sania A, Hayward M, Vallone D, Flaherty B, Braveman PA. Do wealth disparities contribute to health disparities within racial/ethnic groups? J Epidemiol Community Health 2013; 67:439-45. [PMID: 23427209 DOI: 10.1136/jech-2012-200999] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. METHODS Data from the Survey of Consumer Finances (2004, ages 25-64) and the Health and Retirement Survey (2004, ages 50+), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. RESULTS Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). CONCLUSIONS The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.
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Affiliation(s)
- Craig Evan Pollack
- Johns Hopkins School of Medicine and Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD 21287, USA.
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Silva LM, van Rossem L, Jansen PW, Hokken-Koelega ACS, Moll HA, Hofman A, Mackenbach JP, Jaddoe VWV, Raat H. Children of low socioeconomic status show accelerated linear growth in early childhood; results from the Generation R Study. PLoS One 2012; 7:e37356. [PMID: 22649522 PMCID: PMC3359354 DOI: 10.1371/journal.pone.0037356] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 04/20/2012] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES People of low socioeconomic status are shorter than those of high socioeconomic status. The first two years of life being critical for height development, we hypothesized that a low socioeconomic status is associated with a slower linear growth in early childhood. We studied maternal educational level (high, mid-high, mid-low, and low) as a measure of socioeconomic status and its association with repeatedly measured height in children aged 0-2 years, and also examined to what extent known determinants of postnatal growth contribute to this association. METHODS This study was based on data from 2972 mothers with a Dutch ethnicity, and their children participating in The Generation R Study, a population-based cohort study in Rotterdam, The Netherlands (participation rate 61%). All children were born between April 2002 and January 2006. Height was measured at 2 months (mid-90% range 1.0-3.9), 6 months (mid-90% range 5.6-11.4), 14 months (mid-90% range 13.7-17.9) and 25 months of age (mid-90% range 23.6-29.6). RESULTS At 2 months, children in the lowest educational subgroup were shorter than those in the highest (difference: -0.87 cm; 95% CI: -1.16, -0.58). Between 1 and 18 months, they grew faster than their counterparts. By 14 months, children in the lowest educational subgroup were taller than those in the highest (difference at 14 months: 0.40 cm; 95% CI: 0.08,0.72). Adjustment for other determinants of postnatal growth did not explain the taller height. On the contrary, the differences became even larger (difference at 14 months: 0.61 cm; 95% CI: 0.26,0.95; and at 25 months: 1.00 cm; 95% CI: 0.57,1.43) CONCLUSIONS Compared with children of high socioeconomic status, those of low socioeconomic status show an accelerated linear growth until the 18th month of life, leading to an overcompensation of their initial height deficit. The long-term consequences of these findings remain unclear and require further study.
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Affiliation(s)
- Lindsay M Silva
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Borrell LN, Crawford ND. Socioeconomic position indicators and periodontitis: examining the evidence. Periodontol 2000 2012; 58:69-83. [PMID: 22133367 DOI: 10.1111/j.1600-0757.2011.00416.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kucik JE, Alverson CJ, Gilboa SM, Correa A. Racial/ethnic variations in the prevalence of selected major birth defects, metropolitan Atlanta, 1994-2005. Public Health Rep 2012; 127:52-61. [PMID: 22298922 DOI: 10.1177/003335491212700106] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Birth defects are the leading cause of infant mortality and are responsible for substantial child and adult morbidity. Documenting the variation in prevalence of birth defects among racial/ethnic subpopulations is critical for assessing possible variations in diagnosis, case ascertainment, or risk factors among such groups. METHODS We used data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects registry with active case ascertainment. We estimated the racial/ethnic variation in prevalence of 46 selected major birth defects among live births, stillbirths, and pregnancy terminations at >20 weeks gestation among mothers residing in the five central counties of metropolitan Atlanta between 1994 and 2005, adjusting for infant sex, maternal age, gravidity, and socioeconomic status (SES). We also explored SES as a potential effect measure modifier. RESULTS Compared with births to non-Hispanic white women, births to non-Hispanic black women had a significantly higher prevalence of five birth defects and a significantly lower prevalence of 10 birth defects, while births to Hispanic women had a significantly higher prevalence of four birth defects and a significantly lower prevalence of six birth defects. The racial/ethnic disparities in the prevalence of some defects varied by SES, but no clear pattern emerged. CONCLUSIONS Racial/ethnic disparities were suggested in 57% of included birth defects. Disparities in the prevalence of birth defects may result from different underlying genetic susceptibilities; exposure to risk factors; or variability in case diagnosis, ascertainment, or reporting among the subpopulations examined. Policies that improve early diagnosis of birth defects could reduce associated morbidity and mortality.
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Affiliation(s)
- James E Kucik
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30333, USA.
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Fine D, Thomas KK, Nakatsukasa-Ono W, Marrazzo J. Chlamydia positivity in women screened in family planning clinics: racial/ethnic differences and trends in the northwest U.S., 1997-2006. Public Health Rep 2012; 127:38-51. [PMID: 22298921 PMCID: PMC3234396 DOI: 10.1177/003335491212700105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997-2006. We then explored these measures within racial/ethnic subpopulations. METHODS Using data from 667,223 chlamydia tests obtained from women aged 15-24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual- and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation. RESULTS Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR] = 1.93), American Indian/Alaska Native (AOR=1.62), Asian/Pacific Islander (AOR=1.42), and Hispanic (AOR=1.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997-2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual- and population-level factors. CONCLUSIONS Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients.
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Affiliation(s)
- David Fine
- Cardea Services, 1809 Seventh Ave., Ste. 600, Seattle, WA 98101-1313, USA.
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Abstract
AIM To study the uptake of child health care among low-income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state-of-the-art consensus document from the year 2000. METHODS Data were collected for 25,024 infants born 1998-2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio-demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish-born partner. Analysis was conducted by Cox regression and linear regression models. RESULTS Small differences between Swedish vs. immigrant and high vs. low-income families were detected. Low-income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28-0.95) had lower rates of participation in parental groups. CONCLUSION The CHS provided basic child health care to almost all infants including children in immigrant and low-income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.
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Affiliation(s)
- T Wallby
- Department of Women's and Children's Health, Uppsala University, Sweden.
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