Influence of life course socioeconomic position on older women's health behaviors: findings from the British Women's Heart and Health Study

Development of inequalities in fruit and vegetable intake through early adulthood: insights from household panel surveys in the United Kingdom and Australia

BACKGROUND

Adequate fruit and vegetable intake is important for preventing chronic disease. The transition from adolescence to early adulthood involves changes in their social and environmental context, lifestyle and behaviours that may determine lifelong dietary patterns. Differences that emerge between populations over this age range may lead to long-term health inequalities. This study examined the trajectories of fruit and vegetable intake among young adults in the United Kingdom (UK) and Australia.

METHODS

We analysed data from young adults aged 16-30 years from the UK Household Longitudinal Study (UKHLS; n = 2751) and the Household, Income and Labour Dynamics in Australia Survey (HILDA; n = 6255). Hybrid mixed-effect regression models were fitted to assess intake trajectories of fruit and vegetables, exploring differences by sex and socioeconomic position.

RESULTS

Fruit intake decreased and vegetable intake increased with age in both countries. Fruit intake trajectories differed by sex in both cohorts, while vegetable intake trajectories differed by sex in Australia only. Parental education was a predictor of fruit and vegetable intake trajectories in both cohorts, with differences between groups with high and low parental education narrowing with age in Australia for fruit intake.

CONCLUSIONS

The differing trajectories emphasise the importance of understanding contextual influences to effectively tailor public health strategies. Our study highlights early adulthood as a critical period for developing dietary patterns that could influence long-term health outcomes, with differences between groups emerging quickly. Addressing these inequalities is essential when developing policies aimed at improving diet among young adults and reducing the prevalence of chronic disease.

Early adulthood socioeconomic trajectories contribute to inequalities in adult diet quality, independent of childhood and adulthood socioeconomic position

BACKGROUND

Diet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course. This study assessed the associations of early adulthood socioeconomic trajectories (SETs) with adult diet quality, adjusting for childhood socioeconomic position (SEP) and testing for mediation by adulthood SEP.

METHODS

Participants from the 1970 British Cohort Study with socioeconomic data in early adulthood were included (n=12 434). Diet quality at age 46 years, evaluated using the Mediterranean diet pyramid, was regressed on six previously identified classes of early adulthood SETs between ages 16 and 24 years including a continued education class, four occupation-defined classes and an economically inactive class. Causal mediation analyses tested the mediation of the association via household income and neighbourhood deprivation at age 46 years separately. Models were adjusted for sex, childhood SEP, adolescent diet quality and adolescent health.

RESULTS

The continued education class showed the best diet quality at age 46 years while little difference in diet quality was found among the remaining SET classes. The association between the continued education class and adult diet quality was independent of parental SEP in childhood and was largely not mediated by household income or neighbourhood deprivation (0.7% and 3.7% of the total effect mediated, respectively) in mid-adulthood.

CONCLUSIONS

Early adulthood SETs independently contribute to adult diet quality with continuing education associated with better adherence to the Mediterranean diet. Early adulthood therefore represents a sensitive period for intervention to alleviate dietary inequalities in later life.

Socioeconomic mobility, metabolic health, and diet: mediation via subjective socioeconomic status

OBJECTIVE

Socioeconomic mobility, i.e., changing socioeconomic status (SES) between adolescence and adulthood, may impact health through changing resources, social status, and health-related behaviors. This analysis examined whether subjective SES contributes to associations of mobility with metabolic health (BMI and metabolic syndrome) and unhealthy diets (fast-food consumption and sugar-sweetened beverage [SSB] consumption).

METHODS

National Longitudinal Study of Adolescent to Adult Health data were used (n = 4132). Mobility was defined as the difference between adolescent (collected 1994-1995, ages 11-19 years) and adult (collected 2016-2018, ages 33-43 years) SES. Linear and logistic regressions examined associations of mobility with metabolic and dietary outcomes and mediation by subjective SES.

RESULTS

Substantial upward mobility was associated with lower risk of high SSB consumption compared with stable disadvantaged SES (risk difference: -0.10 [95% CI: -0.16 to -0.041]). Subjective SES mediated associations of upward, but not downward, mobility with risks of developing metabolic syndrome, high fast-food consumption, and high SSB consumption; upward mobility was associated with higher subjective SES and lower risks of poor metabolic and dietary outcomes.

CONCLUSIONS

The finding that subjective SES contributed to associations between upward mobility and better health may inform development of interventions designed to promote healthier diets and reduce socioeconomic disparities in metabolic health.

A systematic review of the determinants of seafood consumption

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood.

Sex differences in health and mortality by income and income changes

BACKGROUND

The adverse association between income, health and survival is well documented, but little is known about how income trajectories influence health and survival for men and women. We aim to investigate sex differences in mortality and hospitalisations by income and income changes.

METHODS

We performed a population-based, nationwide study including 1 063 787 Danes born 1935-1955 and residing in Denmark during 1980-2015. Income was calculated during two age intervals: 45-49 and 55-59 years. The average income was divided into quartiles for men and women separately, which formed the basis for the income trajectories. Individuals were followed up from age 60 until 2014/2015 for hospital admission and mortality, respectively.

RESULTS

Men had higher mortality and were more hospitalised than women. Sex differences in mortality were most pronounced for people with stable low income (relative difference in hazard=1.93; 95% CI 1.89 to 1.98) and a downward income trajectory (1.91; 95% CI 1.85 to 1.98) with smaller sex differences for people with an upward trajectory (1.59; 95% CI 1.56 to 1.62) and stable high income (1.37; 95% CI 1.33 to 1.41). A similar pattern was found for family income. Regarding hospitalisations, similar results were found, though less pronounced. Investigation of mortality and hospitalisations by all possible trajectories demonstrated that income at ages 55-59 was an important predictor of mortality, with increasing mortality for decreasing income quartile.

CONCLUSION

Income trajectories as a proxy for change in social position have a larger influence on men's than women's health and mortality. Income in the late 50s is an important predictor of mortality, particularly for men.

Study of Consumer Acceptance by Means of Questionnaire Survey Towards Newly Developed Yogurts with Functional Ingredients

Background:

Presently, consumers are becoming very much aware of the benefits of allying the concepts of pleasant food with health promoting properties. Hence, the market for healthier foods, functional foods or even nutraceuticals has risen in the past decades.

Objective:

This work was designed to assess the consumers’ possible acceptance of newly developed yogurts with functional ingredients.

Methods:

A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 347 participants. The data were collected from October to December 2015 in the Central Region of Portugal. The questionnaires were applied by direct interview after verbally informed consent only to participants aged 18 or over.

Results:

The results obtained showed that more than 90% of the participants liked yogurts and consumed yogurts regularly (∼73%), either in the solid or liquid forms. The participants consumed functional yogurts, specifically for regulation of intestinal transit (∼46%) and for weight control (∼44%). When asked about the new yogurts with functional and detox properties, the participants indicated that they might be potential consumers of yogurts with the ability to eliminate toxins from the body (∼69%). In spite of recognizing the importance of adding ingredients with certain functionalities, like parsley, watercress or celery, the consumers manifested some doubts that those ingredients might combine well in yogurts. A regression model was deduced relating the possible consumption of detox yogurts with some behavioural aspects like physical exercise, consumption of functional foods and detox products.

Conclusion:

This work showed that selling yogurts with detox properties might be a good strategy because there might be a market for that type of product. However, without trying the samples and verifying the real taste of the products, the possible consumers have some doubts about the incorporation of certain ingredients, even though recognizing their roles as important.

Influence of individual life course and neighbourhood socioeconomic position on dietary intake in African Americans: the Jackson Heart Study

OBJECTIVE

African Americans, especially those in the Southeastern USA, have different dietary behaviours from the general US population, and have the highest prevalence, incidence and mortality of diet-related disease outcomes, such as cardiovascular disease. However, there are scant data regarding factors such as socioeconomic position (SEP) across the life course that influence dietary behaviours in this high-risk population. Our aim was to examine the impact of life course and neighbourhood SEPs on dietary intake among African Americans.

PARTICIPANTS AND SETTING

Data for this cross-sectional analysis came from the community-based Jackson Heart Study (JHS). We analysed a total of 3948 JHS participants (mean age: 55.4±12.5; 63.9% women), who had complete dietary intake and covariate information.

METHODS

We examined the associations of childhood SEP (CSEP), adulthood SEP (ASEP) and neighbourhood SEP (NSEP) with 10 selected dietary intake measures, using multilevel log-gamma generalised linear regression models.

OUTCOME MEASURES

Dietary intake measures include daily saturated fat, sodium, protein, fibre, fruits and vegetables, whole grains, sugar-sweetened beverage, nuts, fish and processed meat.

RESULTS

In age, sex and total energy intake adjusted models, most dietary intakes were associated with these three SEP measures. After additional adjustment for other SEP measures, most of the significant associations with CSEP and NSEP were attenuated, except for the associations of fibre with CSEP (relative rate [RR] [95% CI] 1.05 [1.00-1.10]) and whole grains with NSEP (RR [95% CI] 1.28 [1.02-1.61]). The associations (shown as RR [95% CI]) between ASEP and sugar-sweetened beverage: 0.70 (0.59-0.83), processed meat: 0.75 (0.63-0.90), sodium: 0.99 (0.94-1.00), fibre: 1.10 (1.03-1.16), protein: 1.05 (1.01-1.09), fruits and vegetables: 1.21 (1.11-1.32), nuts: 2.13 (1.59-2.87), and fish: 1.57 (1.27-1.95) generally persisted after additional adjustment for both CSEP and NSEP. However, the association between ASEP and whole grains was attenuated.

CONCLUSIONS

High ASEP may have a more beneficial influence on dietary practices in African Americans than CSEP or NSEP.

Effect of Early- and Adult-Life Socioeconomic Circumstances on Physical Inactivity

PURPOSE

This study aimed to investigate the associations between early- and adult-life socioeconomic circumstances and physical inactivity (level and evolution) in aging using large-scale longitudinal data.

METHODS

This study used the Survey of Health Ageing and Retirement in Europe, a 10-yr population-based cohort study with repeated measurements in five waves, every 2 yr between 2004 and 2013. Self-reported physical inactivity (waves 1, 2, 4, and 5), household income (waves 1, 2, 4, and 5), educational attainment (wave of the first measurement occasion), and early-life socioeconomic circumstance (wave 3) were collected in 22,846 individuals 50 to 95 yr of age.

RESULTS

Risk of physical inactivity was increased for women with the most disadvantaged early-life socioeconomic circumstances (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.20-1.86). With aging, the risk of physical inactivity increased for both sexes and was strongest for those with the most disadvantaged early-life socioeconomic circumstances (OR, 1.04 (95% CI, 1.02-1.06) for women; OR, 1.02 (95% CI, 1.00-1.05) for men), with the former effect being more robust than the latter one. The association between early-life socioeconomic circumstances and physical inactivity was mediated by adult-life socioeconomic circumstances, with education being the strongest mediator.

CONCLUSIONS

Early-life socioeconomic circumstances predicted high levels of physical inactivity at older ages, but this effect was mediated by socioeconomic indicators in adult life. This finding has implications for public health policies, which should continue to promote education to reduce physical inactivity in people at older ages and to ensure optimal healthy aging trajectories, especially among women with disadvantaged early-life socioeconomic circumstances.

The influence of lifecourse financial strains on the later-life health of the Japanese as assessed by four models based on different health indicators

In this study, four models used for assessing the influence of lifecourse financial strains on later-life health (the latent period effects, pathway, social mobility and accumulative effects models) were tested in the context of Japan by using different types of health indicators: comorbidity, disabled activities of daily living, disabled cognitive function, self-rated health and depressive symptoms. We hypothesised that suitable models for describing the influence of financial strain would differ according to the type of health indicator used. Participants aged 60–92 years (N = 2,500) were obtained in 2012 by using a two-stage stratified random sampling method. The final number of participants in the sample was 1,324. The results indicate that three models – pathway, accumulative effects and social mobility – describe the influence of a person's lifecourse financial strain on comorbidity, cognitive function, self-rated health and depressive symptoms. In turn, the latent period effects model explains the influence of lifecourse financial strain on comorbidity. However, only the pathway model described the influence of lifecourse financial strain on activities of daily living. These results suggest that disadvantages in lifecourse socio-economic status influence the decline of health in elderly Japanese people, similar to people in Western countries. However, the finding that suitable models for describing the influence of socio-economic status on health will differ according to the type of health indicator is an original contribution of this study.

Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies

Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.

Association between childhood socioeconomic status and fruit and vegetable intake among older Japanese: The JAGES 2010 study

Fruit and vegetable intake (FVI) contributes to the prevention of non-communicable diseases. Although food preference is considered to be determined early in life, few studies have investigated the association between childhood socioeconomic status (SES) and FVI in older age. Because a school lunch program was initiated in Japan after World War II, we were able in this study to examine this association in an older Japanese population. We used data from a population of physically and cognitively independent adults aged 65years or older who were living independently in the community and were recruited from 27 municipalities in the Japan Gerontological Evaluation Study 2010 project (August 2010-January 2012). Three categories of childhood SES (low, middle, and high) and current FVI were evaluated via a self-reported questionnaire. Poisson regression was used to investigate the association between childhood SES and FVI in 19,920 individuals. After adjustment for age and sex, older people with low childhood SES were 1.36 times more likely (95% CI 1.23-1.52) to have poor FVI than those with high childhood SES. In the fully adjusted model, the significant association disappeared. Further age-stratified analysis revealed a positive association between childhood SES and FVI among people aged 70-76years who were partially exposed to the school lunch program, but not among people aged 65-69years old who were fully exposed to the program. In conclusion, social policy such as school lunches targeting children with low SES could help improve FVI in old age.

The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality

Objective

To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease.

Methods

Norwegian health surveys (1974–2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into ‘low’, ‘medium’ and ‘high’ risk, and smoking to ‘daily smoking’ and ‘not daily smoking’.

Results

Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern.

Conclusion

Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample.

[Lifetime socioeconomic status and health-related risk behaviors: the ELSA-Brazil study]

Our objective was to investigate the association between lifetime socioeconomic status and intra-generational social mobility and low consumption of fruits and vegetables, leisure-time physical inactivity, and smoking among 13,216 men and women participating in the baseline of the ELSA-Brazil study (2008-2010). Socioeconomic status in childhood, adolescence, and adulthood was measured by maternal schooling, socio-occupational class of the first occupation, and socio-occupational class of the current occupation, respectively. Social disadvantages in adulthood were consistently associated with higher prevalence of the three behaviors analyzed in men and women. However, socioeconomic status in youth and childhood was less consistently associated with the behaviors. For example, while low maternal schooling reduced the odds of past smoking (women) and current smoking (men and women), it was associated with higher odds of leisure-time physical inactivity in women. Meanwhile, low socioeconomic status in youth increased the odds of past smoking (men and women) and current smoking (women). Analysis of social trajectories lent additional support to the relevance of disadvantages in adulthood for risk behaviors, since only individuals that rose to the high socio-occupational class did not show higher odds of these behaviors when compared to participants that had always belonged to the high socio-occupational class. Our findings indicate that socioeconomic disadvantages in adulthood appear to be more relevant for risk behaviors than disadvantages in childhood and adolescence.

Socio-economic life course and obesity among adults in Florianopolis, southern Brazil

OBJECTIVE

To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults.

METHODS

A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22-63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex.

RESULTS

Mean BMI and WC were about 2kg/m² (95% CI: -3.3 to -0.7) and 6cm (95% CI: -9.7 to -2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men.

CONCLUSION

Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people

BACKGROUND AND AIM

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Intergenerational social mobility and leisure-time physical activity in adulthood: a systematic review

Aim

To systematically review the association between intergenerational social mobility and leisure-time physical activity (LTPA) in adulthood, in order to assess all published evidence relating to the hypothesis that adults socially mobile between childhood and adulthood will have different levels of LTPA than those in the same socioeconomic group across life.

Methods

A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified by searching databases (MEDLINE, Embase, PsycINFO) and reference lists. Eligible studies examined associations between any indicator of social mobility, based on at least one measure of parental socioeconomic position (SEP) and one measure of own adult SEP, and LTPA in adulthood.

Results

13 studies comprising a total of 44 000 participants from the UK, Finland, Sweden, Australia, USA and Brazil were included. Participants were aged 16–70 years and were from population-based surveys, occupational cohorts and primary care registries. Most studies (n=9) used occupational class measures to identify social mobility; education (n=4) and income (n=1) were also used. There was consistent evidence in nine of the 13 studies that stable high socioeconomic groups tended to report the highest levels of participation in LTPA and stable low socioeconomic groups the lowest. Upward and downwardly mobile groups participated in LTPA at levels between these stable groups.

Conclusions

Cumulative exposure to higher SEP in childhood and adulthood was associated with higher LTPA in adulthood. Thus, a potential outcome of policies and interventions which aim to minimise exposure to socioeconomic adversity may be increased LTPA among adults.

Trial registration number

CRD42016036538.

Community level predictors of physical activity among women in the preconception period

Although physical activity is a key behavior targeted during the preconception period given its significant impact on pregnancy/birth outcomes and psychological well-being, few women meet national guidelines. While intrapersonal factors influencing physical activity among this population have been studied, community factors remain unexplored. The objective of this study was to examine community level predictors of physical activity among preconception women. Data from Add Health were limited to women (Wave III; age 18-28; n = 7,596) and excluded respondents who were pregnant, physically disabled, and missing data. The outcome variable was ≥5 instances of moderate-vigorous physical activity (MVPA) in 1 week. Community predictor variables included neighborhood-level structural and social determinants (e.g., socio-demographic composition; landscape diversity; urbanization; access to resources; crime; vehicle availability). Multilevel logistic regression modeling was used to estimate the odds of engaging in ≥5 instances of MVPA. Few women (26 %) reported ≥5 instances of MVPA in 1 week. Adjusted multilevel analysis revealed women in the preconception period were more likely to report high MVPA when living in communities with larger population densities (OR 1.34, 95 % CI 1.02-1.77) and median household income greater than $50,000 (OR 1.33, 95 % CI 1.06-1.66). Additionally, a significant inverse trend was found between high MVPA and proportion of the community without a high school diploma. Findings suggest that neighborhood composition may have an impact on preconception physical activity status. Implications include increased efforts targeting community conditions for facilitating physical activity; ultimately, improving health among women and subsequent offspring.

Early childhood social disadvantage is associated with poor health behaviours in adulthood

BACKGROUND

Individual health behaviours are considered important risk factors for cardiometabolic diseases. These behaviours may be socially patterned by early exposure to social disadvantage, but few studies have prospectively tested this hypothesis empirically.

AIM

This study investigated whether childhood social disadvantage was associated with likelihood of engaging in less healthy behaviours 40 years later.

SUBJECTS AND METHODS

Prospective data were analysed from the New England Family Study, a 2005-2007 adult follow-up of a cohort initiated in 1959-1966 (n = 565). Childhood social environment (age 7 years) was assessed using a cumulative index of socioeconomic and family stability factors. Logistic regression models evaluated associations between social disadvantage and each health-related behaviour and obesity in adulthood.

RESULTS

Relative to low disadvantage, higher disadvantage was associated with 3.6-fold greater odds of smoking (95% CI = 1.9-7.0), 4.8-fold greater odds (in women only) of excess alcohol consumption (95% CI = 1.6-14.2) and 2.7-fold greater odds of obesity (95% CI = 1.3-5.5), but was not associated with unhealthy diet or physical inactivity.

CONCLUSION

These findings suggest childhood social disadvantage may contribute to adult cardiometabolic disease by predisposing children to adopt certain unhealthy behaviours. If replicated, such findings may support intervention strategies that target social environmental factors and behavioural pathways that are established early in life.

Childhood socioeconomic position and adult leisure-time physical activity: a systematic review

Regular leisure-time physical activity (LTPA) benefits health and is thought to be less prevalent in lower socioeconomic groups. Evidence suggests that childhood socioeconomic circumstances can impact on adult health and behaviour however, it is unclear if this includes an influence on adult LTPA. This review tested the hypothesis that a lower childhood socioeconomic position (SEP) is associated with less frequent LTPA during adulthood. Studies were located through a systematic search of MEDLINE, Embase, PsycINFO, CINAHL and SPORTDiscus and by searching reference lists. Eligible studies were English-language publications testing the association between any indicator of childhood SEP and an LTPA outcome measured during adulthood. Forty-five papers from 36 studies, most of which were European, were included. In most samples, childhood SEP and LTPA were self-reported in midlife. Twenty-two studies found evidence to support the review's hypothesis and thirteen studies found no association. Accounting for own adult SEP partly attenuated associations. There was more evidence of an association in British compared with Scandinavian cohorts and in women compared with men. Results did not vary by childhood SEP indicator or age at assessment of LTPA. This review found evidence of an association between less advantaged childhood SEP and less frequent LTPA during adulthood. Understanding how associations vary by gender and place could provide insights into underlying pathways.

Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data

Socio-economic differences in diet are a potential contributor to health inequalities. The present study provides an up-to-date picture of socio-economic differences in diet in the UK, focusing on the consumption of three food groups and two nutrients of public health concern: fruit and vegetables; red and processed meat; oily fish; saturated fats; non-milk extrinsic sugars (NMES). We analysed data for 1491 adults (age ≥ 19 years) from the National Diet and Nutrition Survey 2008-2011. Socio-economic indicators were household income, occupational social class and highest educational qualification. Covariate-adjusted estimates for intakes of fruit and vegetables, red and processed meat, and both nutrients were estimated using general linear models. Covariate-adjusted OR for oily fish consumption were derived with logistic regression models. We observed consistent socio-economic gradients in the consumption of the three food groups as estimated by all the three indicators. Contrasting highest and lowest levels of each socio-economic indicator, we observed significant differences in intakes for the three food groups and NMES. Depending on the socio-economic indicator, highest socio-economic groups consumed up to 128 g/d more fruit and vegetables, 26 g/d less red and processed meat, and 2·6% points less NMES (P< 0·05 for all). Relative to lowest socio-economic groups, highest socio-economic groups were 2·4 to 4·0 times more likely to eat oily fish. No significant patterns in saturated fat consumption were apparent. In conclusion, socio-economic differences were identified in the consumption of food groups and one nutrient of public health importance. Aligning dietary intakes with public health guidance may require interventions specifically designed to reduce health inequalities.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Physical activity in daily life is associated with lower adiposity values than doing weekly sports in Lc65+ cohort at baseline

Background

Overweight and obesity prevalence is the highest at age 65–75 years in Lausanne (compared with younger classes). We aimed to describe 1) eating habits, daily physical activity (PA), and sports frequency in community-dwelling adults aged 65–70, 2) the links of these behaviors with socio-economic factors, and 3) with adiposity.

Methods

Cross-sectional analysis of Lc65+ cohort at baseline, including 1260 adults from the general population of Lausanne aged 65–70 years. Eating habits (8 items from MNA) and PA (sports frequency and daily PA: walking and using stairs) were assessed by questionnaires. Body mass index (BMI), supra-iliac (SISF), triceps skin-folds (TSF), waist circumference (WC), and WHR were measured.

Results

Prevalence of overweight (BMI 25.0-29.9 kg/m²), obesity (BMI ≥30.0 kg/m²), and abdominal obesity was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women.

Intake of fruits or vegetables (FV) ≥ twice/day was negatively associated with male sex (prevalence 81% versus 90%, chi-square P < 0.001). The proportion avoiding stairs in daily life was higher among women (25%) than among men (20%, chi-square P = 0.003).

In multivariate analyses among both sexes, eating FV, using stairs in daily life (“stairs”), and doing sports ≥ once/week were significantly negatively associated with financial difficulties (stairs: OR = 0.54, 95% CI = 0.40-0.72) and positively with educational level (stairs: OR = 1.68, 95% CI = 1.17-2.43 for high school).

For all five log-transformed adiposity indicators in women, and for all indicators except SISF and TSF in men, a gradual decrease in adiposity was observed from category “no stairs, sports < once/week” (reference), to “no stairs, sports ≥ once/week”, to “stairs, sports < once/week”, and “stairs, sports ≥ once/week” (for example: WC in men, respectively: ß = −0.03, 95% CI = −0.07-0.02; ß = −0.06, 95% CI = −0.09- -0.03; ß = −0.10, 95% CI = −0.12- -0.07).

Conclusions

In this population with high overweight and obesity prevalence, eating FV and PA were strongly negatively associated with financial difficulties and positively with education. Using stairs in daily life was more strongly negatively associated with adiposity than doing sports ≥ once/week.

Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies

Background

Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review.

Methods And Findings

We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model.

Conclusions

Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.

The importance of father's and own education for self-assessed health across Europe: an East-West divide?

How are one's own education, father's education, and especially the combination of the two, related to self-assessed health across European societies? In this study, we test hypotheses about differences in self-assessed health between 16 post-socialist countries in Central and Eastern Europe and 17 Western European countries. We find substantial cross-national variation in the (relative) importance of own and father's education for self-assessed health. Over 65 per cent of this cross-national variation is accounted for by the East-West divide. This simple dichotomy explains cross-national differences better than gross domestic product or income inequality. An individual's father's education is more important, both in absolute and relative terms, for self-assessed heath in Eastern Europe than in Western Europe. Intergenerational mobility moderates the relative effects of one's own and one's father's education. In Eastern Europe the relative importance of one's father's education is greater than it is in Western Europe--particularly for those who are downwardly mobile and have a father with tertiary education. The results are sometimes contradictory to initial expectations; the theoretical implications are discussed.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review

Background

This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.

Methods

Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18–65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.

Results

A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.

Conclusions

The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.

Is intergenerational social mobility related to the type and amount of physical activity in mid-adulthood? Results from the 1946 British birth cohort study

PURPOSE

Greater levels of leisure-time or moderate-vigorous physical activity have consistently been found in those with greater socioeconomic position (SEP). Less is known about the effects of intergenerational social mobility.

METHODS

We examined the influence of SEP and social mobility on mid-adulthood physical activity in the Medical Research Council National Survey of Health and Development. Two sub-domains of SEP were used: occupational class and educational attainment. Latent classes for walking, cycling, and leisure-time physical activity (LTPA) were used, plus sedentary behavior at age 36. Associations between types of physical activity and SEP were examined with the use of logistic or multinomial logistic regression.

RESULTS

Being a manual worker oneself or having a father who was a manual worker was, relative to nonmanual work, associated with lower levels of sedentary behavior and greater walking activity, but also with lower LTPA. Compared with those who remained in a manual occupational class, upward occupational mobility was associated with more sedentary behavior, less walking, and increased LTPA. Associations with downward mobility were in the opposite directions. Similar results were obtained for educational attainment.

CONCLUSIONS

This study found clear evidence of social differences in physical activity. Persistently high SEP and upward social mobility were associated with greater levels of LTPA but also increased sedentary behavior and less walking.

The differential association between education and infant mortality by nativity status of Chinese American mothers: a life-course perspective

OBJECTIVES

Integrating evidence from demography and epidemiology, we investigated whether the association between maternal achieved status (education) and infant mortality differed by maternal place of origin (nativity) over the life course of Chinese Americans.

METHODS

We conducted a population-based cohort study of singleton live births to US-resident Chinese American mothers using National Center for Health Statistics 1995 to 2000 linked live birth and infant death cohort files. We categorized mothers by nativity (US born [n = 15 040] or foreign born [n = 150 620]) and education (≥ 16 years, 13-15 years, or ≤ 12 years), forming 6 life-course trajectories. We performed Cox proportional hazards regressions of infant mortality.

RESULTS

We found significant nativity-by-education interaction via stratified analyses and testing interaction terms (P < .03) and substantial differentials in infant mortality across divergent maternal life-course trajectories. Low education was more detrimental for the US born, with the highest risk among US-born mothers with 12 years or less of education (adjusted hazard ratio = 2.39; 95% confidence interval = 1.33, 4.27).

CONCLUSIONS

Maternal nativity and education synergistically affect infant mortality among Chinese Americans, suggesting the importance of searching for potential mechanisms over the maternal life course and targeting identified high-risk groups and potential downward mobility.

Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

BACKGROUND

Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.

METHODS

Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.

RESULTS

Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.

CONCLUSIONS

This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.

Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study

BACKGROUND

There is emerging evidence for a beneficial effect of meat consumption on the musculoskeletal system. However, whether it affects the risk of knee and hip osteoarthritis is unknown. We performed a prospective cohort study to examine the relationship between meat consumption and risk of primary hip and knee replacement for osteoarthritis.

METHODS

Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry.

RESULTS

There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement.

CONCLUSION

A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted.

The relative importance of socioeconomic indicators in explaining differences in BMI and waist:hip ratio, and the mediating effect of work control, dietary patterns and physical activity

Socioeconomic differences in overweight are well documented, but most studies have only used one or two indicators of socioeconomic position (SEP). The aim of the present study was to explore the relative importance of indicators of SEP (occupation, education and income) in explaining variation in BMI and waist:hip ratio (WHR), and the mediating effect of work control and lifestyle factors (dietary patterns, smoking and physical activity). The Oslo Health Study, a cross-sectional study, was carried out in 2000-1, Oslo, Norway. Our sample included 9235 adult working Oslo citizens, who attended a health examination and filled in two complementary FFQ with < 20% missing responses to food items. Four dietary patterns were identified through factor analysis, and were named 'modern', 'Western', 'traditional' and 'sweet'. In multivariate models, BMI and WHR were inversely associated with education (P < 0.001/P < 0.001) and occupation (P = 0.002/P < 0.001), whereas there were no significant associations with income or the work control. The 'modern' (P < 0.001) and the 'sweet' (P < 0.001) dietary patterns and physical activity level (P < 0.001) were inversely associated, while the 'Western' dietary pattern (P < 0.001) was positively associated with both BMI and WHR. These lifestyle factors could not fully explain the socioeconomic differences in BMI or WHR. However, together with socioeconomic factors, they explained more of the variation in WHR among men (21%) than among women (7%).

Determinants of smoking initiation among women in five European countries: a cross-sectional survey

BACKGROUND

The rate of smoking and lung cancer among women is rising in Europe. The primary aim of this study was to determine why women begin smoking in five different European countries at different stages of the tobacco epidemic and to determine if smoking is associated with certain characteristics and/or beliefs about smoking.

METHODS

A cross-sectional telephone survey on knowledge and beliefs about tobacco was conducted as part of the Women in Europe Against Lung Cancer and Smoking (WELAS) Project. A total of 5,000 adult women from France, Ireland, Italy, Czech Republic, and Sweden were interviewed, with 1,000 from each participating country. All participants were asked questions about demographics, knowledge and beliefs about smoking, and their tobacco use background. Current and former smokers also were asked questions about smoking initiation. Basic statistics on the cross-sectional data was reported with chi-squared and ANOVA p-values. Logistic regression was used to analyze ever versus never smokers. Linear regression analyses were used to analyze age of smoking initiation.

RESULTS

Being older, being divorced, having friends/family who smoke, and having parents who smoke were all significantly associated with ever smoking, though the strength of the associations varied by country. The most frequently reported reason for initiation smoking was friend smoking, with 62.3% of ever smokers reporting friends as one of the reasons why they began smoking. Mean age of smoking initiation was 18.2 years and over 80% of participants started smoking by the age of 20. The highest levels of young initiators were in Sweden with 29.3% of women initiating smoking at age 14-15 and 12.0% initiating smoking younger than age 14. The lowest level of young initiators was in the Czech Republic with 13.7% of women initiating smoking at age 14-15 and 1.4% of women initiating smoking younger than age 14. Women who started smoking because their friends smoked or to look 'cool' were more likely to start smoking at a younger age. Women who started smoking to manage stress or to feel less depressed were more likely to start smoking at an older age.

CONCLUSIONS

In all five participating countries, friends were the primary factor influencing ever smoking, especially among younger women. The majority of participants began smoking in adolescence and the average reported age of smoking initiation was youngest in Sweden and oldest in the Czech Republic.