Socioeconomic Status Areas Research Articles

Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study.

Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.

Association of neighbourhood socioeconomic trajectories with preterm birth and small-for-gestational-age in the Netherlands: a nationwide population-based study.

SUMMARYBackgroundAdverse birth outcomes have serious health consequences, not only during infancy but throughout the entire life course. Most evidence linking neighbourhood socioeconomic status (SES) to birth outcomes is based on cross-sectional SES measures, which do not reflect neighbourhoods’ dynamic nature. We investigated the association between neighbourhood SES trajectories and adverse birth outcomes, i.e. preterm birth and being small-for-gestational-age (SGA), for births occurring in the Netherlands between 2003 and 2017.MethodsWe linked individual-level data from the Dutch perinatal registry to the Netherlands Institute for Social Research neighbourhood SES scores. Based on changes in their SES across four-year periods, neighbourhoods were categorised into seven trajectories. To investigate the association between neighbourhood SES trajectories and birth outcomes we used adjusted multilevel logistic regression models.FindingsData on 2 334 036 singleton births were available for analysis. Women living in stable low-SES neighbourhoods had higher odds of preterm birth (OR[95%CI]= 1·12[1·07-1·17]) and SGA (OR[95%CI]= 1·19[1·15-1·23]), compared to those in high SES areas. Higher odds of preterm birth (OR[95%CI]= 1·12[1·05-1·20]) and SGA (OR[95%CI]=1·12[1·06-1·18]) were also observed for those living in areas declining to low SES. Women living in a neighbourhood where SES improved from low to medium showed higher odds of preterm birth (OR[95%CI]= 1·09[1·02-1·18]), but not of SGA (OR[95%CI]= 1·04[0.98-1·10]). The odds of preterm or SGA birth in other areas were comparable to those seen in high SES areas.InterpretationIn the Netherlands, disadvantaged neighbourhood SES trajectories were associated with higher odds of adverse birth outcomes. Longitudinal neighbourhood SES measures should also be taken into account when selecting a target population for public health interventions.FundingErasmus Initiative Smarter Choices for Better Health.

Long-Term Air Pollution Exposures and Major Depression in Older U.S. Adults: The Health and Retirement Study

BACKGROUND AND AIM: Major depression is a leading cause of morbidity worldwide, especially during later life. Since heritability is modest (40-50%), there is interest in understanding risk from environmental factors like air pollution. However, research examining this issue is scarce, and often does not use clinical diagnostic criteria. Here, we aimed to quantify associations of air pollution with prevalent major depression in a cohort that deploys diagnostic assessments. METHODS: We conducted a repeated measure analysis of 2008-2016 interviews from the Health and Retirement Study, a nationally representative cohort of older adults in the United States. Major depression status was determined biennially using the Composite International Diagnostic Interview Short Form, with a cutoff of 5. We estimated 1-year average PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences using fine-scale spatiotemporal models. To estimate prevalence ratios, we fit generalized linear models that accounted for sample weights and clustering by participant. All models included demographic characteristics, individual and neighborhood socioeconomic status, calendar time, and geographic area. RESULTS:Among 25,305 participants with complete data, there was a mean age of 63 years, 53% were female, and most were Non-Hispanic White (73%), with some Black (11%) and Hispanic participants. Eight percent reported major depression. In fully adjusted models, we observed that higher PM2.5 and NO2 concentrations were associated with a greater prevalence of major depression (PR: 1.13 per 3 µg/m³ PM2.5, 95% CI: 1.03, 1.23; PR: 1.23 per 5 ppb NO2, 95% CI: 1.06, 1.20). Only the association with NO2 was robust to adjustment for other pollutants, however, and no associations were observed with PM10-2.5 or O3. CONCLUSIONS:Overall, we observed a robust association of major depression prevalence with long-term exposure to NO2 but not with other air pollutants. This suggests that traffic may be a modifiable risk factor that could be targeted to reduce socioeconomic disparities in mental health. KEYWORDS: Traffic-Related Air Pollution, Major Depression, Psychiatric Epidemiology, Health Disparities

Individual and contextual socioeconomic status as effect modifier in the air pollution-birth outcome association

BackgroundSeveral studies have examined whether air pollution is associated with adverse births outcomes, but it is not clear if socioeconomic status (SES) modifies this relationship. ObjectivesWe investigated if maternal education and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter <10 μm (PM10) on preterm births (PTB; gestational age <37 weeks) and term low birth weight (TLBW; weight < 2500 g on term deliveries). MethodsAnalyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. The final sample included 979,306 births for PTB analysis and 888,133 for TLBW analysis. Exposure to PM10, NO2 and O3 were based on date of birth and estimated for the entire gestation and for each trimester. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both adverse birth outcomes and whether it was modified by individual and area-level SES. ResultsIn fully adjusted models, over the entire pregnancy, a 10 μg/m3 increase in O3 and PM10 was associated with increased chance of PTB (odds ratio; OR = 1.14 CI 1.13, 1.16 and 1.08 CI = 1.02, 1.15 respectively) and PM10 with TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by maternal educational and area-level SES for both outcomes. Mothers of lower education had an additional chance of PTB and TLBW due to PM10 exposure (OR = 1.04 CI 1.04, 1.05 and 1.10 CI 1.08, 1.14 respectively), while mothers living in low SES areas have an additional chance for TLBW (OR = 1.05 CI 1.03, 1.06). Similar modification effects were found for O3 exposure. Trimester specific associations were weaker but followed a similar pattern. ConclusionSocioeconomic status modifies the effect of air pollution on adverse birth outcomes. Results indicate that mothers with lower SES may be more susceptible to air pollution effects.

Evaluating evidence-based interventions in low socio-economic-status populations.

Socio-economic-status (SES) has rarely been reported or investigated in eating disorders (EDs) research. This Research Forum considers, from various perspectives, how SES may impact on evaluating evidence-based treatments for EDs. We first reviewed previous literature that informs how SES impacts prevalence of EDs, help-seeking, and treatment outcome. We then present findings from a case series effectiveness study of an early intervention program in low SES areas for EDs and discuss implications about the impact of SES on the effectiveness of evidence-based interventions. Finally, we examine barriers to conducting rigorous evaluations in this population and discuss directions for future treatment outcome research. Evidence suggests a higher level of disordered eating but less help seeking in lower SES groups. In our case series, 96 participants started treatment and completed a mean of 13.85 sessions, 84 (87.5%) completed a mean of 6.40 sessional measures on ED cognitions and behaviors, but only 31% completed more extensive pre-treatment and post-treatment measures. The completer effect size decrease for the global Eating Disorder Examination-Questionnaire score was 2.05 (95% CI: 1.43, 2.68) commensurate with other effectiveness studies in mixed SES groups. The high rates of missing data related to more extensive assessment present a barrier to evaluating evidence-based treatments in this population. Evidence from the present study revealed individuals from low SES can achieve similar treatment outcomes to other populations when receiving evidence-based ED treatment. Future studies should investigate a range of approaches to maximizing data collection, including use of shorter sessional measures.

Enhancing community weight loss groups in a low socioeconomic status area: Application of the COM-B model and Behaviour Change Wheel.

Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. The Behaviour Change Wheel approach was followed to design an add-on intervention to an existing local authority-run weight loss group, informed by mixed-methods research and stakeholder engagement. The COM-B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal-setting behaviours. The resulting SMART-C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review. This paper details the development of the theory- and evidence-informed SMART-C intervention. This is the first report of the Behaviour Change Wheel being used to design an add-on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders.

“Shining a Light” on Mature-Aged Students In, and From, Regional and Remote Australia

This article shines a light on a little-known cohort of higher education participants, mature-aged students in, and from, regional and remote Australia – the focus of a National Centre for Student Equity in Higher Education mixed-methods study. Notable patterns were found in the quantitative data; for instance, compared to their metropolitan counterparts, higher proportions of regional and remote students were older, female, from low socio-economic status areas, Aboriginal and Torres Strait Islander, and studied online and/or part-time. The presentation of four vignettes from the interviews uncovers the stories behind the numbers, revealing students’ diverse and complex circumstances; two of the students shared experiences of facing systemic obstacles, while the other two described receiving invaluable institutional support. The obstacles can be attributed to systems designed for “ideal”, “implied” and “traditional” students, and entrenched attitudes that privilege some “types” of students over others and limit the aim of full participation for all students.

Association of Field Position and Career Length With Risk of Neurodegenerative Disease in Male Former Professional Soccer Players

Neurodegenerative disease mortality is higher among former professional soccer players than general population controls. However, the factors contributing to increased neurodegenerative disease mortality in this population remain uncertain. To investigate the association of field position, professional career length, and playing era with risk of neurodegenerative disease among male former professional soccer players. This cohort study used population-based health record linkage in Scotland to evaluate risk among 7676 male former professional soccer players born between January 1, 1900, and January 1, 1977, and 23 028 general population control individuals matched by year of birth, sex, and area socioeconomic status providing 1 812 722 person-years of follow-up. Scottish Morbidity Record and death certification data were available from January 1, 1981, to December 31, 2016, and prescribing data were available from January 1, 2009, to December 31, 2016. Database interrogation was performed on December 10, 2018, and data were analyzed between April 2020 and May 2021. Participation in men's soccer at a professional level. Outcomes were obtained by individual-level record linkage to national electronic records of mental health and general hospital inpatient and day-case admissions as well as prescribing information and death certification. Risk of neurodegenerative disease was evaluated between former professional soccer players and matched general population control individuals. In this cohort study of 30 704 male individuals, 386 of 7676 former soccer players (5.0%) and 366 of 23 028 matched population control individuals (1.6%) were identified with a neurodegenerative disease diagnosis (hazard ratio [HR], 3.66; 95% CI, 2.88-4.65; P < .001). Compared with the risk among general population control individuals, risk of neurodegenerative disease was highest for defenders (HR, 4.98; 95% CI, 3.18-7.79; P < .001) and lowest for goalkeepers (HR, 1.83; 95% CI, 0.93-3.60; P = .08). Regarding career length, risk was highest among former soccer players with professional career lengths longer than 15 years (HR, 5.20; 95% CI, 3.17-8.51; P < .001). Regarding playing era, risk remained similar for all players born between 1910 and 1969. The differences in risk of neurodegenerative disease observed in this cohort study imply increased risk with exposure to factors more often associated with nongoalkeeper positions, with no evidence this association has changed over the era studied. While investigations to confirm specific factors contributing to increased risk of neurodegenerative disease among professional soccer players are required, strategies directed toward reducing head impact exposure may be advisable in the meantime.

Distribution of Australian dental practices in relation to the ageing population.

The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia. The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need. Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology. There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities. There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

BackgroundYoung drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and...

Arboviral diseases and poverty in Alabama, 2007-2017.

Mosquito-borne viruses cause diseases of great public health concern. Arboviral disease case distributions have complex relationships with socioeconomic and environmental factors. We combined information about socio-economic (population, and poverty rate) and environmental (precipitation, and land use) characteristics with reported human cases of arboviral disease in the counties of Alabama, USA, from 2007–2017. We used county level data on West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus, Eastern equine encephalitis virus, and Saint Louis encephalitis virus to provide a detailed description of their spatio-temporal pattern. We found a significant spatial convergence between incidence of WNV and poverty rate clustered in the southern part of Alabama. DENV, CHIKV and ZIKV cases showed a different spatial pattern, being mostly located in the northern part, in areas of high socioeconomic status. The results of our study establish that poverty-driven inequities in arboviral risk exist in the southern USA, and should be taken into account when planning prevention and intervention strategies.

Prevalence and Audiological Findings of Functional Hearing Loss

Purpose The purpose of the present study was to estimate the period prevalence of functional hearing loss and to describe the audiological findings of individuals having FHL. Methods Retrospective analysis of records of 1209 individuals who visited the institute for routine audiological evaluation was carried out. Among them, there were 115 individuals with FHL who were identified based on predetermined criteria. Information such as age, gender, socioeconomic status, and geographical area of the individuals with FHL was obtained retrospectively. In addition, findings of behavioral and objective audiological tests in these individuals were analyzed. Results to prevalence of FHL during the period of the study was found to be 9.5%. Demographical analysis suggests that 76 (66.1%) out of 115 individuals were males and 39 (33.9%) individuals were female. Analysis of geographical and socioeconomical data revealed a higher number of individuals were from rural areas (58.3%) and belong to a lower socioeconomic status (68.7%). The agreement between pure tone average and auditory brainstem response was found to be highly sensitive (93%) in identifying FHL. In contrast, the agreement between PTA with other tests such as speech reception thresholds (60%), Acoustic reflex threshold (62%), and otoacoustic emissions (45%) was found to be less sensitive. Conclusion A notable period prevalence suggests that practicing audiologists should be cautious while testing individuals with hearing impairments, especially adults. It is important for audiologists to carefully observe the individuals and also to perform a detailed audiological test battery using behavioral and objective measures.

Ambient temperature and hospitalizations for acute kidney injury in Queensland, Australia, 1995–2016

To examine the associations between ambient temperature and hospitalizations for acute kidney injury (AKI) in Queensland, Australia, 1995–2016. Data were collected on a total of 34 379 hospitalizations for AKI from Queensland between 1 January 1995 and 31 December 2016. Meteorological data were downloaded from the Queensland Government’s Department of Environment and Science. We assessed the temperature-AKI relationship using a time-stratified case-crossover design fitted with conditional quasi-Poisson regression model and time-varying distributed lag non-linear model. Stratified analyses were performed by age, sex, climate zone and socioeconomic group. Both cold and hot temperatures were associated with hospitalizations for AKI. There were stronger temperature-AKI associations among women than men. Cold effects were only positive in the ⩾70 years age group. Hot effects were stronger in the ⩽59 years age group than in the >60 years age group. In different climate zone areas, cold effects decreased with increasing local mean temperatures, while hot effects increased. In different socio-economic status groups, hot effects were stronger in the poor areas than the affluent areas. From 1995 to 2016, the magnitude of associations between cold temperature and hospitalizations for AKI decreased, while the hot effect increased. The associations between hot temperature and hospitalizations for AKI become stronger, while the magnitude of cold effect decreased from 1995 to 2016. This trend may accelerate over the coming decades, which warrants further research. More attention is needed toward susceptible population including women, people ⩾70 years, and the people living in hot climate zones and in low socioeconomic status areas.

The effect of a cluster-randomized controlled trial on lifestyle behaviors among families at risk for developing type 2 diabetes across Europe: the Feel4Diabetes-study

BackgroundThis study investigated the effect of the Feel4Diabetes-intervention, a 2-year multilevel intervention, on energy balance-related behaviors among European families at risk for developing type 2 diabetes. Intervention effects on self-reported physical activity, sedentary behavior and eating behaviors were investigated across and within the participating countries: Belgium, Finland, Greece, Spain, Hungary and Bulgaria.MethodsFamilies were recruited through schools, located in low socio-economic status areas. In total, 4484 families at risk for developing type 2 diabetes were selected using the FINDRISC-questionnaire. Parents’ and children’s energy balance-related behaviors data were collected by questionnaires at three time points (baseline, mid- and post intervention). Families assigned to the intervention group were invited to participate in a 2-year school-, community-, and family-based intervention to promote a healthier lifestyle, including counseling sessions (first intervention year) and text messages (second intervention year). Families assigned to the control group received standard care, including medical check-up results and recommendations and tips regarding a healthy lifestyle. To assess the intervention-effects, Mixed Models were conducted using the R-Package “lmer “with R v3.2.ResultsSignificant intervention effects were found on a certain number of families’ lifestyle behaviors. Significant favorable intervention effects were detected on parents’ water consumption and consumption of fruit and vegetables, and on children’s consumption of sweets and moderate-to-vigorous physical activity. Analyses by country revealed significant favorable intervention effects on water consumption and on moderate-to-vigorous physical activity in Belgian parents and on fruit and vegetable consumption among Belgian children, on sweets consumption among Spanish parents and children, and on moderate-to-vigorous physical activity among Finnish children. Unfavorable intervention effects were found on the consumption of soft drinks and sugar-containing juices among Hungarian children and parents, while when examining the intervention effects for the overall population and per country, 10 from the 112 investigated outcome variables were improved in the intervention group compared to the control group (9%).ConclusionsThe Feel4Diabetes-intervention managed to improve a certain number of targeted lifestyle behaviors while the intervention was not effective on a large number of targeted lifestyle behaviors. The findings of the current study are encouraging, but further research is needed on how we can further improve effectiveness of lifestyle interventions to prevent type 2 diabetes in families at risk.Trial registrationThe Feel4Diabetes-study is registered with the clinical trials registry http://clinicaltrials.gov, ID: 643708.

Magnitude and spatial distribution of food and nutrition security during the COVID-19 pandemic in Tucumán (Argentina).

ObjectiveTo describe the magnitude and spatial distribution of household food and nutrition security (FNS) during the COVID‐19 pandemic in Tucumán (Argentina) and identify factors associated with food insecurity.MethodsDuring April and May 2020 a cross‐sectional quantitative study was performed. Data from 3915 households were analyzed. The study of FNS was performed with the Latin American and Caribbean Scale for Food Security. To identify associated factors, bivariate and multivariate logistic regression models were applied.ResultsHousehold food insecurity affected 55.9% of the sample (mild: 39.3%, moderate: 10.8%, severe: 5.8%). Analyzing the spatial distribution, the eastern area showed the highest food insecurity prevalence, followed by the south and west areas. Logistic regression analysis showed that household food insecurity varied according to household size, presence of children, socioeconomic status, and health area of residence.ConclusionsHousehold size, presence of children, socioeconomic status and public health area of residence were associated to household food insecurity. The perception of hunger was higher in larger households, in those with low and medium socioeconomic status and in households located in the southern area of the province.

Effects of deprivation and age on staging of breast, colon, rectum and prostate cancer in Umbria region, Italy: a multilevel approach.

Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes. Low socioeconomic status (SES) is related to advanced stages at diagnosis; inequalities could explain differences in outcomes by age. The influence of SES, age and residence area on staging was explored in the Umbrian population. 2001-2010 cases were geo-coded by census tract of residence. Stage distribution or Gleason score were analyzed by multilevel multinomial logistic regression with age and SES as the fixed effects and census tract as the random-effect. For breast and colorectal cancers, the screening age class was advantaged. For breast, age effect was modulated by deprivation and census tract. In the elderly, the richest were advantaged, the poorest disadvantaged; issues emerged for the young. For colon, age effect is modulated by census tract in early stages and deprivation in late stages. The elderly were disadvantaged; the young and the deprived had more stages IV. About rectum, age effect was modulated by deprivation in the late stages. The elderly were disadvantaged; the young and the deprived presented more stages IV. For prostate, age effect was modulated by deprivation and census tract. The intermediate age class was advantaged, the elderly disadvantaged. Age was not always the determinant of a delayed staging when SES was considered. For breast and colorectal cancers, issues of delayed diagnosis emerged in the young. If the care center was near the residence, the census tract modified the stage at diagnosis. These results are useful to reduce SES barriers by specific programs adapted to the age of the patient and area of residence.

External validation of a model to predict women most at risk of postpartum venous thromboembolism: Maternity clot risk

IntroductionVenous thromboembolism (VTE) is the leading cause of direct maternal mortality in high-income countries. We previously developed a risk prediction score for postpartum venous thromboembolism (VTE) in women without a previous VTE. In this paper, we provide further external validation and assess its performance across various groups of postpartum women from England. Materials and methodsCohort study using primary and secondary care data covering England. We used data from QResearch comprising women with pregnancies ending in live birth or stillbirth recoded in Hospital Episodes Statistics between 2004 and 2015. Outcome was VTE in the 6 weeks postpartum. Our predictor variables included sociodemographic and lifestyle characteristics, pre-existing comorbidities, and pregnancy and delivery characteristics. ResultsAmong 535,583 women with 700,185 deliveries, 549 VTE events were recorded (absolute risk of 7.8 VTE events per 10,000 deliveries). When we compared predicted probabilities of VTE for each woman from the original model with actual VTE events, we obtained a C-statistic of 0.67 (95% CI 0.65 to 0.70). However, our model slightly over-predicted VTE risk for the higher risk women (calibration slope = 0.84; 95% CI 0.74 to 0.94). Performance was similar across groups defined by calendar time, socioeconomic status, age group and geographical area. The score performed comparably with the existing algorithm used by the UK Royal College of Obstetrician and Gynaecologists. ConclusionsOur model enables flexibility in setting new treatment thresholds. Adopting it in clinical practice may help optimise use of low-molecular-weight heparin postpartum to maximise health gain by better targeting of high-risk groups.

Nutritional anaemia in children in post supplementation era: A cross sectional study

Background: Nutritional anemia is still the primary cause of anemia despite of various nutritional programmes in developing countries.&#x0D; Aims and Objective: The present study was planned to asses Iron, Folate, and Vitamin B12 deficiency anaemia in developing countries.&#x0D; Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in Agra in collaboration with Institute of Genomics and Integrative Biology, New Delhi. Admitted children of age 6 months to 14 years having signs and symptoms of anaemia were included in the study. Sample size calculated was 157. All the cases were subjected to CBC, GBP, serum iron, ferritin, folate and vitamin B12 level estimation.&#x0D; Results: Out of 672 children, 157 children with clinical feature of anaemia were enrolled in the study. Among these 157 children, 52.87% were male. Percent proportion of anaemia was highest among toddlers (27.39%) and lowest in adolescent (10.83%). The maximum cases were of urban area (65.6%) and middle socioeconomic status (47.13%). Most of the children were undernourished/underweight (60.4%). Mean iron level was significantly low in female children, children of rural areas, low socioeconomic status and malnutrition/underweight. Mixed iron, folate and B12 deficiency was found in 48.41%, 30.57% and 22.93% cases respectively. In 24.20% cases no deficiencies were found and were classified as anaemia due to some unspecified causes.&#x0D; Conclusion: Nutritional deficiency anaemia is contributing to a large proportion of anaemic patients. More intensified programmes are needed especially for female children, children of rural areas, low socioeconomic status and malnutrition/underweight.

A state-wide audit of unhealthy sponsorship within junior sporting clubs in Victoria, Australia.

To systematically audit the extent of unhealthy sponsorship within junior community sporting clubs and ascertain whether differences exist across geographical areas and sport types. Club sponsorship data were assessed to determine the extent of unhealthy food/beverage, alcohol and gambling sponsorship using a cross-sectional design. Differences across geographical areas were assessed using logistic regressions. A stratified random sampling procedure was used to select thirty communities across the state of Victoria, Australia. Within each community, local clubs across the top eight participating junior sports were selected for audit. Sponsorship data were collected from 191 club websites and Facebook pages in September-November 2019. Unhealthy sponsorships represented 8·9 % of all identified sponsorship arrangements. A quarter of all clubs accepted alcohol (25·6 %) and unhealthy food sponsors (25·9 %), and one-fifth of all clubs accepted high-risk food (unhealthy brands with large market share) (18·1 %) and gambling sponsors (20·4 %). Acceptance of unhealthy sponsorship differed across sport types with football, netball, cricket and soccer clubs having the greatest numbers. Compared with metro areas, a significantly greater proportion of sporting clubs in regional areas were affiliated with unhealthy food (32·7 % v. 19·6 %) and high-risk food sponsors (26·9 % v. 9·8 %). A higher proportion of clubs in low socio-economic status (SES), compared with the high SES areas, were affiliated with alcohol (33·9 % v. 16·5 %) and gambling sponsors (27·4 % v. 12·6 %). Victorian children participating in community junior sports are being exposed to marketing of unhealthy brands and products. Public health intervention is necessary to protect children from this exposure.

The relationship between residential proximity to outdoor play spaces and children's mental and behavioral health: The importance of neighborhood socio-economic characteristics

Urban outdoor play spaces are reported to improve children's health. However, there is little empirical evidence on the impact of outdoor play spaces on childhood mental and behavioral health. To fill this gap, we investigated the associations between residential proximity to outdoor play spaces and the prevalence of diagnosed mental and behavioral disorders. We explored whether these associations differ by individual and area-level socio-economic status (SES). This cross-sectional study included 151 110 children who were 0–12 years old in 2014 and were visited in public primary health care centers in Barcelona (Spain). Each child's demographic and mental and behavioral disorders information was extracted for 2005–2014, including diagnoses on disorders of psychological development together with other four types of mental and behavioral disorders. The pediatrician diagnosed mental and behavioral disorders we explored in this study were: mood/affective; neurotic, stress-related and somatoform; psychological development; behavioral and emotional; and overall mental and behavioral disorders. We assessed 300 m network buffer residential proximity to overall outdoor play spaces (i.e., the overall sum of play spaces of any type), outdoor green play spaces, and to a diversity of outdoor play spaces. We used robust Poisson regression models to investigate the association between proximity to outdoor play spaces indicators and each health outcome. We tested interaction terms for indicators of proximity to outdoor play spaces and individual and area SES. For measures with significant interaction terms, we conducted stratified models. We found residential proximity to outdoor play spaces to be protective of disorders of psychological development. Proximity to overall outdoor play spaces, proximity to outdoor green play spaces and proximity to a greater diversity of outdoor play spaces were associated with a 4% (95% CI: 1,7), 4% (95% CI: 1,7) and 5% (95% CI: 2,9) lower prevalence rates of disorders of psychological development respectively. Most of the associations were found to be in the same direction-although more pronounced-in low SES areas, but in the opposite direction for children living in high SES areas. No differences in these associations were found by individual SES. Residential proximity to outdoor play spaces is protective of children's mental and behavioral health living in low SES areas.