Family Socioeconomic Position Research Articles

Socioeconomic position, family context, and child cognitive development.

Socioeconomic position (SEP) may have different effects on cognitive development and family context could play a role in this association. This work aimed to analyse the role of socioeconomic positions, measured via various indicators collected longitudinally, in cognitive development at 7-11years of age, evaluating the role of family context as a potential mediator. The study sample included 394 and 382 children from the INMA Gipuzkoa and Valencia cohorts, respectively. SEP indicators were assessed during pregnancy (family social class, parental education, employment, and disposable income) and at 7 (Gipuzkoa) and 11 (Valencia) years of age (At Risk of Poverty or Social Exclusion (AROPE)). Family context and cognitive development were measured with the Haezi-Etxadi Family Assessment Scale 7-11 (HEFAS 7-11) and Raven's Coloured Progressive Matrices (Raven's CPM), respectively. Linear regression models were developed to assess the relationships between (a) SEP-family context, (b) SEP-cognitive development, and (c) family context-cognitive development, adjusting for a priori-selected confounders. Simple and multiple mediation analyses were performed to explore the role of family context in the SEP-cognitive development relationship. Lower SEP was related with a lower cognitive score, this association being particularly robust for family social class. SEP indicators were related to subscales of family context, in particular those regarding cognitive stimulation, parental stress, and parenting. A relationship was also found between these three subscales and child cognitive development, mediating the effect of family social class on child cognition by 5.2, 5.5, and 10.8%, respectively, and 12.0% jointly. Conclusion: Both family SEP and context contribute to a child's cognitive development. Equalising policies and positive parenting programmes could contribute to improving cognitive development in children. What is Known: • Parental social class, education, and employment status have been widely employed to measure socioeconomic position. What is New: • This work focuses on standard measurements of socioeconomic position but also other economic indicators such as the EHII and AROPE, and their effect on child cognitive development and family context. • Promotion of cognitive and linguistic development, parental stress and conflict, and parental profile fostering child development mediated the effect of family social class on cognitive development.

Impact of Socio-economic Status on Socio-emotional Development of Children Attending Different Early Childhood Care and Education (ECCE) Centers

The purpose of the 2018–20 study, which took place in the Karnataka state's Dharwad taluk, was to determine how children's social and emotional development was impacted by their socioeconomic status. The study's objectives were to evaluate the social and emotional development of children in both rural and urban locations, as well as to determine the impact of SES on these development factors. A total of 208 children aged between three and six years, comprising 104 from rural and 104 from urban areas, were chosen for the study. Children's social and emotional development was evaluated using the Transdiciplinary Play Based Assessment-2 instrument. The child's family's socioeconomic position was assessed using a Aggarwal Socio-economic status scale. A qualitative approach utilizing the naturalistic observation method was used to observe, analyze, and study the effects of play-based activities on social and emotional development. Naturalistic observations were produced by combining field notes from participant observation with video footage of kids playing in an unstructured manner. The findings showed that most kids in both urban and rural anganwadis were in the social and emotional development watch and worry category. The social and emotional development of children was shown to be significantly correlated with their socioeconomic level. According to the statistical analysis, preschoolers in both rural and urban areas showed a substantial relationship and difference. In both rural and urban settings, children from lower middle class families scored lower on social and emotional development and related domains than did children from upper middle class families.

Differences in weight status among Australian children and adolescents from priority populations: a longitudinal study.

Australia has a high level of cultural and linguistic diversity, including Aboriginal and Torres Strait Islander peoples. Children from specific cultural and ethnic groups may be at greater risk of overweight and obesity and may bear the additional risk of socioeconomic disadvantage. Our aim was to identify differences in body-mass index z-score (zBMI) by: (1) Cultural and ethnic groups and; (2) Socioeconomic position (SEP), during childhood and adolescence. We used data from the Longitudinal Study of Australian children (n = 9417) aged 2-19 years with 50870 longitudinal measurements of zBMI. Children were classified into 9 cultural and ethnic groups, based on parent and child's country of birth and language spoken at home. These were: (1) English-speaking countries; (2) Middle East & North Africa; (3) East & South-East Asia; (4) South & Central Asia; (5) Europe; (6) Sub-Saharan Africa; (7) Americas; (8) Oceania. A further group (9) was defined as Aboriginal and Torres Strait Islander from self-reported demographic information. Longitudinal cohort analyses in which exposures were cultural and ethnic group and family socioeconomic position, and the outcome was zBMI estimated using multilevel mixed linear regression models. We stratified our analyses over three periods of child development: early childhood (2-5 years); middle childhood (6-11 years); and adolescence (12-19 years). Across all three periods of child development, children from the Middle East and North Africa, the Americas and Oceania were associated with higher zBMI and children from the two Asian groups were associated with lower zBMI, when compared to the referent group (English). zBMI was socioeconomically patterned, with increasingly higher zBMI associated with more socioeconomic disadvantage. Our findings identified key population groups at higher risk of overweight and obesity in childhood and adolescence. Prevention efforts should prioritize these groups to avoid exacerbating inequalities in healthy weight in childhood.

Social inequalities in early childhood language development during the COVID-19 pandemic: a descriptive study with data from three consecutive school entry surveys in Germany

BackgroundSocial health inequalities are still of great public health importance in modern societies. The COVID-19 pandemic may have affected social inequalities in people's health due to containment measures. As these measures particularly affected children, they might have been particularly vulnerable to increased social inequalities. The aim of the study was to describe health inequalities during the pandemic based on language delay (LD) in children in order to inform public health interventions for a population at risk of long-term health and education inequalities.MethodsData of 5–7 year old children from three consecutive school entry surveys in the German federal state of Brandenburg were used, including data compulsorily collected before the pandemic (2018/2019: n = 19,299), at the beginning of the pandemic (2019/2020: n = 19,916) and during the pandemic (2020/2021: n = 19,698). Bivariate and multivariate binary regression analyses [OR, 95% CI] cross-sectionally examined the relationship between the prevalence of LD [yes/no] and social inequalities, operationalized by family socioeconomic position [SEP low/middle/high], migration background [native-German language/non-native German language] and length of kindergarten attendance [< 4 years/ ≥ 4 years]. Factors contributing to inequality in LD were examined by socioeconomic stratification.ResultsCross-sectionally, LD prevalence has decreased overall (2018/2019: 21.1%, 2019/2020: 19.2%, 2020/2021: 18.8%), and among children from both high SEP and native German-speaking families. As LD prevalence increased among children from families with low SEP and remained stable among non-native German speakers, social inequalities in LD prevalence increased slightly during the pandemic i) by low SEP (2018/2019: OR = 4.41, 3.93–4.94; 2020/2021: OR = 5.12, 4.54–5.77) and ii) by non-German native language (2018/2019: OR = 2.22, 1.86–2.66; 2020/2021: OR = 2.54, 2.19–2.95). During the pandemic, both migration background and kindergarten attendance determined LD prevalence in the high and middle SEP strata. However, the measured factors did not contribute to LD prevalence in children from families with low SEP.ConclusionSocial inequalities in LD increased due to opposing trends in prevalence comparing low and high SEP families. To promote health equity across the life course, early childhood should be of interest for tailored public health actions (e.g. through targeted interventions for kindergarten groups). Further analytical studies should investigate determinants (e.g., parental investment).

Exposure to Adverse Life Events among Children Transitioning into Adolescence: Intersections of Socioeconomic Position and Race.

Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities' diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence. To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence. In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9-10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers. Family income and married family structure had an overall inverse association with children's exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents. While family SEP is protective against children's exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.

Impact of family socioeconomic position on childhood asthma outcomes, severity, and specialist referral - a Danish nationwide study.

Asthma is the most common chronic illness in children, carrying a major burden. Socioeconomic position (SEP) affects adult asthma outcomes, but its impact on childhood asthma, particularly in primary versus specialist care, has not been studied thoroughly. In a Danish cohort consisting of all children aged 2-17years redeeming inhaled corticosteroids in 2015, parental SEP impact on asthma outcomes was investigated. Workforce attachment, income, education, and metropolitan residence were chosen as covariates in logistic regression. Outcomes were uncontrolled (excessive use of short-acting beta2-agonists), exacerbating (oral corticosteroid use or hospitalization), and severe asthma (according to GINA 2020). The cohort comprised 29,851 children (median age 8.0, 59% boys). 16% had uncontrolled asthma, 8% had ≥1 exacerbation. Lower income and metropolitan residence correlated with higher odds of poor control, exacerbations, and severe asthma. Lower education correlated with worse asthma outcomes. Education and income were protective factors in primary care, but not in specialist care. Metropolitan residence was the sole factor linked to specialist care referral for severe asthma. Low parental SEP and metropolitan residence associated with poor asthma outcomes. However, specialist care often mitigated these effects, though such care was less likely for at-risk children in non-metropolitan areas.

Adversity in childhood and later involvement in serious violent crime

ObjectiveTo use longitudinal birth cohort data linked to police records to examine whether the relationship between adverse childhood experiences (ACEs) and police-recorded serious violence depends on the type, timing or duration of ACEs.&#x0D; MethodsThe sample are 5070 participants (born 1991-1992) from the Avon Longitudinal Study of Parents and Children who allowed linkage to Avon and Somerset (A&amp;S) local police data, lived in A&amp;S from age 16-24 years, and had exposure and confounder data. The binary outcome (no, yes) is having a police record for a serious violence (SV) offence from age 16-24. ACEs were parent-reported from birth to age 11 and include measures of parental physical and emotional abuse. Logistic regression was used to examine associations between the timing of different ACEs and SV, adjusted for child sex, ethnicity, and family socioeconomic position.&#x0D; Results6% of the participants had experienced physical abuse, 17% emotional abuse, and 121 individuals (2.4%) had at least one SV record. In adjusted models, there was evidence of an association between physical (OR 1.90, 95% 1.08-3.35) but not emotional (0.96, 0.60-1.54) abuse and risk of SV. Results suggest that those who experienced physical abuse in both early (&lt;4 years) and later (4-11 years) childhood, or later childhood only, might have been at greater risk of SV than those who experienced it only during early childhood, although numbers were small and confidence intervals were consequently wide.&#x0D; ConclusionResults to date suggest that associations with SV differ between ACE types, and that timing may be important. In our presentation, we will also present findings for other ACEs.

The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis

BackgroundLower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing...

Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy.

In this study, we aimed at evaluating whether, during the COVID-19 pandemic, children affected by chronic diseases were impacted by the deferral of planned healthcare caused by the restriction measures. This study was conducted using data from the Italian NINFEA birth cohort, which include children born between 2005 and 2016. Women who completed the 4-year NINFEA follow-up questionnaire before November 2020 (N = 5,307) were invited to complete a questionnaire targeted at evaluating the impacts of the pandemic on their children's health. The questionnaire asked mothers to report whether their children had a chronic disease or condition that required one or more regular health checks by a doctor in 2019 (used as a reference period) and whether the children had problems getting routine health checks after March 2020. We obtained information on 3,721 children. Out of 353 children with a chronic disease that required at least one medical visit in 2019, 130 (36.8%) experienced problems during the pandemic. Lower family income was associated with a higher risk of experiencing health access problems. We observed that children living in families at lower income tertiles had more chance of experiencing healthcare access problems than children living in families at the highest income tertiles (prevalence rate ratio for a tertile decrease in family income: 1.22; 95% CIs: 1.02-1.49). Our study underlines that the COVID-19 pandemic may have caused healthcare access problems for children with prevalent chronic diseases, especially among those living in households with a low socioeconomic position.

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI. We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents. Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus. We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

Socioeconomic position and executive functioning from childhood to young adulthood: Evidence from Santiago, Chile.

Optimizing cognitive development through early adulthood has implications for population health. This study aims to understand how socioeconomic position (SEP) across development relates to executive functioning. We evaluate three frameworks in life-course epidemiology - the sensitive period, accumulation, and social mobility hypotheses. Participants were young adults from Santiago, Chile who were studied from 6 months to 21 years. Family SEP was measured at ages 1y, 10y, and 16y with the modified Graffar Index. Executive functioning was assessed at ages 16y and 21y by the Trail Making Test Part B (Trails B). Analyses estimating 16y and 21y executive function involved 581 and 469 participants, respectively. Trails B scores were modeled as a function of SEP at 1y, 10y, and 16y, as the total accumulation of disadvantage, and as change in SEP between 1y and 10y and between 10y and 16y. Participants were low- to middle-income in infancy and, on average, experienced upwards mobility across childhood. Half of participants (58%) improved Trails B scores from 16y and 21y. Most (68%) experienced upward social mobility between infancy and 16y. When examined independently, worse SEP measured at 10y and 16y related to worse (longer time to complete) Trails B scores at Age 21 but did not relate to the other outcomes. After mutual adjustment as a test of the sensitivity hypothesis, no SEP measure was independently related to any outcome. Testing the accumulation hypothesis, cumulative low SEP was associated with worse cognitive performance at 21y (β=3.6, p=0.04). Results for the social mobility hypothesis showed no relation to cognitive scores or to change in cognitive scores. Comparing all hypotheses, SEP at 16y explained the most variability in executive functioning at 21y, providing support for the sensitive period hypothesis. Results indicate that experiencing cumulatively low socioeconomic position from infancy to adolescence can have a negative impact on cognitive functioning in young adulthood. Findings also provide evidence in support of adolescence as a key developmental period during which SEP can most strongly impact cognitive functioning.

School grades in mathematics: the role of intelligence, family socioeconomic position, dyscalculia propensity and mathematics anxiety

School grades in mathematics: the role of intelligence, family socioeconomic position, dyscalculia propensity and mathematics anxiety

The association between cognitive ability and body mass index: A sibling-comparison analysis in four longitudinal studies.

Body mass index (BMI) and obesity rates have increased sharply since the 1980s. While multiple epidemiologic studies have found that higher adolescent cognitive ability is associated with lower adult BMI, residual and unobserved confounding due to family background may explain these associations. We used a sibling design to test this association accounting for confounding factors shared within households. We used data from four United States general youth population cohort studies: the National Longitudinal Study of Youth 1979 (NLSY-79), the NLSY-79 Children and Young Adult, the NLSY 1997 (NLSY-97), and the Wisconsin Longitudinal Study (WLS); a total of 12,250 siblings from 5,602 households followed from adolescence up to age 62. We used random effects within-between (REWB) and residualized quantile regression (RQR) models to compare between- and within-family estimates of the association between adolescent cognitive ability and adult BMI (20 to 64 years). In REWB models, moving from the 25th to 75th percentile of adolescent cognitive ability was associated with -0.95 kg/m2 (95% CI = -1.21, -0.69) lower BMI between families. Adjusting for family socioeconomic position reduced the association to -0.61 kg/m2 (-0.90, -0.33). However, within families, the association was just -0.06 kg/m2 (-0.35, 0.23). This pattern of results was found across multiple specifications, including analyses conducted in separate cohorts, models examining age-differences in association, and in RQR models examining the association across the distribution of BMI. Limitations include the possibility that within-family estimates are biased due to measurement error of the exposure, confounding via non-shared factors, and carryover effects. The association between high adolescent cognitive ability and low adult BMI was substantially smaller in within-family compared with between-family analysis. The well-replicated associations between cognitive ability and subsequent BMI may largely reflect confounding by family background factors.

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? – Single mediation analyses of data from German preschool children

Children’s overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German ‘PReschool INtervention Study’. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children’s measured weight status and parents’ reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors ‘sweets consumption in front of TV’ (OR = 1.31[1.05–1.59]) and ‘no sports’ (OR = 1.14[1.01–1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

Multilevel interactions between family and neighbourhood socioeconomic indices in childhood and later risks of self-harm and violent criminality in Denmark: a national cohort study

A socioeconomically disadvantaged childhood has been associated with elevated self-harm and violent criminality risks during adolescence and young adulthood. However, whether these risks are modified by a neighbourhood's socioeconomic profile is unclear. The aim of our study was to compare risks among disadvantaged young people residing in deprived areas versus risks among similarly disadvantaged individuals residing in affluent areas. We did a national cohort study, using Danish interlinked national registers, from which we delineated a longitudinal cohort of people born in Denmark between Jan 1, 1981, and Dec 31, 2001, with two Danish-born parents, who were alive and residing in the country when they were aged 15 years, who were followed up for a hospital-treated self-harm episode or violent crime conviction. A neighbourhood affluence indicator was derived based on nationwide income quartiles, with parental income and educational attainment indicating the socioeconomic position of each cohort member's family. Bayesian multilevel survival analyses were done to examine the moderating influences of neighbourhood affluence on associations between family socioeconomic position and sex-specific risks for the two adverse outcomes. 1 084 047 cohort members were followed up for 12·8 million person-years in aggregate. Individuals of a low socioeconomic position residing in deprived neighbourhoods had a higher incidence of both self-harm and violent criminality compared with equivalently disadvantaged peers residing in affluent areas. Women from a low-income background residing in affluent areas had, on average, 95 (highest density interval 76-118) fewer self-harm episodes and 25 (15-41) fewer violent crime convictions per 10 000 person-years compared with women of an equally low income residing in deprived areas, whereas men of a low income residing in affluent areas had 61 (39-81) fewer self-harm episodes and 88 (56-191) fewer violent crime convictions per 10 000 person-years than men of a low income residing in deprived areas. Even in a high-income European country with comprehensive social welfare and low levels of poverty and inequality, individuals residing in affluent neighbourhoods have lower risks of self-harm and violent criminality compared with individuals residing in deprived neighbourhoods. More research is needed to explore the potential of neighbourhood policies and interventions to reduce the harmful effects of growing up in socioeconomically deprived circumstances on later risk of self-harm and violent crime convictions. European Research Council, Lundbeck Foundation Initiative for Integrative Psychiatric Research, and BERTHA, the Danish Big Data Centre for Environment and Health funded by the Novo Nordisk Foundation Challenge Programme.

Incidence and Related Factors of Different Types of Skin Diseases among Children

Background: The global burden of non-fatal diseases is greatly increased by skin problems. Children bear a disproportionately large portion of the burden of skin problems, which are also responsible for numerous visits to primary healthcare institutions. Objective: The goal of this study was to estimate the incidence of skin conditions in children and describe how they relate to different factors. Methods: This study was a prospective cross-sectional study conducted among 1722 patients at outpatient department (OPD) of Paediatrics in Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh; from 1 April to 31 July 2022. Where 1040 Participants less than or equal to 15 years old and of both sexes who visited the hospital's Paediatrics department for Skin &amp; Venereal diseases were included in this study. Result: A total of 1040 participants were recruited in this study, out of which 550 (52.9%) were boys and 490 (47.1%) were girls. 170 (16.3%) were aged between 0-5 years and followed by 410 (39.4%) were 6-10 years, 460 (44.2%) were 11-15 years. 620 (59.6%) were rural and 420 (40.4%) were urban. The majority of mothers, 484 (46.5%), were educated up to primary level. Most of the fathers, 502 (48.3%), studied up to secondary level. The majority of the participants, 263 (46.1%), had fungal infectious diseases whereas 178 (37.9%) of children had eczema, a non-infectious disease. Conclusion: The study comes to the conclusion that most prevalent type of skin illness identified in this study was fungal infection, followed by eczema and urticaria. Age, education level of parents, poor personal hygiene, history of prior skin disease, sharing of clothing and towels with other family members and socioeconomic position were the related factors that linked to skin disease in children.

Do regional characteristics predict developmental delay? Analyses of German school entry examination

Abstract Background Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP. Methods The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP. Results Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP. Conclusions In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP. Key messages • Regional socioeconomic deprivation contributes to inequalities in children's development and health. • Besides family SEP, regional socioeconomic circumstances are of particular interest to promote health over the life course.

A sport focus of ECEC centres appears especially health-promoting for boys from lower socio-economic background

Abstract Background Pediatric overweight is considered one of the 21st century's most serious public health challenges. Many studies investigated individual level determinants of children's body mass index (BMI), yet studies measuring determinants at the meso- level are sparse. As there is a lack of theoretical and empirical knowledge about the role of child care facilities, the aim was to examine the combined effects of family socio-economic position (SEP) and the meso-level variable early childhood education and care (ECEC) centre with sport focus on the BMI of pre-schoolers. Methods We used data from the German National Educational Panel Study (NEPS) and included 1,891 children from 224 ECEC centre groups. Multilevel mixed-effects linear regressions were applied to calculate the main association of ECEC centre focus and family SEP, as well as their interaction on children's BMI. All analyses were adjusted for age, migration background, number of siblings, and employment status of parents and were stratified by gender. Results Boys attending an ECEC centre with a sport focus have on average a lower BMI than boys from ECEC centres not having this focus. Interactive effects between family SEP and ECEC centre focus were found. Considering predictive margins, boys with low family SEP not attending a sport focused ECEC centre had the highest BMI while boys with low family SEP attending a sport focused ECEC centre had the lowest BMI. For girls, no association regarding ECEC centre focus or interactive effects emerged. Girls in the high family SEP tertile had the lowest BMI in both ECEC centre types. Conclusions Our analysis shows the social gradient towards a higher BMI for children from lower SEP families. Considering meso-level factors, we provide evidence for the relevance of ECEC centre characteristics for BMI in boys, whereas for girls the association of family SEP with BMI remains. The ECEC centre focus appears to lower the association of family SEP with BMI for boys.

Do family characteristics explain a social gradient in overweight in early childhood?

Abstract Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index &amp;gt; 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.

9.H. Workshop: Understanding the institutional context of health inequalities. A life stage approach

Abstract Background The health of young people is strongly linked to their socioeconomic background. However, there is little systematic research on the complex mechanisms underlying the association between family socioeconomic position and health among young people, particularly regarding contextual factors at the (intermediate) meso-level. Several institutional contexts are relevant for young people's lives: the family, kindergarten, primary and secondary school, higher education system, vocational school and training, workplace and the healthcare system. Previous studies demonstrated that characteristics of these institutional contexts are associated with young people's health and well-being. It is unclear, which role they play regarding health inequalities. The aim of the workshop is to analyse the role of institutional characteristics, such as compositional (which people are found in an institution) and contextual (the structural characteristics of an institution) factors for the development or existing health inequalities. Methods The research unit FOR2723 analyses the role of meso-level, institutional characteristics regarding health inequalities considering the whole period of early life based a common conceptual framework. The results are based on empirical analyses of various secondary data, such as the National Educational Panel Study (NEPS) or the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bodymass index (BMI) and the subjective self-assessment of health are considered as outcomes. Results We found substantial social inequalities in health and health behaviour at any life stage investigated. In each life stage we found meso-level characteristics of the family (family investment, family stress, family atmosphere, and parental health behaviour and well-being), the kindergarten (the association between ECEC centre focus and family SEP on pre-school children's BMI), the school (composition of the school in terms of education, income, and occupational prestige of the students’ parents), the institutions and labour market states involved in the school-to-work transition (vocational training places, universities, workplaces, unemployment spells) as well as the health care system (regional health policy), which are associated with social inequalities in young people's self-rated health, subjective well-being and BMI. Discussion In addition to micro-level determinants, meso-level characteristics of important institutions that young people are exposed to (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities. More research is needed to understand how institutional contexts contribute to health inequalities and which institutional changes are needed to reduce inequalities. Key messages • The role of institutional characteristics, such as compositional and contextual factors for health inequalities is unclear. • Meso-level characteristics of institutions in young people (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities.