Higher Socioeconomic Position Research Articles

Trajectories of socioeconomic inequality in social, cognitive, and motor development: A birth-cohort

Abstract Background The World Health Organization's main strategy to reduce health inequalities in adulthood is preventing socioeconomic inequalities in early childhood. Yet, little is known about how children's socioeconomic position (SEP) shapes their development over time. Therefore, we investigated trajectories of socioeconomic inequality in early child development. Methods Data (n = 5104) was used from Generation R, a prospective population-based cohort in The Netherlands. SEP inequalities (defined by maternal education) in trajectories of internalizing and externalizing problems (mother reported Child Behavior Checklist at 1.5, 3, 5, and 9 years), and of language and motor development (mother reported Child Development Inventory at 0.5, 1, 1.5, 2, 3 and 4 years) were estimated using linear mixed models with standardized scores at each time point. Results Low SEP children had more internalizing (B = 0.72, 95%CI=0.51;0.95) and externalizing (B = 0.25, 95%CI=0.10;0.40) problems at 1.5 years, but better language skills at 1 year (B = 0.50, 95%CI=0.36;0.64), and better fine (B = 0.26, 95%CI=0.12;0.40) and gross motor (B = 0.40, 95%CI=0.25;0.55) skills at 0.5 years of age than high SEP children. For internalizing and externalizing problems, inequalities decreased over time. The low SEP advantage regarding language scores reversed in early childhood, and at 4 years of age, low SEP children (B=-0.38, 95%CI=-0.61;-0.15) had substantially worse language skills than high SEP children. For motor skills, the low SEP advantage at baseline decreased over time and disappeared around 4 years. Conclusions Socioeconomic inequalities in early child development differ by developmental domain: whereas inequalities in problem behavior and motor skills decreased over time, inequalities in language development increased. This indicates that low SEP children are already at a cognitive disadvantage before entering primary education, providing further evidence that interventions are needed before the age of 4. Key messages We investigated trajectories of socioeconomic inequality in early child development within a Dutch prospective birth cohort. Results showed that socioeconomic inequalities in child development decreased over time for emotional, behavioral and motor development, but increased for cognitive development.

Trajectories of socio-economic position over four time points and mortality: The role of gender

Abstract Background Studies investigating the effect of social mobility on mortality in Sweden have used socioeconomic position (SEP) at only two time points and traditional methodological approaches. Our recent study has used SEP at four time points, but not employed latent class analyses when investigating the relationship between SEP trajectories and mortality in later life. Methods A cohort of 14,192 live births at Uppsala University Hospital between 1915-1929, of whom 97% were traced through parish records until routine registers became available in the 1960s. 5729 men and 5607 women were alive and living in Sweden in 1980. SEP was measured as social class of the head of household: at birth, in childhood (age 10, +/- five years), in adulthood (age 30-45, in the 1960 Census), and in later life (age 50-65, in the 1980 Census). Latent class analysis was employed to identify social class trajectories and Cox proportional hazard models used to estimate all-cause and cause-specific mortality (data from Causes of Death Register). Results Compared to men and women with stable high SEP trajectories, we found a higher risk of death from circulatory disease among men with stable low (HR 1.56, 95%CI 1.29-1.87), stable middle (HR 1.28, 95%CI 1.06-1.55) and upwardly mobile from low (HR 1.35, 95%CI 1.10-1.66) SEP trajectories, as well as in women with stable low or mobile from low to middle SEP trajectory (HR 1.27, 95%CI 1.02-1.59). SEP trajectories and total mortality showed similar, albeit, weaker associations in both genders. SEP trajectories were gender-specific and associations of SEP trajectories with circulatory disease mortality tended to be weaker in women. Conclusions Men's and women's socioeconomic position during childhood and over the life course affect their risk of late life all-cause mortality, and death from circulatory disease in particular. Improvements in social conditions at early stages of the life course are likely to contribute to reducing mortality at old age. Key messages Men’s and women’s socio-economic position during childhood and over the life course affect their risk of late life all-cause mortality and mortality from circulatory disease in particular. Trajectories of socioeconomic position across life course appear to be related to cause specific and total mortality in a gender specific pattern.

Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort.

AimTo test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio‐economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life‐style and social factors.DesignA longitudinal cohort study with baseline in 2002 or 2006, with record‐linkage to national registers.SettingStockholm County, Sweden.ParticipantsA total of 37 484 individuals, aged 25–70 years, responding to the survey in 2002 or 2006.MeasurementsThe outcome of alcohol‐related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self‐reported information on occupational class (measure of SEP), AC, HED as well as other health‐related factors were extracted from the surveys. Average follow‐up time was 13.3 years.FindingsDuring follow‐up, a total of 1237 first‐time events of alcohol‐related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED.ConclusionsThe greater adverse impact of alcohol consumption on health in Sweden on people with lower socio‐economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018

BackgroundDespite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time.MethodsWe used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2–17 years in 2011–2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time.ResultsDiabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67–3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40–0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18–0.34). Disparities were especially apparent among children aged 2–9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018.ConclusionsWhile poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.

Identifying children at risk of intellectual disability in UNICEF’s multiple indicator cluster surveys: Cross-sectional survey

BackgroundResearch on intellectual disability has been criticized for primarily addressing the situation of people in high-income countries. Objective/Hypothesis. To determine whether MICS6 data on ‘functional difficulty associated with learning’ (FDAL) in low- and middle-income countries could be used as a proxy indicator for intellectual disability. MethodsSecondary analysis of nationally representative data collected in Round 6 of UNICEF’s Multiple Indicator Cluster Surveys (MICS) on 244,915 children in 18 middle- and low-income countries. ResultsThe prevalence of FDAL in middle- and low-income countries was broadly similar to the estimated prevalence of intellectual disability in high-income countries. The association between risk of FDAL and household wealth was weak, with alternative measures of developmental delay showing significantly stronger associations with household wealth. The risk of making potential false negative errors in identifying FDAL increases as household wealth and level of maternal education decrease. The risk of making potential false positive errors in identifying FDAL is greater among more highly educated respondents, although this association is only statistically significant among older children. ConclusionsThe use of FDAL as a proxy indicator for intellectual disability cannot be recommended given: (1) it would probably underestimate the overall prevalence of intellectual disability in middle and low income countries; and (2) it is likely to be overestimate prevalence among families with higher socio-economic position (SEP) and underestimate prevalence among families with lower SEP.

Education-related variation in coronary procedure rates and the contribution of private health care in Australia: a prospective cohort study

BackgroundContemporary Australian evidence on socioeconomic variation in secondary cardiovascular disease (CVD) care, a possible contributor to inequalities in cardiovascular disease outcomes, is lacking. This study examined the relationship between education, an individual-level indicator of socioeconomic position, and receipt of angiography and revascularisation procedures following incident hospitalisation for acute myocardial infarction (AMI) or angina, and the role of private care in this relationship.MethodsParticipants aged ≥45 from the New South Wales population-based 45 and Up Study with no history of prior ischaemic heart disease hospitalised for AMI or angina were followed for receipt of angiography or revascularisation within 30 days of hospital admission, ascertained through linked hospital records. Education attainment, measured on baseline survey, was categorised as low (no school certificate/qualifications), intermediate (school certificate/trade/apprenticeship/diploma) and high (university degree). Cox regression estimated the association (hazard ratios [HRs]) between education and coronary procedure receipt, adjusting for demographic and health-related factors, and testing for linear trend. Private health insurance was investigated as a mediating variable.ResultsAmong 4454 patients with AMI, 68.3% received angiography within 30 days of admission (crude rate: 25.8/person-year) and 48.8% received revascularisation (rate: 11.7/person-year); corresponding figures among 4348 angina patients were 59.7% (rate: 17.4/person-year) and 30.8% (rate: 5.3/person-year). Procedure rates decreased with decreasing levels of education. Comparing low to high education, angiography rates were 29% lower among AMI patients (adjusted HR = 0.71, 95% CI: 0.56–0.90) and 40% lower among angina patients (0.60, 0.47–0.76). Patterns were similar for revascularisation among those with angina (0.78, 0.61–0.99) but not AMI (0.93, 0.69–1.25). After adjustment for private health insurance status, the HRs were attenuated and there was little evidence of an association between education and angiography among those admitted for AMI.ConclusionsThere is a socioeconomic gradient in coronary procedures with the most disadvantaged patients being less likely to receive angiography following hospital admission for AMI or angina, and revascularisation procedures for angina. Unequal access to private health care contributes to these differences. The extent to which the remaining variation is clinically appropriate, or whether angiography is being underused among people with low socioeconomic position or overused among those with higher socioeconomic position, is unclear.

The effects of nudging and pricing on healthy food purchasing behavior in a virtual supermarket setting: a randomized experiment

BackgroundEvidence on what strategies - or combination of strategies - are most effective and equitable in promoting healthier diets is needed. This study examined the efficacy of nudging and pricing strategies on increasing healthy food purchases and the potential differential effect by socio-economic position (SEP) among Dutch adults in a virtual supermarket.MethodsA randomized study design was conducted within a virtual supermarket (SN VirtuMart). Participants were exposed to five within-subject study conditions (control, nudging, pricing, price salience and price salience with nudging) and randomized to one of three between-subject study arms (a 25% price increase on unhealthy products, a 25% discount on healthy products, or a 25% price increase and discount). In total, 455 participants of low and high SEP (using either education or income as proxy) were randomized to conduct their weekly shopping in a virtual supermarket for five consecutive weeks. The primary outcome included the percentage of healthy purchases. Data were analyzed using linear mixed models.ResultsIn total, 346 (76%) adults completed all five shops within the SN VirtuMart. Median age was 32.5, 49.2% had high education and 32.8% had high income. Out of the 12 conditions, four conditions were statistically significantly different from the control condition. Nudging and non-salient pricing strategies alone did not statistically significantly increase healthy food purchases, whereas a combination of salient price increases and discounts led to an increase in the percentage of healthy food purchases (B 4.5, 95%CI 2.6; 6.4). Combining salient pricing and nudging strategies led to increases in the percentage of healthy products in all three pricing arms, with largest effects found in the combined price increase and discount arm (B = 4.0, 95%CI = 2.0; 6.0). Effects were not modified by SEP.ConclusionsCombining health-related price increases and discounts and combining these salient pricing strategies with nudges in a supermarket setting seems to stimulate healthy food purchases for both low and high SEP populations. However, further research in real-world settings is needed.Trial registrationThis randomized trial (NTR7293) was registered in the Dutch trial registry (www.trialregister.nl).

Education across the life-course and hypertension in adults from Southern Brazil.

The present study examines the association between life-course socioeconomic position (SEP) and hypertension (SAH), focusing on the health impacts of childhood SEP (SEPc), adult SEP (SEPa), as well as SEP mobility. Data from the Brazilian EpiFloripa Cohort Study (n = 1,720; 56% women; 55% <= 30 years) were analyzed. SAH was determined by the average of two measures of systolic and diastolic blood pressure, previous medical diagnosis or use of anti-hypertensive medication (43% of the sample was hypertensive). The main independent variables were: SEPa - participants' level of education; SEPc - parental educational attainment; and SEP mobility - the socio-economic trajectories from SEPc to SEPa. Five logistic regressions models were adjusted for sex, age or income, and were compared among each other. High SEPa was associated with a 37% reduction in the odds of SAH compared to low SEPa. High SEP over the life course was associated with 34-37% lower odds of SAH compared to persistent low SEP. Mobility models explained more of the outcome variance than the sensitive period model. The results reinforce the importance of education in the risk of SAH and the relevance of a socioeconomic mobility approach for the analysis of social inequalities in health.

A Dream Deferred: African American Women's Diminished Socioeconomic Returns of Postponing Childbearing from Teenage to Adulthood.

Brookings Institution has identified postponing childbirth from teenage to adulthood as a major strategy that is needed for upward social mobility of women. However, according to the Minorities' Diminished Returns (MDRs), the associations between aspirations, investments, behaviors, and socioeconomic position (SEP) may be diminished for marginalized groups such as African Americans. To extend the existing knowledge on the MDRs, the current study had two aims: First to compare White and African American women for the association between postponing childbearing to adulthood and SEP in a national sample of American women. Second, to test correlates of postponing childbearing to adulthood and SEP at birth with long term outcomes 15 years later when the child was 15 years old. For this longitudinal study, data came from the Fragile Families and Child Well-being Study (FFCWS), a national longitudinal prospective study in the United States (US) that followed an ethnically diverse sample of women from childbirth for 15 years from 1998 to 2016. For the first aim, this study included 2679 women composed of 723 Whites and 1956 African Americans. For the second aim, among 1842 individuals who had available data 15 years later, we measured various economic, behavioral, and mental health outcomes when the child was 15 years old. For aim 1 we ran linear regression. Postponing childbearing to adulthood was the independent variable. The dependent variable, SEP (poverty) was treated as a continuous measure with higher score indicating more poverty. Confounders included marital status and delivery characteristics. For the aim 2, we ran Pearson correlation test (exploratory analysis) to test if baseline SEP correlates with future outcomes. Postponing childbearing from adolescence to adulthood was associated with higher SEP in adulthood, net of all confounders including marital status and education. We found a significant interaction between postponing childbearing from adolescence to adulthood and race on SEP, suggesting that the economic reward of postponing childbearing may be weaker for African American women than for White women. Although postponing the age at childbirth is a recommended strategy for women who wish to maximize their chance of upward social mobility, this strategy may be associated with smaller economic returns for African American women than White women. The results can also be interpreted as MDRs in investments in terms of a postponing childbearing. In a fair society, the same investment should be similarly rewarded across diverse racial groups. In the reality, however, the US society differently rewards White and African American women who postpone childbearing. Research should explore the roles of social stratification, blocked opportunities, and concentrated poverty in explaining the unequal return of such an investment for African American and White women.

Predictors for place of death among children:A systematic review and meta-analyses of recent literature.

Through a systematic review and meta-analyses, we aimed to determine predictors for place of death among children. We searched online databases for studies published between 2008 and 2019 comprising original quantitative data on predictors for place of death among children. Data regarding study design, population characteristics and results were extracted from each study. Meta-analyses were conducted using generic inverse variance method with random effects. Fourteen cohort studies met the inclusion criteria, comprising data on 106,788 decedents. Proportions of home death varied between countries and regions from 7% to 45%. Lower age was associated with higher odds of hospital death in eight studies (meta-analysis was not possible). Children categorised as non-white were less likely to die at home compared to white (pooled OR 0.6; 95% CI 0.5-0.7) as were children of low socio-economic position versus high (pooled OR 0.7; 95% CI 0.6-0.9). Compared to patients with cancer, children with non-cancer diagnoses had lower odds of home death (pooled OR 0.5; 95% CI 0.5-0.5).Conclusion: Country and region of residence, older age of the child, high socio-economic position, 'white' ethnicity and cancer diagnoses appear to be independent predictors of home death among children. What is Known: • Home is often considered an indicator of quality in end-of-life care. • Most terminally ill children die in hospitals. What is New: • Through a systematic review and meta-analyses, this study examined predictors for place of death among children. • Country and region of residence, older age of the child, high socio-economic position, white ethnicity and having a cancer diagnosis appear to be independent predictors of home death among terminally ill children.

The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis

Background and aimType 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. Methods and resultsThis study analysed data from 1977 Nepalese adults aged 40–69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable “PA” was created using the information on domains of PA while the latent variable “socioeconomic position” was created using the variables education, occupation and ethnicity. Participants’ fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported.Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. ConclusionAmong Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.

The influence of socioeconomic position on adjuvant treatment of stage III colon cancer: a systematic review and meta-analysis

Background Patients with colon cancer (CC) with low socioeconomic position (SEP) have a worse survival than patients with high SEP. We investigated the association between different socioeconomic indicators and the steps in the treatment trajectory leading to initiation of adjuvant chemotherapy (ACT) for patients with stage III CC. Materials and Methods A systematic review and meta-analyses were conducted in accordance with the MOOSE checklist. MEDLINE and EMBASE were searched for eligible studies. Meta-analyses were performed on the separate socioeconomic indicators with the random-effects model. The heterogeneity across studies was assessed by the Q and the I 2 statistic. Results In total, 27 observational studies were included. SEP was measured by insurance, income, poverty, employment, education, or an index on an area or individual level. SEP, regardless of indicator, was negatively associated with the steps in the treatment trajectory leading to initiation of ACT among patients with resected stage III CC. The meta-analyses showed that patients with low SEP had a significantly lower odds of receiving ACT and increased odds of delayed treatment start, whereas SEP had no impact on the choice of therapy: combination or single-agent therapy. Conclusion SEP was associated with less initiation of and higher risk for delayed initiation of ACT. Our findings suggest there is a social disparity in receipt of ACT in patients with stage III CC.

Association of Socioeconomic Position With e-Cigarette Use Among Individuals Who Quit Smoking in England, 2014 to 2019

e-Cigarette use among individuals who quit smoking more than 1 ago in England is highest among those with lower socioeconomic position and may affect smoking-related health inequalities, depending on whether the devices protect against relapse to tobacco smoking. To assess trends in current e-cigarette use by socioeconomic position among individuals who have quit smoking for at least 1 year, to capture postcessation initiation among those who quit within the past year and did not use an e-cigarette in their most recent quit attempt (representing recent initiation), and to capture postcessation initiation among those who quit smoking before e-cigarettes became popular in 2011 (representing late initiation). This cross-sectional study of 34 442 adults (≥16 years) who formerly smoked used data from the Smoking Toolkit Study (conducted 2014-2019), a nationally representative, monthly, repeated, cross-sectional, household survey of smoking and smoking cessation in England. Data analysis was conducted in December 2019. Socioeconomic position based on occupation. Current self-reported e-cigarette use. Weighted samples consisted of 19 297 individuals who had quit smoking for at least 1 year (mean [SD] age, 59.2 [17.0] years; 9024 [46.8%] women), 904 who quit in the past year and did not use an e-cigarette in their most recent quit attempt (mean [SD] age, 41.6 [17.1] years; 445 [49.3%] women), and 14 241 who quit before 2011 (mean [SD] age, 63.6 [14.6] years; 6619 [46.5%] women). Among those who had quit smoking fot at least 1 year, e-cigarette use increased from 3.3% (95% CI, 2.7%-4.0%) in 2014 to 10.4% (95% CI, 9.2%-11.6%) in 2019 among all socioeconomic groups. Use was more common among those with lower socioeconomic position than those with higher socioeconomic position (odds ratio, 1.59; 95% CI, 1.05-2.40; P = .03). Regarding postcessation initiation of e-cigarettes, among those who quit smoking in the past year and did not use an e-cigarette in their most recent quit attempt, 7.1% (95% CI, 5.9%-9.3%) initiated e-cigarette use after smoking cessation, and there was no clear trend over time or any difference according to socioeconomic position. Among those who quit before 2011, there was an overall increase in use of e-cigarettes (0.8% [95% CI, 0.5%-1.2%] in 2014 to 2.1% [95% CI, 1.4%-2.8%] in 2019), but there were no apparent differences in use across socioeconomic position. In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely. Late, but not recent, postcessation initiation of e-cigarettes has increased over time but is not likely to affect smoking-related health inequalities because there were no differences by socioeconomic position.

Socio-economic and Regional Differences in Walkability and Greenspace Around Primary Schools: A Census of Australian Primary School Neighbourhoods.

Socio-economic inequality in the physical activity environment surrounding primary schools may contribute to socio-economic gradients in physical activity and childhood obesity levels. Using a cross-sectional study design, ordinary least squares and logistic regressions were fitted to assess variation in walkability and greenspace within 1km of primary schools (n = 7133) according to area-level socio-economic position (SEP) and remoteness. Effect modification by school location (major cities or regional/remote) was assessed through stratified analyses. Walkability scores significantly increased from low to high school neighbourhood SEP (p < 0.01) and from remote/very remote to major city locations (p < 0.01). Greenspace area (hectares) in the school neighbourhood was greater in highest compared to lowest SEP areas (β = 18.75, 95%CI 6.63, 30.87) and less in major cities compared to remote/very remote locations (β = -23.9, 95%CI -39.7, -8.1). Schools in highest SEP areas and major cities had higher odds of having any greenspace in their neighbourhood, compared to those in lowest SEP and remote/very remote locations (OR 5.93, (95% CI 4.50, 7.05), OR 20.19, (95% CI 16.05, 25.39) respectively). Stratified results (major cities or regional/remote locations) found the highest SEP school neighbourhoods had higher walkability scores and more greenspace compared to lowest SEP school neighbourhoods in both strata, although overall SEP gradient in walkability and greenspace area only remained in major cities. Walkability and greenspace infrastructure in the school neighbourhood could be improved in areas of lower SEP so that all school children have the opportunity for physical activity.

Ageing without dementia: can stimulating psychosocial and lifestyle experiences make a difference?

In a world with an ageing population, dementia has become an urgent threat to global health and wellbeing. Psychosocial and lifestyle factors, such as higher socioeconomic positions, longer times spent in education, greater occupational complexity, reduced stress at work, and engagement in mental, physical, and social activities, have been hypothesised to supply resilience against dementia. Although questions remain surrounding the role of these factors in the development of dementia, scientific advancements have considerably expanded our understanding of modifiable psychosocial and lifestyle factors and their neuroprotective and compensatory influences over a life course. Evidence from observational studies is robust enough to suggest that stimulating psychosocial and lifestyle factors are protective against dementia. And, although the corresponding evidence from intervention studies is still scarce, public health campaigns promoting psychosocial and lifestyle factors might improve the health and wellbeing of people aged 60 years and older.

Area-level socioeconomic disparity trends in nutritional status among 5–6-year-old children in Israel

ObjectiveThis study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over...

The role of socio-economic factors in food consumption of Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016.

This study aimed to evaluate the association between socio-economic factors and the food consumption of a young population. Participants were from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) aged from 3 to 17 years (n 1153). Food consumption was assessed using two non-consecutive days of food diaries in children and two 24-h recalls for adolescents. A latent class analysis (LCA) was used to classify children's socio-economic status (socio-economic composite classification (SCC)), categorised in low, middle or high. The associations between socio-economic variables and food consumption were evaluated through linear or logistic regression models, weighted for the Portuguese population distribution. A positive association was found between belonging to a higher level of SCC and consumption of fruits and vegetables (FV), by children (β = 2·4, 95 % CI 1·1, 3·8) and by adolescents (β = 52·4, 95 % CI 9·6, 95·3). A higher SCC, but particularly higher maternal education, was positively associated with consumption of 'white meat, fish and eggs'. Both higher SCC and parental education were positively associated with salty snack consumption in the adolescents' group. In conclusion, children and adolescents with higher educated parents and belonging to a high socio-economic level have a higher daily intake of FV and white meat, fish and eggs. Socio-economic factors play an important role in justifying differences in the food consumption of children and adolescents and must be considered in future interventions. The relationship between higher socio-economic position and salty snack consumption in adolescents needs to be further explored in other populations.

Healthy is (not) tasty? Implicit and explicit associations between food healthiness and tastiness in primary school-aged children and parents with a lower socioeconomic position

Many people implicitly (automatically) believe that unhealthy foods are tastier than healthy foods, even when they explicitly (deliberately) report that they don’t. It is unclear whether this ‘unhealthy = tasty intuition’ is already present in childhood. Children from families with a lower socioeconomic position (SEP) consume poorer diets than children from families with a higher SEP. Paradoxically, populations with a lower SEP are underrepresented in research and least reached by lifestyle interventions. This study explored implicit and explicit associations between healthiness, tastiness and liking of foods in primary school-aged children and parents with a lower SEP.These associations and an estimate of dietary intake were assessed with implicit association tests and paper-and-pencil questionnaires, developed and adapted specifically for this target group. Participants were recruited at Dutch food banks.Results of 37 parent-child dyads indicated that children and parents implicitly associated healthy foods and tastiness more strongly with each other than healthy foods and not tasty (D = −0.19, p = .03 and D = −0.46, p < .001, respectively). Explicitly, parents showed similar results, while children rated pictures of unhealthy foods as tastier than pictures of healthy foods.Following the discrepancy between our hypotheses, results, and more unhealthy eating habits that often prevail in families with a lower SEP, potential explanations are discussed. We address the possibility that an internalised social norm was exposed, rather than an intrinsic belief. We propose that this research calls for in-depth qualitative research on food-related preferences and norms in the everyday life of low SEP families.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

Socioeconomic Patterning of Children's Accelerometer-Assessed Physical Activity Intensities and Adiposity: A Pooled Analysis of Individual-Level Data for 26,915 Children and Adolescents from 36 European Cohorts

Background: Childhood obesity is increasing globally with widening socioeconomic inequalities. It is unclear if differences in the accumulation and intensity distribution of children’s physical activity is contributing to these rising disparities. We investigated if the intensity patterning of physical activity differs between socioeconomic groups across Europe and if this relationship differs by national level income inequality and age to help explain obesity disparities. Methods: We pooled and harmonised individual-participant accelerometer-assessed activity and socioeconomic position (SEP) data from 36 European child studies. Included participants were between 5 to 16 years of age with valid accelerometer data (≥480 minutes of daily wear time on 3 days), parental education and anthropometric measurements. Study-level multivariable linear regression models were run to assess differences in moderate-vigorous physical activity (MVPA), vigorous physical activity (VPA) and adiposity by socioeconomic position (by parental education). Effects were pooled in random effect meta-analyses. Findings: 26,915 participants (mean age: 10·1y [SD:1.2]; 51·7% female) from 16 European countries met the inclusion criteria. Meta-analyses revealed proportionally more average daily minutes of VPA were performed by children from a higher socioeconomic position (High vs low SEP, b: 0·57, 95%CI: 0·28, 0·85 mins), despite lower overall levels of physical activity (MVPA; b: -1·51, 95%CI: -2·36, -0·67 mins). Higher intensity activity in children from a higher socioeconomic position was paralleled by lower levels of adiposity measured by BMI z-score (b: -0·20, 95%CI: -0·24, -0·16). Stepwise differences were apparent moving from low to medium to high socioeconomic position [e.g. BMI z-score: (Low vs Med SEP; b: -0·10, 95%CI: -0·14, -0·07) (Low vs High SEP; b: -0·20, 95%CI: -0·24, -0·16)]. Inequalities in VPA and BMI z-score widened with age and were not affected by national level income inequality. Interpretation: Lower levels of adiposity in children from a higher socioeconomic position are paralleled by relatively higher amounts of VPA despite overall lower levels of MVPA. Physical activity promotion efforts should focus on providing opportunities for less affluent children to be vigorously active. Funding Statement: BHF, CRUK, ESCR, MRC, Wellcome Trust, Research Council of Norway Declaration of Interests: All authors declare that they have no conflicts of interest. Ethics Approval Statement: The authors declared not applicable.