Highest Education Category Research Articles

Determinants of Maternal Behavior in Measles Prevention in Children Aged Toddlers in Banda Aceh City 2023

Introduction: Measles or Mealses Rubella (MR) is an infectious disease caused by a virus and is easily transmitted. Measles cases at the Lampaseh Health Center always increase every year. In 2022, the most measles cases reached 70 cases and in 2023 measles cases at the Lampaseh Health Center reached 23 cases. Objective: This study aims to identify determinants of maternal behavior in the prevention of measles in children aged toddlers (1-5 years) in the working area of the Lampaseh Health Center. Method: This study used analytical observational method with a cross-sectional approach. The population in this study is mothers registered in the posyandu registration book in six villages in the working area of the Lampaseh Health Center. Sampling with a simple random sampling technique amounted to 90 mothers who had toddlers. Data collection was conducted by interviews using questionnaires. Data analysis using chi-square test and logistic regression test using SPSS 22 program. Result: The results of the study based on univariate analysis showed mothers who had good behavior in measles prevention 60.0%, the highest education category was the middle category 56.7%, mothers the most as IRT 62.2%, families with high income 55.6%, mothers who had information sources 73.3%, mothers whose families were less supportive 51.1% and mothers with health workers played a role 55.6%. The results of bivariate analysis showed that there was a relationship between education levels (P-Value = 0.039), family income (P-Value = 0.009), information sources (P-Value = 0.001), family support (P-Value = 0.001) and the role of health workers (P-Value = 0.001) with maternal behavior in measles prevention in children under five years old. Multivariate test results obtained that family support (P-Value = 0.001; OR = 10.206) and the role of health workers (P-Value = 0.005; OR = 5.942). Conclusion: There is a relationship between maternal education, family income, sources of information, family support and the role of health workers and maternal behavior in measles prevention in children under five years old.

The K-16 education movement: common themes across K-12 and higher education systems to inform development and evaluation

The K-16 education movement broadly includes efforts to streamline educational pathways across K-12 and higher academic and other systems to enhance adult and career readiness and address inequitable opportunities and resources faced by many vulnerable students. The movement remains largely aspirational, however, with little consensus and few tenets available to guide K-16 program development and evaluation. This article presents a preliminary scoping review of several major student themes that crosscut K-12 and higher education systems and that could inform K-16 education initiatives. These themes include student progression and completion; student engagement; student mental health; and student demographic and generational characteristics. Each theme is explored with respect to commonalities across K-12 and higher education systems. Examples include risk/protective factors, ecological levels, barriers, sophisticated data analysis, intervention, school climate, belongingness, student-teacher interactions, academic warning signs, tiered/stepped care models, and demographic and generational changes. A key underlying thesis throughout the article is movement toward a dimensional perspective that considers student development, support needs, learning strategies, and other domains along an educational spectrum rather than as distinct K-12 and higher education categories.

Socioeconomic factors and bleeding events in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

Low socioeconomic status has been associated with higher risk of ischemic stroke and death in patients with atrial fibrillation (AF). However, whether socioeconomic status affects risk of bleeding events is unknown. We assessed the hypothesis that low income and educational attainment are associated with higher risk of bleeding in patients with AF. The registry-based FinACAF study covers all patients with AF in Finland during 2007-2018. Patients were divided into income quartiles and three categories based on their educational attainment. Outcomes of interest were the first-ever gastrointestinal (GI), intracranial (IC) and any bleeding. We identified 205 019 patients (50.9% female; mean age 72.3 (SD 13.4) years) with incident AF without prior bleeding. Mean follow-up time was 4.0 (SD 3.2) years, during which 25013 (12.2%) patients experienced first-ever any bleeding (incidence rate 3.07 (95% CI 3.03-3.10) /100 patient-years). Low income was independently associated with hazard of any bleeding as well as GI and IC bleeding (adjusted hazard ratios (HRs) comparing lowest vs highest income quartile: 1.13 (1.08-1.17), 1.32 (1.23-1.41) and 1.15 (1.06-1.24), respectively). Income-related bleeding disparities were larger among younger patients under 65years and among men. Education-related bleeding disparities were smaller than income related-disparities (adjusted HRs comparing lowest vs highest educational category: any bleeding 1.06 (1.02-1.11), GI bleeding 1.16 (1.08-1.24), IC bleeding 1.10 (0.93-1.09)). Patients with AF and low income are at higher risk of bleeding, especially GI bleeding.

Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention. The nationwide registry-based Finnish AntiCoagulation in Atrial Fibrillationcohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004-2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription. We identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007-2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07-1.10), 1.13 (1.11-1.14) and 1.13 (1.12-1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90-0.93]). Income-related disparities were larger and education-related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1-year follow-up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels. These findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education-related disparities in OAC initiation appear controversial.

Does body mass index mediate the relationship between socioeconomic position and incident osteoarthritis?

ObjectivesTo investigate associations of socioeconomic position (SEP) and obesity with incident osteoarthritis (OA), and to examine whether body mass index (BMI) mediates the association between SEP and incident OA. MethodsData came from the English Longitudinal Study of Ageing, a population-based cohort study of adults aged ≥50 years. The sample population included 9,281 people. Cox regression analyses were performed to investigate the associations between SEP (measured by education, occupation, income, wealth and deprivation) and obesity (BMI ≥30 kg/m2) at baseline and self-reported incident OA. The mediating effect of BMI on the relationship between SEP and incident OA were estimated using Structural Equation Models. ResultsAfter a mean follow-up time of 7.8 years, 2369 participants developed OA. Number of person-years included in the analysis was 65,456. Lower SEP was associated with higher rates of OA (for example, hazard ratio (HR) lowest vs highest education category 1.52 (95% confidence interval (CI) 1.30, 1.79)). Obesity compared with non-obesity was associated with increased rates of incident OA (HR 1.37 (95% CI 1.23, 1.52)). BMI mediated the relationship between a lower SEP and OA (β = 0.005, p < 0.001) and the direct effect was not significant (β = 0.004, p = 0.212). ConclusionsStrategies to reduce social inequalities and obesity prevalence may help to reduce OA risk.

Occupational Segregation Based on Gender and Wage Inequality by Education, Age and Mobility (South Sumatra, Indonesia)

Purpose:this study measures gender segregation by occupations and wage inequality based on overall segregation, vertical segregation, andhorizontal segregation in terms of labour supply, namely differences in wages, hours of work, age, level of education, and mobility (rural andurban) in South Sumatra Province in 2019.Methods:the data used in this study are secondary data sourced from the 2019 South Sumatra Province Labour Force Survey (SAK19.AK) whichis limited to individuals aged 15 to 64 who are currently working, namely as many as 10,429 individuals, of whom 6,873 men and 3,556 women.Classification of the main occupations using quantitative analysis techniques, namely measuring segregation is based on the overall, verticaland horizontal dimensions based on the Gini coefficient, Somer D Statistic, and Pythagorean Theorem.Results:(1) Women are more segregated based on the main occupations, especially jobs with high social stratification and wage groups. (2)Women have more advantages in workplaces with low social stratification and higher education categories. (3) There is no wage inequalitybased on the main occupations, education, age, and mobility.Conclusions and Relevance:the results of the study prove that there is high segregation based on wage groups and educational composition.Women emphasize increasing education because based on vertical segregation, women with higher education level advantage more and theyoccupy jobs that are equal to men based on wage stratification.

Knowledge, attitudes and influencers of North American dog-owners surrounding antimicrobials and antimicrobial stewardship.

To quantify the individual influences of antimicrobial cost, method of administration and drug importance in human medicine on dog-owner antimicrobial preference, and determine knowledge, attitudes and influencers of dog-owners surrounding antimicrobials and antimicrobial stewardship. Data were collected through an online survey targeting three dog-owner participant groups. These consisted of individuals residing in: (1) Canada, (2) USA and (3) any country recruited through an educational social media site. USA and Canadian participants were financially compensated. Conjoint analysis was used to quantify the influence of antimicrobial cost, method of administration and drug importance in human medicine. Descriptive and analytical statistics were used for data evaluation. A total of 809 surveys were completed. Antimicrobial cost accounted for 47% of dog-owner preferences, followed by method of administration (31%) and drug importance in human medicine (22%). All groups preferred lower cost drugs that were administered once by injection. Participants were more likely to prefer drugs considered "very important" in human medicine, except for the social media participants, who preferred drugs that were "not at all important." Most respondents (86%) reported antimicrobial resistance as important in human medicine and 29% believed antimicrobial use in pets posed a risk for antimicrobial resistance in humans. Participants recruited through social media, and those in the highest education category, were significantly more likely to report antimicrobial use in pets as a risk to people. Cost was the most important factor in dog-owner antimicrobial preferences. There is a need for dog-owner antimicrobial stewardship education.

Maternal education and equity in breastfeeding: trends and patterns in 81 low- and middle-income countries between 2000 and 2019

BackgroundIn low- and middle-income countries (LMICs), low levels of formal maternal educational are positively associated with breastfeeding whereas the reverse is true among women with higher levels of formal education. As such, breastfeeding has helped to reduce health equity gaps between rich and poor children. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades.MethodsWe used 319 nationally representative surveys from 81 countries. We used WHO definitions for breastfeeding indicators and categorized maternal education into three categories: none, primary, and secondary or higher. We grouped countries according to the World Bank income groups and UNICEF regions classifications. The trend analyses were performed through multilevel linear regression to obtain average absolute annual changes in percentage points.ResultsSignificant increases in prevalence were observed for early initiation and exclusive breastfeeding across all education categories, but more prominently in women with no formal education for early breastfeeding and in higher level educated women for exclusive breastfeeding. Small decreases in prevalence were seen mostly for women with no formal education for continued breastfeeding at 1 and 2 years. Among formula indicators, only formula consumption between 6 and 23 months decreased significantly over the period for women with primary education. Analysis by world regions demonstrated that gains in early and exclusive breastfeeding were almost universally distributed among education categories, except in the Middle East and North Africa where they decreased throughout education categories. Continued breastfeeding at 1 and 2 years increased in South Asia, Latin America and the Caribbean, and Eastern Europe and Central Asia for primary or higher education categories. Declines occurred for the group of no formal education in South Asia and nearly all education categories in the Middle East and North Africa with a decline steeper for continued breastfeeding at 2 years. With a few exceptions, the use of formula is higher among children of women at the highest education level in all regions.ConclusionsOver the course of our study, women with no formal education have worsening breastfeeding indicators compared to women with primary and secondary or higher education.

Education and its effect on risk and age at onset in Alzheimer disease (AD) in African Americans

AbstractBackgroundIncreased years of education have been previously associated with a decreased risk of developing Alzheimer disease (AD) with cognitive reserve suggested as the source of the protective effect in Non‐Hispanic Whites (NHW). African Americans (AA) are twice as likely to develop AD compared to NHW. We investigated the hypothesis that education was similarly correlated with risk of AD in the AA population. We also examined the relationship of education and age at onset (AAO) of AD in AA.MethodParticipants consisted of 132 AA AD cases and 428 AA cognitively intact (CI) individuals with known years of completed education, ascertained for a genetics study of AD. Education levels were stratified into three categories: &lt;8 years, 9‐12 years, &gt;12 years. We used logistic regression to determine the effect of age, sex, education level and APOE4 status between cases versus controls. Additionally, using a linear model we examined the effect of education on AAO including sex and APOE4 status as covariates.ResultResults showed that increasing years of education had a protective effect on AD risk. Initially including sex and age as covariates, both higher education categories were significant, with 9‐12 years (p = 0.02;OR = 0.461[0.23,0.9])) and &gt;12 years (p = 1.30e0‐04;OR = 0.26[0.13,0.41]). Adding APOE4 dosage (0(Ref), 1,2 alleles) to the model (significant at p = 9.54e‐05; p = 5.27e‐07), the effect of education remained significant (p = 0.03;OR = 0.46[0.23,0.93]) and p = 4.84e‐05;OR = 0.22[0.10,0.46]) for 9‐12 and &gt;12, respectively further supporting its role in AD risk. We examined the effect of education on AAO. Education (8‐12 years) trended in significance (p‐value = 0.07; β = ‐3.76[‐7.82,0.307]) with &gt;12 years significant (p‐value = 1.63e‐04; β = ‐13.07,‐4.25]) supporting later AAO with higher education. The effect of APOE4 on AAO was not significant (p = 0.226). APOE4 added to the model as a covariate did not have a significant effect on AAO, however, education levels continued trending (8‐12; p = 0.07; β = ‐3.76[‐7.86,0.34]) and significant (&gt;12; p = 3.71e‐04; β = ‐8.33[‐12.84,‐3.82]).ConclusionThese data support the hypothesis that higher education results in a decreased risk of AD in AA regardless of APOE4 status. We also found a similar protective effect for a later AAO. Thus, the potential outcome of education on cognitive reserve appears across multiple racial backgrounds.

Socio-demographic differences in alcohol-related work impairment.

The costs of alcohol-related presenteeism (being at work in an impaired state due to alcohol use) have been estimated as substantially larger than the costs of alcohol-related absenteeism. Past studies indicate that employees with lower socio-economic status experience more alcohol-attributable problems than employees in higher socio-economic strata. We aimed to estimate the prevalence of alcohol-related presenteeism among Norwegian adults and its association with sex, age, income and education. Annual national cross-sectional telephone surveys on alcohol, tobacco and drug use (2016-19) among Norwegian adults. A total of 5430 full- and part-time employees aged 16-79years; 53% were men. The main outcome was self-reported 12-month occurrence of work impairment due to alcohol use the previous day. Main predictors were income and education obtained from national registries, age and gender. A secondary outcome variable was self-reported alcohol-related absenteeism. The 12-month prevalence of alcohol-related work impairment was 8.7%, 95% confidence interval (CI)=7.9, 9.4. Adjusted risk ratios (RR) indicated a higher risk for men compared with women (RR=1.26, 95% CI=1.06, 1.50) and higher risk for young employees (e.g. less than 26years compared with 55+, RR=7.64, 95% CI=4.88, 11.95). The risk increased as a function of higher education (in order of increasing education, RR=1.12, 95% CI=0.87, 1.45; RR=1.64, 95% CI=1.26, 2.12; RR=2.19, 95% CI=1.63, 2.95). The risk was estimated as lower in the middle-income categories compared with the lowest (RR=0.76, 95% CI=0.58, 1.00, RR=0.89, 95% CI=0.66, 1.20, RR=0.94, 95% CI=0.68, 1.29) and higher for employees with the highest income (RR=1.04, 95% CI=0.73, 1.48; RR=1.47, 95% CI=1.09, 2.00). In Norway, the risk of alcohol-related work impairment for employees in the highest education category is approximately twice that of employees with secondary education or less. Except for employees in the lowest income category, who had a higher risk than those in the middle-income categories, higher income is associated with increased risk of work impairment. Being younger and male are also associated with increased risk of alcohol-related work impairment.

Sex-specific characteristics associated with the elevated triglyceride to high-density lipoprotein cholesterol ratio in a population-based study

AimsEvidence suggests that changes in the ratio of triglycerides to HDL-c (TG/HDL-c) predict metabolic and cardiovascular diseases, but the factors that might be associated with TG/HDL-c and whether they would be different between men and women are still unknown. We aimed to identify the sex-specific variables associated with TG/HDL-c in adults. MethodsThis cross-sectional population-based study investigated 1603 adults not taking lipid-lowering medication. Sociodemographic characteristics were obtained in a home interview. Blood lipids were measured in participants instructed to fast for at least 10 h. Anthropometric parameters were obtained using standard methods. ResultsTG/HDL-c increases in men towards the higher educational categories, while in women, it decreases in those with a higher educational level. Additionally, TG/HDL-c was higher in the highest socioeconomic class in men but lower in women. In men, age, overweight/obesity, sedentary behavior, and those with higher educational levels were independently associated with high TG/HDL-c (4th quartile). In women, however, overweight/obesity, hypertension, diabetes and tobacco smoking were associated with higher TG/HDL-c, while brown and black women presented lower chances of having a high TG/HDL-c than that of white women. ConclusionsMen and women have different characteristics that are associated with a higher TG/HDL-c, highlighting the need for individualized approaches for preventing cardiometabolic diseases based on sex-specific differences in the TG/HDL-c.

Using mortality follow-up of surveys to estimate social inequalities in healthy life years

BackgroundThe estimation of healthy life years (HLY) by socio-economic status (SES) requires two types of data: the prevalence of activity limitation by SES generally extracted from surveys and mortality rates by SES generally derived from a linkage between the SES information in population databases (census, register) and mortality records. In some situations, no population-wide databases are available to produce mortality rates by SES, and therefore some alternatives must be explored. This paper assesses the validity of calculating HLY by SES using mortality rates derived from a linkage between surveys and mortality records.MethodsTwo surveys were chosen to explore the validity of the proposed approach: The Belgian Health Interview Survey (HIS) and the Belgian Survey on Income and Living Conditions (SILC). The mortality follow-up of these surveys were used to calculate HLY by educational level at age 25. These HLY were compared with HLY estimates calculated using the mortality follow-up of the 2001 census. The validity of this approach was evaluated against two criteria. First, the HLY calculated using the census and those calculated using the surveys must not be significantly different. Second, survey-based HLY must show significant social inequalities since such inequalities have been consistently reported with census-based HLY.ResultsBoth criteria were met. First, for each educational category, no statistically significant difference was found when comparing census-based and survey-based HLY estimates. For instance, men in the lowest educational category have shown a HLY of 34 years according to the HIS, and while this figure was 35.5 years according to the census, this difference was not statistically significant. Second, the survey-based HLY have shown a significant social gradient. For instance, men in the highest educational category are expected to live 9.5 more HLY than their counterparts in the lowest educational category based on the HIS estimates, compared with 7.3 HLY based on the census estimates.ConclusionsThis article suggests that using the mortality follow-up of a nationally representative cross-sectional survey is a valid approach to monitor social inequalities in HLY in the absence of population-wide data.

Correlates of weight status among Norwegian 11-year-olds: The HEIA study

BackgroundThe underlying mechanisms of overweight and obesity in adolescents are still not fully understood. The aim of this study was to investigate modifiable and non-modifiable correlates of weight status among 1103 Norwegian 11-year-old adolescents in the HEalth in Adolescents (HEIA) study, including demographic factors such as gender and parental education, and behavioral factors such as intake of sugar-sweetened beverages, snacks and breakfast consumption, watching TV and playing computer games, physical activity and sedentary time.MethodsWeight and height were measured objectively, body mass index (BMI) was calculated and International Obesity Task Force cut-offs were used to define weight status. Physical activity and sedentary time were measured by accelerometers. Other behavioral correlates and pubertal status were self-reported by questionnaires. Parental education was reported by the parents on the consent form for their child. Associations were investigated using logistic regressions.ResultsThere were gender differences in behavioral correlates of weight status but not for weight status itself. Adolescents with parents in the highest education category had a 46% reduced odds of being overweight compared to adolescents with parents in the lowest education category. Adolescents with parents with medium education had 42% lower odds of being overweight than adolescents with parents with the lowest education category. Level of parental education, breakfast consumption and moderate to vigorous physical activity were positively associated with being normal weight, and time watching TV was positively associated with being overweight for the total sample. Gender differences were detected; boys had a doubled risk of being overweight for every additional hour of watching TV per week, while for girls there was no association.ConclusionsThe present study showed a social gradient in weight status in 11-year-olds. Both breakfast consumption and moderate to vigorous physical activity were inversely associated with weight status. No associations were found between intake of sugar-sweetened beverages and snacks, playing computer games and weight status. Watching TV was positively associated with weight status for boys but not for girls. Interventions are needed to gain more insight into the correlates of change in weight status.

Maternal education inequalities in height growth rates in early childhood: 2004 Pelotas birth cohort study.

SummaryMatijasevich A, Howe LD, Tilling K, Santos IS, Barros AJD, Lawlor DA. Maternal education inequalities in height growth rates in early childhood: 2004 Pelotas birth cohort study. Paediatric and Perinatal Epidemiology 2012; 26: 236–249.Socio-economic inequalities in attained height have been reported in many countries. The aim of this study was to explore the age at which maternal education inequalities in child height emerge among children from a middle-income country. Using data from the 2004 Pelotas cohort study from Brazil we modelled individual height growth trajectories in 2106 boys and 1947 girls from birth to 4 years using a linear spline mixed-effects model. We examined the associations of maternal education with birth length and trajectories of growth in length/height, and explored the effect of adjusting for a number of potential confounder or mediator factors.We showed linear and positive associations of maternal education with birth length and length/height growth rates at 0–3 months and 12–29/32 months with very little association at 3–12 months, particularly in boys. By age 4 years the mean height of boys was 101.06 cm (SE = 0.28) in the lowest and 104.20 cm (SE = 0.15) in the highest education category (mean difference 3.14 cm, SE = 0.32, P < 0.001). Among girls the mean height was 100.02 cm (SE = 0.27) and 103.03 cm (SE = 0.15) in the lowest and highest education categories, respectively (mean difference 3.01 cm, SE = 0.31, P < 0.001). For both boys and girls there was on average a 3-cm difference between the extreme education categories. Adjusting for maternal height reduced the observed birth length differences across maternal education categories, but differences in postnatal growth rates persisted.Our data demonstrate an increase in the absolute and relative inequality in height after birth; inequality increases from approximately 0.2 standard deviations of birth length to approximately 0.7 standard deviations of height at age 4, indicating that height inequality, which was already present at birth, widened through differential growth rates to age 2 years.

P2-449 Maternal education and height growth trajectories in childhood: 2004 Pelotas Birth Cohort Study

IntroductionThe aim of this study was to explore the age at which socioeconomic inequalities in child height emerge among children from a middle-income country.MethodsUsing data from the 2004 Pelotas cohort...

Can Weighting Compensate for Sampling Issues in Internet Surveys?

While Internet surveys have increased in popularity, results may not be representative of target populations. Weighting is commonly used to compensate for sampling issues. This article compared two surveys conducted in the Netherlands—a random mail survey (n = 353) and a convenience Internet survey (n = 181). Demographic characteristics of the samples were weighted by three variables (sex, current residence, age) using Census data. Prior to weighting, the mail sample approximated the population in half of the joint distributions formed by the weighting variables. The Internet sample differed from the population on all 12 cell-by-cell comparisons and no respondents were over age 65. After weighting, the two samples yielded different estimates for non-weighting variables. The Internet sample overrepresented those in the highest education category and appears to have overrepresented those who are ambivalent toward wildlife. Caution is advised when generalizing results from open access Internet surveys.

The association of education with body mass index and waist circumference in the EPIC-PANACEA study

BackgroundTo examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).MethodThis study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.ResultsCompared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.ConclusionIn this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

Education, survival and avoidable deaths in cancer patients in Finland.

Background:Relative survival after cancer in Finland is at the highest level observed in Europe and has, in general, been on a steady increase. The aim of this study is to assess whether the high survival is equally shared by different population subgroups and to estimate the possible gains that might be achieved if equity prevailed.Materials and method:The educational level and occupation before the cancer diagnosis of patients diagnosed in Finland in 1971–2005 was derived from an antecedent population census. The cancers were divided into 27 site categories. Cancer (cause)-specific 5-year survival proportions were calculated for three patient categories based on the educational level and for an occupational group of potentially health-conscious patients (physicians, nurses, teachers etc.). Proportions of avoidable deaths were derived by assuming that the patients from the two lower education categories would have the same mortality owing to cancer, as those from the highest educational category. Estimates were also made by additionally assuming that even the mortalities owing to other causes of death were all equal to those in the highest category.Results:For almost all the sites considered, survival was consistently highest for patients with the highest education and lowest for those with only basic education. The potentially health-conscious patients had an even higher survival. The differences were, in part, attributable to less favourable distributions of tumour stages in the lower education categories. In 1996–2005, 4–7% of the deaths in Finnish cancer patients could have potentially been avoided during the first 5-year period after diagnosis, if all the patients had the same cancer mortality as the patients with the highest educational background. The proportion would have also been much higher, 8–11%, if, in addition, the mortality from other causes had been the same as that in the highest educational category.Interpretation:Even in a potentially equitable society with high health care standards, marked inequalities persist in cancer survival. Earlier cancer diagnosis and the ability to cope within the health care system may be a partly relevant explanation, but personal habits and lifestyles also have a role, particularly for the cancer patients’ mortality from other causes of death than cancer.

The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood.

BackgroundThe life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.MethodsThe data derived from the Health 2000 Survey represent the Finnish young adults aged 18–29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.ResultsPoor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.ConclusionTo develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.

Socioeconomic and psychosocial gradients in cardiovascular pathogen burden and immune response: The multi-ethnic study of atherosclerosis

Background The biologic mechanisms linking socioeconomic position and psychosocial factors to cardiovascular disease (CVD) are not well understood. Immune response to persistent pathogens may be one of these mechanisms. Methods We analyzed cross-sectional data from the multi-ethnic study of atherosclerosis ( N = 999) composed of adults age 45–84. Log-binomial regression and ordinal logistic regression models were used to examine associations of socioeconomic factors and psychosocial factors with pathogen burden and immune response among those infected. Pathogen burden was assessed based on seroprevalence of Helicobacter pylori, cytomegalovirus, herpes simplex virus-1, and Chlamydia pneumoniae and antibody levels were used to characterize high immune response to all four pathogens. Results Low education was a strong and significant independent predictor of higher pathogen burden after adjustment for covariates (adjusted odds ratio (OR) 95% confidence interval (CI) 1.37, 1.19–1.57). Among subjects seropositive for all four pathogens, low education and a higher level of chronic psychosocial stress showed a positive association with higher antibody response, although associations were no longer significant in models with all covariates included (OR = 1.64, 95% CI 0.82–3.31 for lowest vs. highest educational category and OR = 1.29, 95% CI 0.96–1.73 for a one level increase in chronic stress). Conclusion Pathogen burden and heightened immune response may represent a biological pathway by which low socioeconomic position and chronic stress are related to increased rates of cardiovascular disease.