Levels Of Social Disadvantage Research Articles

Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation

BackgroundLate access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort.MethodsA retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007—March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13–19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors.ResultsOverall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke.ConclusionsThere is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.

Transport poverty meets car dependency: A GPS tracking study of socially disadvantaged groups in European rural peripheries

This article explores the spatial mobility of disadvantaged populations in order to enhance our understanding of transport poverty. It is based on participatory GPS tracking data collected in peripheral rural regions in Czechia and Germany. The data provide information on the two-week mobility of 61 socially disadvantaged study participants belonging to the following groups: (a) the lone elderly, (b) the labor market disadvantaged, and (c) single parents. The quantitative analysis utilizes group comparisons of activity space metrics. The results show that the mobility of disadvantaged people varied little between countries and regions, which indicates that individual social disadvantage mattered more than regional spatial disadvantage. Daily mobility depended on individual mobility strategies, and on people's embeddedness in social networks. The mobility patterns of socially disadvantaged groups differed, and showed considerable within-group variability. Our analysis finds that the effects of car access depended on the respondents' levels of social disadvantage; and that a car was not a merely a transport variable, but a socially conditioned variable. Understanding how automobility in rural peripheries is mediated by social ties, and how it can both enable and constrain chances for social participation, is essential for developing measures aimed at reducing transport poverty.

Ethical and Methodological Considerations Interviewing Dementia Caregivers

Greater inclusion of people living with dementia (PLWD) and their caregivers in research is a global research priority and an expressed priority of dementia advocacy organizations. Absent inclusion of PLWD and caregivers, our understanding of dementia-related experiences and optimization of care and caregiving interventions is stymied. Qualitative interviewing techniques constitutes a primary method for obtaining PLWD and caregivers’ perspectives. Yet, there is little guidance on use of qualitative interviewing techniques among PLWD and caregivers or discussion of potential challenges encountered, despite unique vulnerabilities faced throughout the research process, which may be further heightened among historically excluded groups. Meaningful progress toward inclusion of PLWD and their caregivers in dementia research necessitates broader examination of associated methodological and ethical considerations that arise in the conduct of interviews. Drawing from a large multi-site qualitative study of dementia caregivers with exposure to high levels of social disadvantage, we used a multiple-triangulation qualitative approach across interview transcripts, memos, and interviewer discussions to identify methodological and ethical challenges that arose during the interviewing process. Challenges were identified across all phases of research, and included relational concerns with PLWD and family members due to disclosure of sensitive information, risk of re-traumatization in discussing past experiences, multiple roles of caregivers with conflicting perspectives, variable recall capacity, limited prior appraisal of caregiving, and request of interviewers for medical advice or selecting services . We outline events evidencing these challenges and proposed strategies (i.e. use of research consults, interview debriefing) to strengthen research capacity to anticipate and respond to them.

Social Deprivation and the Performance of Pedestrian Infrastructure for School Children: Identifying Need in the Putnam City School District, Oklahoma City, Oklahoma

Social disadvantage is thought to correlate with and might indeed be compounded by insufficient transport infrastructure. Additionally, the prevalence of pedestrian mode choice for trips is shown to be affected by levels of social disadvantage and vulnerability. For elementary school-age children and their guardians, these relationships could complicate daily mode choice and travel with respect to getting to school. This research explores the spatial dependence of socioeconomic and pedestrian network service indicators through a comparative spatial analysis of pedestrian level of service (LOS; Landis et al. 2001) and social deprivation index (SDI; Butler et al. 2013) across suburban census tracts comprising the Putnam City School District in Oklahoma City, Oklahoma. Results indicate statistically significant clusters where substandard pedestrian LOS and challenging socioeconomic conditions colocate at specific census tracts in the study area, along with significant effects demonstrated under spatial lag regression modeling. Implications for planning and public health are discussed, inclusive of both social (public awareness initiatives, walking school buses) and physical (improvements to the pedestrian environment) intervention.

Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study)

BackgroundImmigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes.MethodsThis longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul.DiscussionThis is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts.Trial registrationN.A. (Observational study, no clinical trial, no interventions on human participants).

Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index.

Disparities in adult morbidity and mortality may be rooted in patterns of biological dysfunction in early life. We sought to examine the association between pathogen burden and a cumulative deficits index (CDI), conceptualized as a pre-clinical marker of an unhealthy biomarker profile, specifically focusing on patterns across levels of social disadvantage. Using the data from the National Health and Nutrition Examination Survey 2003-2004 wave (aged 20-49years), we examined the association of pathogen burden, composed of seven pathogens, with the CDI. The CDI comprised 28 biomarkers corresponding to available clinical laboratory measures. Models were stratified by race/ethnicity and education level. The CDI ranged from 0.04 to 0.78. Nearly half of Blacks were classified in the high burden pathogen class compared with 8% of Whites. Among both Mexican Americans and other Hispanic groups, the largest proportion of individuals were classified in the common pathogens class. Among educational classes, 19% of those with less than a high school education were classified in the high burden class compared with 7% of those with at least a college education. Blacks in the high burden pathogen class had a CDI 0.05 greater than those in the low burden class (P < 0.05). Whites in the high burden class had a CDI only 0.03 greater than those in the low burden class (P < 0.01). Our findings suggest there are significant social disparities in the distribution of pathogen burden across race/ethnic groups, and the effects of pathogen burden may be more significant for socially disadvantaged individuals.

‘Southern’ Northern Soul: Changing Senses of Direction, Place, Space, Identity and Time

‘Southern’ Northern Soul: Changing Senses of Direction, Place, Space, Identity and Time

Maternal alcohol consumption in the Norwegian Mother and Child Cohort Study (MoBa) – Research opportunities

The Norwegian Mother and Child Cohort Study (MoBa) is a valuable resource for the study of the effects of maternal alcohol consumption. MoBa’s strengths include a population-based sample of over 107,000 pregnancies, concurrent and retrospective assessment of maternal prenatal and postnatal alcohol consumption, and prospective follow-up for pregnancy and child outcomes. Direct questions were asked on the frequency, dose and timing of maternal alcohol consumption. Screening tools including the T-ACE and partial Rutgers Alcohol Problem Index were used to identify women at risk for drinking during pregnancy. Comprehensive information on potential confounders was collected including maternal medical history, reproductive history, smoking, and other substance use. The detailed alcohol data allow the differentiation between non-binge and binge-level drinking, important for studying different thresholds of exposure. The availability of maternal and infant DNA enables the study of genetic differences in alcohol metabolism. Besides conventional analyses, sibship studies of differentially exposed siblings can be conducted among the offspring of over 15,000 women who participated in the study for more than one pregnancy. Although there are low levels of social disadvantage in Norway (poverty increases the risk of harms from prenatal drinking), binge drinking is a common pattern of consumption and previous studies found that drinking alcohol during pregnancy is not uncommon. Here, I provide a brief review of prenatal alcohol literature and measurement issues, describe MoBa alcohol variables, and discuss how MoBa can contribute to maternal alcohol research within the context of Norway.

Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis

BackgroundA range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services.MethodsAll inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation – Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person’s home postcode, and stratified by socio-economic disadvantage.ResultsThis study covered July – December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person’s home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage.ConclusionThese data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.

A Novel Look at Racial Health Disparities: The Interaction Between Social Disadvantage and Environmental Health

We explored the notion that social disadvantage increases vulnerability to the health effects of environmental hazards. Specifically, we examined (1) whether race modifies the association between blood lead and blood pressure and (2) whether socioeconomic status (SES) plays a role in this modifying effect. Using the National Health and Nutrition Examination Survey (2001-2008) and linear regression, we estimated the association between blood lead and blood pressure. Using interactions among race, SES, and lead, we estimated this association by levels of social disadvantage. Black men and women showed a 2.8 (P < .001) and 4.0 (P < .001) millimeters mercury increase in SBP, respectively, for each doubling of blood lead. White adults showed no association. This lead-SBP association exhibited by Blacks was primarily isolated to Blacks of low SES. For example, poor but not nonpoor Black men showed a 4.8 millimeters mercury (P < .001) increase in SBP for each doubling of blood lead. Our results suggest that social disadvantage exacerbates the deleterious health effects of lead. Our work provides evidence that social and environmental factors must be addressed together to eliminate health disparities.

Schools, Governance and Community: A Next Practice Intervention

The article analyses an innovative scheme for the re-organization of school governance that sought to enhance the voice of community members and contribute towards the improvement of educational achievement. The scheme was located in the north of England, a region characterized by high levels of social disadvantage and low participation rates in higher education. The research adopted a case study methodology informed by observation, minutes of governors’ meetings, training workshops, conferences, face-to-face interviews, online surveys and local authority (LA) documentation. The fieldwork was conducted in 2007—2008. The findings suggest that although aspects of community engagement are present they are inhibited by a number of factors operating at the strategic level in LA policy. This results in an aspirational model of school governance that reflects traditional practices in which the LA intercedes as the indispensable broker and external agent for innovation and change. In order to move away from the restrictions of this approach the LA needs to expand its strategies to involve members of the community in governance and develop mechanisms to devolve greater decision-making power to the community.

Chronic Offenders or Socially Disadvantaged Youth? Institutionalized Males as Missing Cases in School‐based Delinquency Research

Previous criminological studies comparing institutional youth populations with community samples have for the most part focused on youths institutionalized primarily as a result of involvements in delinquency. The present study compares levels of social disadvantage and criminal involvement within a nationally representative sample of Swedish schoolboys with those of a national population of institutionalized males that includes both serious young offenders and youths institutionalized for other reasons. Whilst at the aggregate level, mean levels of offending are higher within the institutional sample, the institutional population includes youths from across the entire range of levels of offending. Levels of social disadvantage are substantially elevated among the institutionalized males by comparison with the school sample. The study notes that institutionalized samples, where these include both young offenders and youths institutionalized for other reasons, may provide a fruitful ground for life‐course research into the way involvements in crime interact with other indicators of social disadvantage to affect the likelihood of continued marginalization into adulthood.

The influence of attractiveness factors and distance to general practice surgeries by level of social disadvantage and global access in Perth, Western Australia

The impact on attendance of the distance to general practice surgeries, and the attributes offered by those surgeries, was investigated. One thousand and forty four subjects, selected at random from the metropolitan area of Perth, Western Australia, responded to a household interview survey concerning which attributes of general practice (GP) surgeries they found attractive and the identity of the surgery they preferred to attend. The sample was stratified by different levels of social disadvantage and by good and poor global levels of spatial accessibility of GP surgeries. In separate fieldwork, interviewers collected detailed environmental data from practice staff at 466 GP surgeries available to the community survey respondents within metropolitan Perth. Respondents living in areas of poor global access were more likely to attend their nearest surgery (25% vs. 6%) and to bypass fewer surgeries to attend a preferred surgery (median 2 vs. 20). Those who were most socially disadvantaged were less likely than those who were better off to bypass surgeries where global access was poor, but more likely to bypass nearby surgeries and to seek out a surgery that bulk billed in areas where global access was good. A number of attractiveness factors had an important influence on choice of surgery, including: ‘easy to make an appointment’; ‘generally sees patients on time’; ‘pharmacy nearby’; ‘bulk bills’ and ‘open at all on Sundays’. Respondents attending their nearest surgery were more likely to have all of their nominated ‘very important’ attributes satisfied at that surgery than non-attenders (40% vs. 16%). A logistic regression model, adjusting for distance effects and size of surgery, showed within each level of global access and social disadvantage a consistent increase in the odds of attending a surgery that satisfied the attributes desired by respondents.

Helping parents to stop smoking: which interventions are effective?

Parental smoking increases children's risk of respiratory illness. Encouraging parents not to smoke in the home helps, but stopping smoking altogether is more effective in reducing children's exposure. The prevalence of smoking increases with higher levels of social disadvantage and is therefore a major contributor to widening inequalities in health. Randomised trials have shown that adults can be helped to stop with simple advice from health professionals, behavioural support, nicotine replacement and antidepressants.

Depression among postnatal women in an urban Irish community

AbstractObjectives:To estimate the prevalence of postnatal depression in a community sample of women in a disadvantaged urban area in West Dublin, and to examine the factors which may be associated with it.Method: All women who had a live birth in the area over a one year period were identified (944) and the self-rated Edinburgh Postnatal Depression Scale (EPDS) was distributed to those who could be contacted by the public health nurses. Those scoring in the depressed range (&gt; 12) were compared to non-depressed for age, marital status, employment, parity, presence of a confidant, mode of delivery, previous miscarriage and previous psychiatric history.Results: Contact was made with 596 women and 377 responded. Responders were older and more likely to be first time mothers, but there was no significant difference between responders and eligible population for marital status. One hundred and eight women (28.6%) scored in the depressed range. Ten sociodemographic and clinical variables were entered into a logistic regression. Scores over the threshold (&gt; 12), suggesting clinical depression, were significantly associated with four variables, lower age, absence of a confidant, previous miscarriage and previous treatment for depression by a GP.Conclusions: A high prevalence of postnatal depression of 28.6% was reported, which may be associated with overall high levels of social disadvantage in this sample. There were implications for the targeting of resources into such areas. The associated factors are discussed.