Low Affluence Research Articles

Type 1 diabetes in North East England and North Cumbria: patterns and time trends in 0-14-year-olds from 2012 to 2020.

It is important to understand patterns in the epidemiology of type 1 diabetes because they may provide insight into its etiology. We examined the incidence of type 1 diabetes in children aged 0-14 years, and patient demographics and clinical parameters at presentation, over the period 2012-2020 using the North East and North Cumbria Young Persons diabetes register. Patients up to the age of 14 years with type 1 diabetes, and their families- managed in a total of 18 young persons diabetes clinics-were approached in person at the time of clinic appointments or in the days following diagnosis and they consented to their data being included in the register. Data were submitted regionally to a central unit. Descriptive statistics including crude and age-specific incidence rates were calculated. Temporal trends were analyzed using Joinpoint regression. Comparisons in incidence rates were made between age, sex and areas of higher and lower affluence as measured by the Index of Multiple Deprivation (IMD). A total of 943 cases were recorded between January 2012 and December 2020. Median age at diagnosis was 8.8 years (Q1: 5.3, Q3: 11.7). There were more males than females (54% male). The median HbA1c at diagnosis was 100 mmoL/L (IQR: 39) and over one third (35%) were in ketoacidosis (pH < 7.3). Crude incidence decreased from 25.5 (95% confidence interval [CI] 20.9, 29.9) in 2012 to 16.6 (95% CI: 13.0, 20.2) per 100,000 in 2020 (5.1% per annum, 95% CI 1.1, 8.8%). During the period of the study there was no evidence of any trends in median age, HbA1c, BMI or birthweight (p = 0.18, 0.80, 0.69, 0.32) at diagnosis. Higher rates were observed in males aged 10-14 years, but similar rates were found for both sexes aged 0-9 years and there was no difference between areas of higher or lower deprivation (p = 0.22). The incidence of diabetes in the young may be falling in the North East of England and North Cumbria. The reasons are unclear as there were no associations identified between levels of deprivation or anthropometric measurements. Potential mechanisms include alterations in socioeconomic background or growth pattern. Further research is needed to understand the reasons behind this finding.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018.

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

Mechanisms accounting for gendered differences in mental health status among young Canadians: A novel quantitative analysis

Adolescent girls consistently report worse mental health than boys. This study used reports from a 2018 national health promotion survey (n = 11,373) to quantitatively explore why such gender-based differences exist among young Canadians.Using mediation analyses and contemporary social theory, we explored mechanisms that may explain differences in mental health between adolescents who identify as boys versus girls. The potential mediators tested were social supports within family and friends, engagement in addictive social media use, and overt risk-taking. Analyses were performed with the full sample and in specific high-risk groups, such as adolescents who report lower family affluence.Higher levels of addictive social media use and lower perceived levels of family support among girls mediated a significant proportion of the difference between boys and girls for each of the three mental health outcomes (depressive symptoms, frequent health complaints, and diagnosis of mental illness). Observed mediation effects were similar in high-risk subgroups; however, among those with low affluence, effects of family support were somewhat more pronounced.Study findings point to deeper, root causes of gender-based mental health inequalities that emerge during childhood. Interventions designed to reduce girls' addictive social media use or increase their perceived family support, to be more in line with their male peers, could help to reduce differences in mental health between boys and girls. Contemporary focus on social media use and social supports among girls, especially those with low affluence, warrant study as the basis for public health and clinical interventions.

Universal salt iodization potentially contributes to health equity: socio-economic status of children does not affect iodine status.

Many studies have shown that socio-economic status (SES) contributes to health inequalities, with nutrition as one of the major risk factors. Iodine intake entirely depends on external sources, and deficiencies are known to be more prevalent in lower social groups, especially in countries with limited access to iodized salt. This study aimed to determine the influence of SES on iodine status and iodine availability from household salt in North Macedonia. Using cluster sampling, 1,200 children were recruited, and 1,191 children participated (response rate: 99.2%). Iodine status was assessed through urinary iodine concentration (UIC), and iodine availability through iodine content in household salt requested from participants. SES was assessed using standardized Family Affluence Score (FAS). No statistically significant correlation was found between FAS and iodine in salt. Median regression revealed no significant associations of middle vs. low FAS (β=0.00; 95%-confidence interval (CI)=[-0.61, 0.62]; p=0.999) or high vs. low affluence (β=0.48; 95% CI=[-1.37, 0.41]; p=0.291) with iodine content in household salt. UIC levels were significantly lower in middle FAS children compared to low FAS children (β=-16.4; 95% CI=[-32.3,-0.5]; p=0.043). No statistically significant differences in UIC were found between children with high and low affluence (β=-12.5; 95% CI=[-35.5, 10.5]; p=0.287), possibly due to lowered statistical power for this comparison. Universal salt iodization (USI) proves to be a cost-effective measure for appropriate iodine intake in healthy children and adults, irrespective of their social status. It can thus be concluded that USI contributes to reducing health inequalities related to iodine status among population of different social strata.

Prevalence and determinants of Internet Addiction among medical students and its association with depression

BackgroundInternet addiction has been a topic of discussion in the academic literature for many years. As of April 2020, about 60 % of the world's population (nearly 4.6 billion people) were active internet user in their early adulthood. The prevalence among adolescent and college students ranged from 0.9 % to 33 %. The current study aimed to explore internet addiction's prevalence and correlates among undergraduate medical students at an Egyptian university. Also, to assess the relationship between internet addiction, depression symptoms, and socioeconomic status. MethodsA cross-sectional study of 321 undergraduate medical students at Assiut University using the Internet Addiction Scale, Patient Health Questionnaire, and Family Affluence Scale. ResultsAbout 9 % of the study participants screened positive for internet addiction. The most important determinants among medical students were sex, mother's employment status, family affluence, depressive symptoms, and unmonitored internet access. LimitationsWe did not investigate another psychiatric disease, daily time of internet usage, most frequent time of usage, type of internet usage, and cost of use. ConclusionsInternet Addiction is an important psychological problem affecting about 9 % of Assiut university medical students during their undergraduate stage, which may interfere with their lives and studies. Students with lower Internet addiction rates were female students whose mothers were employed, lived in a low affluence family, had fewer depressive symptoms, and had unmonitored internet privacy.

Considerable Unaccounted Local Sources of NOx Emissions in China Revealed from Satellite.

High-resolution (e.g., 5 km) emission data of nitrogen oxides (NOx = NO + NO2) provide localized knowledge of pollution sources for targeted regulations, yet such data are lacking or inaccurate over most regions at present. Here we improve our PHLET-based inversion method to derive NOx emissions in China at a 5-km resolution in summer 2019, based on the TROPOMI-POMINO satellite product of nitrogen dioxide (NO2) columns. With low computational costs, our inversion explicitly accounts for the effects of horizontal transport and nonlinear chemistry. We find numerous small-to-medium sources related to minor roads and small human settlements at relatively low affluence levels, in addition to clear emission signals along major transportation lines, consistent with road line density and Tencent location data. Many small-to-medium sources and transportation emissions are unclear or missing in the spatial distributions of four widely used emission inventories. Our emissions offer a unique reference for targeted emission control.

Factors associated with uncorrected refractive errors in school-going adolescents in Kakamega County, Kenya

Background: Uncorrected refractive errors (URE) present an enormous burden on children in Kenya. The study investigated factors associated with URE in school-going adolescents in Kakamega County, Kenya. Material and methods: An observational, cross-sectional study with multistage sampling was conducted with randomly selected secondary school students in forms one to four. Comprehensive clinical examinations conducted by optometrists were used to determine participants’ URE types and dioptric strength. Structured pre-validated questionnaires were administered to participants to elicit information on their sociodemographic and socioeconomic statuses. Results: A total of 165 students, aged 17.45 ± 1.44 years, with URE classified into myopia, hyperopia, and astigmatism, participated in the study. There were more males (57%) than females in this study, and most participants had astigmatism (52%). The study found no-to-weak association between predefined factors and URE. While males had decreased odds [odds ratio (OR): 0.557, 95% confidence interval (CI): 0.211–1.470] for myopia than astigmatism, the converse was true for hyperopia (OR: 1.165, 95% CI: 0.385–3.524) compared with astigmatism. Even though participants from families with lower affluence and living in rural settings had up to 18 times increased odds (OR: 18.699, 95% CI: 0.840–416.442) for myopia than astigmatism and hyperopia, significant dioptric power was less likely to be present in those with myopia (OR: 0.529, 95% CI: 0.165–1.698) and hyperopia (OR: 0.011, 95% CI: 0.001–0.192). Conclusions: URE may not be significantly associated with school-going adolescents’ sociodemographic and socioeconomic statuses. However, myopia and astigmatism are increasingly likely to be present among participants from families with lower affluence and living in rural settings.

Expectations for engagement in community issues as perceived by young people.

BackgroundInvolvement in constructive activities is an important but rarely empirically studied developmental asset.ObjectiveThe aim of the study is to assess the intentions of Polish youth to undertake prosocial activities after graduating from high school, and the selected determinants of these intentions.Material and methodsAnonymous surveys were conducted in 213 schools within the last round of the HBSC (Health Behaviour in School-aged Children) survey in 2018. The nationwide representative sample included 4,972 students aged 11.1–18.5 (mean age 15.4 ± 1.73). The main dependent variable was the Expectations for Engagement in Community Issues Index (EECII), built on the basis of 3 questions and ranged 0–12 points. Its relationship with 10 demographic and socio-economic variables was studied.ResultsThe mean EECII score was 5.59 (SD = 2.65). Seven factors and three significant two-way interactions were indicated in the general linear model. The strongest correlation was found to be between the EECII level and recognised personal values, current participation in youth groups, and the level of social ties in the neighbourhood. Girls achieve higher EECII levels than boys. However, factors such as family social position and attitudes towards school modify the gender differences. Higher family social position measured on subjective scale increases the tendency to plan prosocial activities in the group coming from low affluence families.ConclusionsPolish youth have an average inclination towards prosocial activities. When planning activities aimed at strengthening the involvement of young people, it is worth considering the specificity of various demographic and social groups.

Using Latent Class Analysis to Explore Complex Associations Between Socioeconomic Status and Adolescent Health and Well-Being

PurposeResearch demonstrates a strong socioeconomic gradient in health and well-being. However, many studies rely on unidimensional measures of socioeconomic status (SES) (e.g. educational qualifications, household income), and there is often a more limited consideration of how facets of SES combine to impact well-being. This paper develops a multidimensional measure of SES, drawing on family and school-level factors, to provide more nuanced understandings of socioeconomic patterns in adolescent substance use and mental well-being. MethodsData from the Student Health and Wellbeing Survey from Wales, UK was employed. The sample compromised 22,372 students and we used latent class analysis to identify distinct groups using three measures of SES. These classes were then used to estimate mental well-being, internalizing symptoms, and substance use. ResultsThe five-class solution offered the best fit. Findings indicated distinct classes of families as follows: “nonworking,” “deprived working families,” “affluent families in deprived schools,” “lower affluence,” and “higher affluence.” There was a clear relationship among the classes and mental well-being, internalizing symptoms, smoking, and cannabis use; alcohol was the exception to this. ConclusionsThe identification of these classes led to a fuller understanding of the health and well-being effects of SES, showing clearer patterning in health behaviors that often is not captured in research. The implications for adolescent health and well-being are discussed, including considerations for future research.

Financial status and materialism – The mediating role of self-esteem

ABSTRACT Objective: One of the reasons why people develop a materialistic attitude may be their desire to compensate for economic deprivation. Poor people experience negative emotions as a result of deprivation, and this translates into low self-esteem. It is argued that, as a means of dealing with low self-esteem, people often use material goods, and thus become more materialistic. However, this idea has only previously been tested in studies of adolescents. The aim of the present study is to investigate the relationship between financial status (both objective and subjective), self-esteem and materialism. Method: The study was conducted using a representative sample of Polish working adults (N = 1138) recruited from an online panel. Data were analysed through correlation, regression and mediation analyses. Results: The study found no significant relationship between financial status and general materialism. However, relationships between both measures of financial status and two separate dimensions of materialism were observed (positive correlations with centrality, and negative correlations with happiness). Moreover, the study showed self-esteem to be a mediator of the relationship between financial status and the happiness dimension of materialism, and that self-esteem acts as a suppressor of the relationship between financial status and the centrality dimension of materialism. Conclusion: These results show that particular dimensions of materialism may be related to financial status in completely different ways. While poorer people more closely associate material goods with their happiness, richer people consider ownership to be more central in their lives. KEY POINTS What is already known about the topic: Previous theoretical considerations indicated that low financial status can promote materialism. Children and teenagers belonging to poorer families exhibit higher levels of materialism than their peers belonging to richer families. Previous research on children and adolescents found that lower affluence was associated with greater materialism, and that this was explained by lower self-esteem among the poorer participants. What this topic adds: Among adults, financial status (both objective and subjective) does not correlate with general materialism but is significantly related to two of the three dimensions of materialism (happiness and centrality). Financial status (both objective and subjective) correlates negatively with happiness dimension of materialism and positively with centrality dimension of materialism. Self-esteem is a mediator of the relationship between financial status and the happiness dimension of materialism, and a suppressor of the relationship between financial status and the centrality dimension of materialism.

Risky Alcohol Drinking Pattern and Its Association with Educational Attainment and Wealth Index among Adult Men Population in Ethiopia: Further Analysis of 2016 Ethiopian Demographic Health Survey.

Risky alcohol drinking is one of the major public health problems and an important health risk factor for premature death and disability worldwide. Identifying the determinants of risky alcohol drinking patterns is crucial for developing and improving intervention on drinking behavior. In Ethiopia, the role of educational attainment and affluence in reducing risky alcohol drinking patterns among men remains unclear. Therefore, this study aimed to assess the association of educational status and affluence with risky alcohol drinking patterns using national representative data in Ethiopia. Secondary data analysis was conducted on 12,688 adult men using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The dependent variable was a risky alcohol drinking pattern which is defined as the consumption of alcohol every day in the last 12 months before the interview. Multivariable logistic regression was employed to assess the association between educational attainment, Ethiopian standard wealth index, and risky alcohol drinking pattern, after adjusting for the potential confounders. The overall magnitude of risky alcohol drinking patterns among men in Ethiopia was 4.5% (95% CI: 3.4–5.9). Of the total men who had ever taken alcohol, 9.7% of men drink almost every day in the last 12 months. The odds of having a risky alcohol drinking pattern were lower among men who completed secondary education (AOR = 0.56 (0.329–0.961)) and men who completed higher education levels (AOR = 0.35 (0.164–0.765)) as compared to men who did not attend any formal education. Adult men in the top two wealth quintiles were twice more likely to have risky alcohol drinking patterns than those in the lowest wealth quintile (AOR = 2.13 (1.254–3.605)). This study showed that from the total adult male population, nearly 5% of Ethiopian men had risky drinking patterns. Individuals with low educational status and greater affluence engaged in high-risk alcohol consumption behavior.

A Community Audit of 300 "Drop-Out" Instances in Children Undergoing Ponseti Clubfoot Care in Bangladesh-What Do the Parents Say?

Introduction: Drop-out before treatment completion is a vexing problem for all clubfoot clinics. We and others have previously identified better engagement with parents as a crucial method of ameliorating incomplete clubfoot treatment, which increases deformity relapse. Materials and methods: The novel use of community facilitators enabled an audit of over 300 families who had dropped-out from a child’s clubfoot treatment. A questionnaire standardized the parent interviews. Parents were encouraged to present for clinical review of their child’s clubfeet. Results: When treatment was discontinued for six months, 309 families were audited. A social profile of families was developed, showing that most lived in tin houses with one working family member, indicating low affluence. Family issues, brace difficulty, travel distances, and insufficient understanding of ongoing bracing and follow-up were the main reasons for discontinuing treatment. Overt deformity relapse was found in 9% of children, while half of the children recommenced brace use after review. Conclusions: Identifying families at risk of dropping out from clubfoot care enables support to be instigated. Our findings encourage clinicians to empathize with parents of children with clubfoot deformity. The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support.

Factors Contributing to Delay in Driving Licensure Among U.S. High School Students and Young Adults

PurposeMore teens delay in driving licensure (DDL). It is conceivable they miss Graduated Driver Licensing (GDL) safety benefits. We assessed prevalence, disparities, and factors associated with DDL among emerging adults. MethodsData used were from all seven waves (W1–7) of the NEXT Generation Health Study (W1 in 10th grade [2009–2010]). The outcome variable was DDL (long-DDL [delayed >2 years], intermediate-DDL [delayed 1–2 years] versus no-DDL), defined as participants receiving driver licensure ≥1 year after initial eligibility. Independent variables included sex, urbanicity, race/ethnicity, family structure, parental education, family affluence, parental monitoring knowledge, parent perceived importance of alcohol nonuse, and social media use. Logistic regressions were conducted. ResultsOf 2,525 participants eligible for licensure, 887 (38.9%) reported intermediate-DDL and 1,078 (30.1%) long-DDL. Latinos (adjusted odds ratio [AOR] = 2.5 vs. whites) and those with lower affluence (AOR = 2.5 vs. high) had higher odds of intermediate-DDL. Latinos (AOR = 4.5 vs. whites), blacks (AOR = 2.3 vs. whites), those with single parent (AOR = 1.7 vs. both biological parents), whose parents’ education was high school or less (AOR = 3.7 vs. bachelor+) and some college (AOR = 2.0 vs. bachelor+) levels, and those with lower affluence (AOR = 4.4 vs. high) had higher odds of long-DDL. Higher mother’s monitoring knowledge (AOR = .6) was associated with lower odds of long-DDL, but not intermediate-DDL. ConclusionsSome teens that DDL “age out” of protections afforded to them by GDL driver restrictions. Minority race/ethnicity, socioeconomic status, urbanicity, and parenting factors contribute to DDL. Further study of these factors and their individual/collective contributions to DDL is needed to understand potential unintended consequences of GDL, particularly in more vulnerable youth.

Determinants of energy drink consumption in adolescents: identification of sex-specific patterns

ObjectivesTo investigate sex differences in sociodemographic and lifestyle correlates of frequent energy drink (ED) consumption in adolescents. Study designThis study was based on data collected among French-speaking Belgian adolescents aged 11–20 years (n = 8137) within the 2018 Health Behaviour in School-aged Children study. MethodsMultiple logistic analyses stratified by sex were performed to estimate the associations between consuming EDs more than once a week, and various sociodemographic and lifestyle characteristics. ResultsOverall, 14.0% of boys and 7.6% of girls consumed ED more than once a week. For both genders, the likelihood of consuming ED more than once a week was higher among adolescents consuming soft drinks daily (vs. < daily), alcohol weekly (vs. < weekly), spending at least 5 h/day in front of screens (vs. < 5 h/day), and going to bed later than 11:30 PM (vs. ≤ 10:00 PM). Among boys, adolescents reporting at least 1 h of moderate-to-vigorous physical activity (MVPA) daily (vs. < 1 h/day MVPA) were more likely to consume ED more than once a week (adjusted odd ratio (aOR) = 1.49 (95% confidence interval [CI] 1.11–2.01)). Among girls, adolescents from low affluence families (vs. high affluence) (aOR = 2.03 (95% CI 1.19–3.48)) and immigrants (vs. natives) (2nd generation: aOR = 1.75 (95% CI 1.31–2.32); 1st generation: aOR = 1.90 (95% CI 1.20–3.03)) were more likely to consume ED more than once a week. ConclusionsWe identified different patterns of ED consumption in boys and girls. These results suggest that sex-tailored interventions could be relevant to reduce ED consumption in adolescents.

Socioeconomic and demographic determinants of familial social capital inequalities: a cross-sectional study of young people in sub-Saharan African context

BackgroundSocial capital is broadly acknowledged as a vital ‘health asset’ that promotes young people’s health and wellbeing and has the potential to prevent social- and health-related risk behaviours in the life-course. However, limited research has investigated the determinants of social capital for young people in sub-Saharan Africa. This study examines the role of socioeconomic and demographic factors in establishing inequalities in familial social capital among young people in Ghana.MethodsThe study utilised a cross-sectional survey data involving 2068 in-school adolescents (13-18 years) in the Upper West Region, Ghana. Familial social capital was assessed by ‘family sense of belonging’, ‘family autonomy support’ and ‘family control’. Multinomial logistic regressions established the relationships between socioeconomic and demographic factors and the measures of familial social capital.ResultsAdolescents from low affluence households had about 63 and 61% lower odds of attaining a high family sense of belonging (FSB) (OR = 0.373; 95%CI: 0.27–0.513) and high family autonomy support (FAS) (OR = 0.387; 95%CI: 0.270–0.556) respectively but had 67% higher odds of reporting high family control (FC) (OR = 1.673; 95%CI: 1.187–2.359) than their counterparts. Males had about 55 and 71% higher odds to possess high FSB (OR = 1.549; 95%CI: 1.210–1.983) and high FAS (OR = 1.705; 95%CI: 1.272–2.284) respectively but had 38% lower odds to report high family control (OR = 0.624; 95%CI: 0.474–0.822) than females. The odd of young adolescents to attain high FSB than older adolescents were about 66% higher (OR = 1.662; 95%CI: 1.168–2.367). Religion, educational level, ethnicity, family structure, and marital status were also significant predictors of adolescents’ family sense of belonging, family autonomy support and, family control.ConclusionsSocioeconomic and demographic factors influence inequalities in the amount of familial social capital possessed by young people which suggests possible risks of social inequality. The family context is possibly failing some cohorts of young people with particular reference to female and poor adolescents regarding familial cognitive social capital. Public health strategies should include families in addressing socioeconomic and demographic differences in social capital with a key focus on the cohorts of young people at risk of social capital inequality.

Association of stress with cardiovascular diseases and risk factors in a population (ESSE-RF in Kemerovo region)

Aim. To assess the prevalence of stress and its association with socio-demographic characteristics, cardiovascular risk factors and cardiovascular diseases (CVD) in the Siberian population.Material and methods. A cross-sectional study was performed in the framework of the Russian multicenter epidemiological study ESSE-RF in the Kemerovo Region in 2013. The presented study included 1628 individuals aged 25 to 64 years. Information was assessed on the presence of stress, some socio-demographic and economic characteristics, a history of CVD, as well as behavioral habits and quality of life. To eliminate the modifying effect of socio-demographic characteristics, a logistic regression analysis was used. The odds ratio (OR) and the 95% confidence interval (CI) were calculated.Results. The prevalence of stress was 22,6%; stress was statistically significantly more often recorded in women (28,1%) than in men (11,7%). After adjusting for sociodemographic characteristics, stress was statistically significantly more often recorded in people with secondary and primary education compared with those with higher education (24,9% and 19,1%, p=0,006), as well as in people with middle and high financial affluence compared with low affluence (24,5% and 11,3%, p&lt;0,001). This association is observed only at the expense of women. For unemployed participants, the stress rate is higher only among males — 18,8% versus 11,4% among workers (p=0,015). Stress was also statistically significantly more often recorded in groups with arterial hypertension, lack of sleep, quality of life on the EQ-VAS scale and on the EuroQol scale. Smokers are more likely to have stress (23,8% vs 22,0%) and have a history of stroke (35,3% vs 22,2%). Among all CVDs and their risk factors, an inverse association of stress with obesity was revealed only in men.Conclusion. Study showed that people with stress are under large load of some cardiovascular risk factors. At the same time, ambiguous associations between stress and arterial hypertension and quality of life were obtained. This confirms the need for further study of the association of stress with other factors of cardiovascular risk, taking into account age and gender and socio-economic characteristics of the population.

Health asset profiles and health indicators among 13- and 15-year-old adolescents

ObjectivesWe examined the associations between adolescents’ health assets and various health indicators (smoking, alcohol use, sleep length, physical activity, healthy eating, oral health, self-reported health, multiple health complaints).MethodsA nationally representative sample was drawn from Finnish-speaking schools, comprising 13- and 15-year-old adolescents (n = 3833). The measures taken covered the adolescents’ health assets, which were labelled Family-financial, Psychological, Family-social, Friends-social, School-social, and Human. Our analysis applied two-step cluster analysis and multilevel mixed-effects binary logistic regression.ResultsSix asset profiles were identified: ‘Limited in most assets, despite medium affluence’, ‘Mostly average assets, but low affluence’, ‘Mostly average assets, though high affluence’, ‘Mostly above average assets’, ‘Rich in most assets’, and ‘Rich in all assets’. There were significant differences between the profiles in terms of risk level and desirable level health outcomes.ConclusionsAdolescents differ in their asset profiles. Having multiple health assets appears to protect adolescents from risky behaviour or poor health, and to promote positive health. There is a need for health initiatives to develop a range of health-protecting and health-promoting assets, rather than focus on only one.

Self-Reported Oral Health Related Behaviour and Gum Bleeding of Adolescents in Slovakia in Relation to Socioeconomic Status of Their Parents: Cross-Sectional Study Based on Representative Data Collection.

Background: Oral health strongly affects overall health and is related to many factors. The aim of our study was to analyse oral health related behaviours (OHRBs) and gum bleeding among Slovak adolescents and assess the effect of socioeconomic factors on the outcomes. Methods: Data from the Health Behaviour in School-aged Children study (HBSC) were used (N = 8896, age range = 10–16 years, M = 13.4; SD = 1.4; 50.9% boys). Sociodemographic and socioeconomic indicators and frequency of OHRBs (dental hygiene, toothbrush changing, preventive check-up) and gum bleeding were collected. Effects of sociodemographic and socioeconomic variables on outcome variables were analysed by binary logistic regression. Results: We found that prevalence of OHRBs slightly decreases with age, and worse outcomes were reported by boys compared to girls (OHRB odds ratio range 0.45–0.75, (95% C.I. range 0.40–0.91), gum bleeding 1.38 (95% C.I. 1.19–1.61), p < 0.05). OHRBs were in most cases significantly associated with socioeconomic variables, lower affluence predicts worse outcomes (odds ratio range 0.76–0.88 (95% C.I. range 0.68–0.96), p < 0.05). Conclusion: Our study provides representative findings on ORHBs in Slovakia and shows important associations of socioeconomic factors related to adolescents’ oral health issues.

Neighbourhood influence on the fourth dose of diphtheria-tetanus-pertussis vaccination.

Using 542,159 vaccination records from children born between April 1, 2007, and March 31, 2012, in the Michigan Care Improvement Registry and data from the American Community Survey, we determine if neighbourhood-level characteristics at the Census tract level and block level are associated with low uptake of the fourth dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP4). This study was a cross-sectional study. We used exploratory factor analysis to determine important socio-economic factors at the Census block level and tract level. We then used generalised estimating equations to test the relationship between block- and tract-level socio-economic factors and DTaP4 uptake. DTaP4 coverage was 88.6% (95% confidence interval [CI]: 88.4%-88.7%) in Michigan. At the Census tract level, two factors surfaced as important for DTaP4 vaccination: 'affluence' (Cronbach's alpha=0.88) and 'socio-economic disadvantage' (Cronbach's alpha=0.89). At the Census block level, one factor was important: 'affluence' (Cronbach's alpha=0.90). Affluence may relate to knowledge about medical exemptions and antivaccination sentiment, while socio-economic disadvantage may indicate limited access to healthcare resources. Children in high-affluence tracts had 1.08% lower vaccination coverage (95% CI: -1.62% to -0.55%) than children in low affluence tracts. Children in low socio-economic disadvantage tracts had 2.92% higher coverage than children in high socio-economic disadvantage tracts (95% CI: 2.58%-3.26%). This study articulates the need to further understand the contribution of neighbourhood-level characteristics, from both affluent and socioeconomically disadvantaged areas to low vaccination rates. Developing a better understanding of these social environmental factors will help determine useful community-level interventions to improve vaccination rates and reduce disease burden.

Multilevel Analysis of the Risk Factors in High-Risk Health Behavior among Korean Adolescents.

ObjectivesTo examine health behaviors among Korean adolescents with a focus on both individual and school-based factors, specifically in relation to predictors of high-risk groups.MethodsSecondary data analysis was conducted with data from the 8th Korea Youth Risk Behavior Web-Based Survey, using descriptive statistics, t tests, χ2 test, and multilevel logistic regression analysis. Health Practice Index was calculated and a range of 0 to 2 was classified as a high-risk group.ResultsThe results revealed that the individual-level variables of sex, age, stress, depression, subjective health status, school performance, health education, father’s level of education, and living situation were significant predictors of high-risk behaviors. The risk was greater in girls, greater with higher age and higher stress scores, greater in adolescents with depression, greater with lower paternal educational level, and greater in adolescents who did not live with both parents, as were the school-level variables of school grade and school affluence score. The possibility of being in the high-risk group in health behavior was greater if a student attended a school where the Family Affluence Score (FAS) was lower.ConclusionSchool health education should be expanded to manage students’ high-risk health behaviors, especially in schools that have many students from families with a low affluence status.