People Of Low Socioeconomic Status Research Articles

Nothing beats taste or convenience: a national survey of where and why people buy sugary drinks in Australia

ObjectiveThere is limited knowledge of what influences sugary drink purchasing decisions in the Australian population. This study aimed to identify the most common locations and reasons across different demographic groups for purchasing sugary drinks in Australia. MethodsA total of 891 respondents (who purchased sugary drinks for personal consumption at least occasionally) from a broader national population telephone survey of Australian adults conducted in 2017 (n=3,430) were included in the analysis. Results‘Taste’ was a ubiquitous reason for purchase (94%) and the majority also agreed with ‘easily available’ (76%). Males, younger people and people of lower socioeconomic status (SES) were significantly more likely to agree that sugary drinks were ‘cheap’ and ‘better value than water’. Furthermore, males and younger people were more likely to report buying sugary drinks because they were ‘part of a meal deal’. The most common purchase locations were supermarkets (56%), followed by convenience stores (19%) and food or entertainment venues (17%). ConclusionTaste is paramount in decisions to purchase sugary drinks, and widespread availability and value for money support consumption. Implications for public healthPolicies and interventions targeting point‐of‐sale sugary drink purchasing decisions among the most ‘at risk’ consumers are warranted.

The Scientific Self-Literacy of Ordinary People: Scientific Dialogic Gatherings

In the last decade, researchers have responded to a social demand for science to become more responsible and have a greater effect on society by looking for innovative ways to link science and lay people. The movement to democratize expert knowledge is growing. This movement is creating tools that are used for improving the scientific literacy of citizens. This article presents dialogues between researchers and lay people of low socioeconomic status and low educational level on the social impact of a Scientific Dialogic Gathering (SDG) as a tool for promoting scientific self-literacy that is being developed at an urban adult school in Spain. Based on a communicative and qualitative approach, an SDG encourages people of low socioeconomic status and low educational level to learn about the latest scientific breakthroughs on issues that interest them, such as health-related topics. Participants in a SDG, together with researchers and educators, discuss scientific articles in an egalitarian dialog. One of the main results of this experience is that SDGs are helping lay people to make better decisions in the face of the challenges of today’s society.

Does online ticket booking system make people better off? An empirical study on railway service

The Spring Festival Travel Rush (SFTR) as the largest annual migration on earth has been a serious challenge for the railway system in China. In order to reduce the difficulty of ticket purchase, Chinese government has adopted information and communications technology (ICT) include online ticket booking system so that more ticket channels are available for passengers to choose from. However, whether the online ticket booking system in transportation can improve passengers’ well-being with the Spring Festival experience remains unknown. In this study, a structural equation model is developed to investigate the impact of online ticket booking system, socioeconomic status and perceived control on passengers’ well-being during SFTR. Results show that online ticket booking system has a direct positive influence on passengers’ well-being. In addition, the application of online ticket booking system and perceived control play an important mediating role between socioeconomic status and passengers’ well-being of Spring Festival. In particular, online ticket booking system had made it easier for people of lower socioeconomic status to purchase tickets and thus significantly raised their well-being.

Moderation by socioeconomic status of the relationship between familiarity with mental illness and stigma outcomes.

PurposeMultiple studies suggest response to mental health treatment is worse for people of lower socioeconomic status, a group who also express more mental illness stigma. Worse response to treatment may lead to greater therapeutic pessimism, an important component of stigma. However, familiarity with mental illness is associated with lower levels of stigma. This study therefore examines whether, among the general public, socioeconomic status moderates the relationships between familiarity and stigma related outcomes: knowledge; attitudes; and desire for social distance.MethodsWe carried out secondary analysis of data from the Attitudes to Mental Illness survey, collected annually from different general population samples from 2009-17, and every two years from 2017-19. Three separate multiple linear regression models examined factors associated with each outcome, with interaction tests between socioeconomic status and familiarity. Stigma related knowledge was measured using the Mental Health Knowledge Schedule (MAKS), which includes items on treatment effectiveness and recovery, thus addressing aspects of therapeutic pessimism. Attitudes were measured using the Community Attitudes towards the Mentally Ill Scale; and desire for social distance using the Reported and Intended Behaviour scale.ResultsIn lower socioeconomic groups, personal experience was more frequent, while familiarity with someone else was less frequent. Interaction tests were significant for stigma related knowledge (p<0.0001) and desire for social distance (p=0.0118), but not for attitudes (p=0.057). The direction of the interaction differed between knowledge and the other outcomes. In lower socioeconomic groups the positive effect of familiarity on knowledge was weaker, as hypothesised, but for attitudes and desire for social distance, its effect was stronger.ConclusionsOur results support the promotion of familiarity through encouraging discussion of mental health problems within social networks. However, lower stigma related knowledge among people with personal experience in lower socioeconomic groups suggests different responses to mental illness among these groups are needed.

Trends in the dietary patterns of Mexican adults by sociodemographic characteristics

BackgroundSociodemographic characteristics are associated with the dietary patterns of populations. However, the direction of the association is not consistent among countries: it is contingent on the nutritional transition phase, level of economic development, cultural contexts and both the social and health policies prevailing in each country. The objective of this study was to identify the trends in dietary patterns observed in 2006, 2012 and 2016 among Mexican adults by sociodemographic characteristic.MethodsTo determine and compare dietary patterns, we performed a secondary analysis of dietary and sociodemographic data for adults 20–59 years old. Data were drawn from the 2006 and 2012 National Health and Nutrition Surveys (ENSANUTs) together with the 2016 Half-Way National Health and Nutrition Survey (ENSANUTMC). To estimate the dietary patterns, we used an adapted version of the Healthy Eating Index-2015 (HEI-2015) and a quantile-based regression model to compare the HEI medians by sociodemographic characteristic.ResultsFrom 2006 to 2016, the quality of the diet of Mexican adults scored under 50 points on a scale of 0 to 100, markedly below the maximum scores for the majority of HEI-2015 components. Diet quality varied according to age, sex, socioeconomic status (SES), area (urban/rural) and region of residence, with the highest quality observed among older individuals (within the 40–59 age group), women, people of lower SES and residents of rural areas, particularly in southern Mexico. Although this trend remained constant overall throughout 2006, 2012 and 2016, specific HEI-2015 components showed an opposite trend by sociodemographic strata.ConclusionThe diet quality of Mexican adults was suboptimal from 2006 to 2016, with notorious disparities persisting over time among sociodemographic strata. Our results can serve as a basis for formulating recommendations on ways to improve the population diet, where those components diverging the most from adequate scores could be highlighted in public-health messages.

1049 Sleep Fragmentation And Sleep Restriction Are Associated With Increased Energy Intake Among Individuals Who Have Involuntarily Lost Their Jobs

Abstract Introduction Obesity is a major public health concern disproportionately affecting people of lower socioeconomic status. Involuntary job loss is a predictor of economic hardship and unemployment has been associated with poor sleep quality. Little is known about daily sleep and energy intake in this high-risk population. We hypothesized that disrupted, short sleep would be associated with increased energy intake among individuals who experienced involuntary job loss within the last 90 days. Methods Complete baseline data were analyzed from the ongoing Assessing Daily Activity Patterns through occupational Transitions (ADAPT) study. Over the same two-week period, participants (n = 191; 117 female; 63 Hispanic) were instructed to complete 14 days of daily sleep diaries and up to three 24-hour dietary recalls, conducted by trained interviewers using the Nutrition Data System for Research. The primary sleep variable was a composite score summarizing standardized number of awakenings and reversed-scored total sleep time; higher scores represented worse sleep. Energy intake was estimated as average 24 hour reported kcals/day. Linear regression was employed with age, gender, and body mass index as covariates. Results Higher sleep composite scores were associated with higher self-reported intake in kilocalories (kcal), B = 84.83, SE = 38.01, t = 2.23, &amp;lt;i&amp;gt; p &amp;lt;/i&amp;gt; &amp;lt; .05. Wake time after sleep onset, sleep onset latency, and sleep efficiency were not associated with energy intake. Interestingly, higher subjective sleep quality was associated with consumption of more average daily kcals. Conclusion In a sample population of adults experiencing stress and economic hardship related to job loss, sleep continuity and quantity were associated with higher energy intake. With further prospective support, these findings suggest that public health interventions for obesity may benefit from behavioral sleep intervention components targeting both sleep fragmentation and sleep restriction. Support #1R01HL117995-01A1

The Two Subalterns: Perceived Status and Violent Punitiveness

From the mid-twentieth century, state and public conceptions of deviance and crime control have turned increasingly punitive (Hallett 115; Hutchinson 138). In a Western context, criminal justice has long been retributive, prioritising punishment over rehabilitation (Wenzel et al. 26). Within that context, there has been an increase in punitiveness—understood here as a measure of a punishment’s severity—the intention of which has been to help restore the moral imbalance created by offending while also deterring future crime (Wenzel et al. 26). Entangled with the global spread of neoliberal capitalism, punitiveness has become internationally pervasive to a near-hegemonic degree (Sparks qtd. in Jennings et al. 463; Unnever and Cullen 100). The punitive turn has troubling characteristics. Punitive policies can be expensive, and increased incarceration stresses the criminal justice system and leads to prison overcrowding (Hutchinson 135). Further, punitiveness is not only applied unequally across categories such as class, race, and age (Unnever and Cullen 105-06; Wacquant 212) but the effectiveness of punitive policy relative to its costs is contested (Bouffard et al. 466, 477; Hutchinson 139). Despite this, evidence suggests public demand is driving punitive policymaking, but that demand is only weakly related to crime rates (Jennings et al. 463). While discussion of punitiveness in the public sphere often focuses on measures such as boot camps for young offenders, increased incarceration, and longer prison sentences, punitiveness also has a darker side. Our research analysing discussion taking place on a large, regional, crime-focused online forum reveals a startling degree and intensity of violence directed at offenders and related groups. Members of the discussion forum do propose unsurprising measures such as incarceration and boot camps, but also an array of violent alternatives, including beating, shooting, dismemberment, and conversion into animal food. This article draws on our research to explore why discussion of punitiveness can be so intensely violent.

Determinants of prescription opioid use: population-based evidence from Finland.

Previous studies have shown that prescription opioid use is more common in socio-economically disadvantaged communities in the United States. This study examined the area and individual-level determinants of prescription opioid use in Finland during the period 1995-2016. Logistic regression analysis using nation-wide data on filled opioid-related prescriptions dispensed at Finnish pharmacies and covered by National Health Insurance. Opioid consumption was linked, using personal identification codes, to population-based data maintained by Statistics Finland, which records individual background and area-level characteristics. Working-age population aged between 15 and 64years in Finland during the periods 1995-2007 (n=4 315 409) and 2009-16 (n=4 116 992). Annual prescription opioid use was measured using defined daily doses (DDD) and whether people used opioids during a year. Prescription opioid use increased in Finland from 1995 to 2016 (from less than 1 to 7%), but the increase was explained by the change in the treatment of codeine-based opioids in National Health Insurance. The area-level unemployment rate was positively correlated with the share of opioid users at the municipal level (r=0.36; P<0.001). In comparison with being employed, being outside the labour force was associated with increased opioid use in 1995-2007 [odds ratio (OR)=2.22, 95% confidence interval (CI)=2.10-2.36] and non-codeine opioid use in 2009-16 (OR=2.16, 95% CI=2.06-2.27), but not with codeine opioid use in 2009-16. Prescription opioid use in Finland appears to be more common among low socio-economic status people, similar to the United States and the United Kingdom.

Review on Portable Dental Services in Different Regions of America as an Example for Pakistan to Increase Overall Oral Healthcare

Objective: To assess the reach and effectiveness of mobile dental vans as a delivery method for providing oral healthcare access to people of low socioeconomic status.Methods: A literature review was conducted to identify mobile delivery methods of oral healthcare, the basic aim of which was to address the increasing oral health disparity concern. Forty one articles met the inclusion criteria. Out of the 41 articles, only 7 analysed the coverage and reach of the mobile dental clinics. Data was compiled from the literature in order to assess, evaluate and compare the different mobile dental care delivery methods in dentistry.Results: There is an association between transportation barrier and lack of access to oral healthcare. Thus, mobile dentistry helps deliver dental care to vulnerable populations.Conclusion: Mobile dental clinics are effective methods in improving access to oral healthcare among people of low socioeconomic status, which can be taken as an example for Pakistan in order to increase overall oral healthcare access.

Providing Access to Urban Green Spaces: A Participatory Benefit-Cost Analysis in Spain.

The opening up of green spaces could provide significant benefits to society. This study develops a framework to assess the economic benefits and costs of public interventions providing citizen access to urban green spaces. The Thinking Fadura project in Getxo (Spain) was used as a case study. A method for participatory benefit-cost analysis is developed, where a stakeholder-participatory evaluation is combined with a standard cost-benefit analysis. The participatory evaluation followed a bottom-up approach in a sequential evaluation including three main focal points: key stakeholders and experts, visitors and the general public. The assessment demonstrates that the Thinking Fadura project’s benefits outweigh the costs. The results suggest that projects designed with the purpose of improving green space accessibility to the general public can be beneficial from a societal perspective. The highest economic benefits were an increase in the amenity and recreational value and an increase in people’s physical activity. The participatory evaluation indicates that giving access to people of lower socio-economic status and vulnerable groups and improving recreational use were perceived as the most beneficial. An increase in noise, dirt, and risk of criminal activities as well as potential conflicts between green space users were perceived as the most negative impacts of opening a previously restricted area to the general public. The economic assessment of Thinking Fadura project could serve as a model in the decision-making process in locations where the use of greenspaces is restricted.

Socioeconomic - related inequalities in overweight and obesity: findings from the PERSIAN cohort study

BackgroundOverweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults.MethodsData were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity.ResultsOf the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich.ConclusionsOverall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Use of Patient Portals of Electronic Health Records Remains Low From 2014 to 2018: Results From a National Survey and Policy Implications.

To investigate the trend of patient portal use in the general population and the barriers to adoption. We analyzed 3 iterations of the Health Information National Trends Survey (HINTS) collected in 2014, 2017, and 2018. Patient portal use, high-speed Internet access, data safety confidence, prior experience of online patient provider communication (OPPC), and demographic variables. Logistic regression analyses were conducted separately for the 3 iterations of HINTS. The use of patient portals increased from 25.6% in 2014 to 30.5% in 2017, and 31.4% in 2018. These users were more likely to be white female with higher levels of education or income. Meanwhile, high-speed Internet access, prior experience of OPPC, and data safety confidence were positive predictors of patient portal use in all 3 iterations. The use of patient portals in the general public remains low and a significant digital divide persists, presenting a major challenge on meaningful use of electronic health record. We call for more effective interventions to address these gaps. Such interventions should target people of low socioeconomic status and focus on improving eHealth literacy and patients' confidence in data safety.

Access to Health Care for Low-Income African American Women: Lived Experiences and Expectations.

Women of color and people of low socioeconomic status continue to have poorer health outcomes than their counterparts. This study explored patientsatisfaction and perceptions of low-income African American women regarding access to care. The study took a mixed-methods approach. Ninety-five women were surveyed using the Short-form Patient Satisfaction Questionnaire (PSQ-18). Two sub-scales assessed satisfaction with access to care. Qualitative data were collected using one-on-one interviews (n=22) and two focus groups of community leaders. A thematic analysis was then conducted. On a 5-point scale, patient-satisfaction with access was moderate (accessibility and convenience -2.99; financial aspects -3.35). Emerging themes included obtaining insurance, dynamics of insurance eligibility, adequacy and scope of insurance coverage, scheduling appointments, and transportation. Providing insurance coverage for people with low incomes is not sufficient to close the racial/ethnic disparities gap in access to care. Understanding the challenges from patients' perspectives can help to make health care resources and services more accessible.

Neighborhood Food Environment and Health Outcomes in U.S. Low-Socioeconomic Status, Racial/Ethnic Minority, and Rural Populations: A Systematic Review

This review examined associations between the neighborhood food environment and health outcomes in populations with the highest obesity rates in the United States: people of low-socioeconomic status (SES), racial/ethnic minorities, and rural residents. We searched multiple databases using preselected search terms through June 2017. Forty-three sources met criteria of peer-reviewed U.S. studies that tested food environment-health associations (e.g. obesity, diabetes) in the populations of interest. Evidence was sparse for multiple populations. For populations with multiple studies of adequate sample size, few found significant food environment-health associations. Modest evidence indicates that negative health outcomes were associated with (1) convenience store access for Black and Hispanic youth and (2) fast food access for Black and Hispanic adults and youth. Additionally, lower body weights were associated with supermarket and grocery store access in low-SES adults. Food environment interventions may have health benefits for some populations, but additional research is needed.

Association between socioeconomic status and influenza-like illness: A study from Western part of India.

Objectives:Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI).Materials and Methods:This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income <2000 INR) and non-lower SES groups.Results:810 cases and 830 controls were compared. Many cases were from lower SES, had poor hand hygiene, and were using soil, mud, ash (SMA) for hand cleaning as compared to the control. Among the cases significant numbers were from lower SES (543/810[67%], P < 0.02), many were alcoholics, smokers, had poor hand hygiene, were using SMA for hand cleaning, and had preexisting chronic obstructive pulmonary disease (COPD), while few were having diabetes in the lower SES group as compared to the non-lower SES group. ILI was more common among lower SES class in unadjusted analysis (odds ratio [OR] 1.58, 95% CI 0.89–2.76) and the results were significant even after the adjustment of covariates (OR 1.62, 95% CI, 0.94–2.85).Conclusion:Lower SES people were 2.8 times more prone to ILI as compared to the age- and sex-matched control in western part of India.

Asterion localization - variability of the location for surgical and anthropological relevance.

This work aimed to study the variability in location of the asterion in a Polish population, which may be important for both surgical and anthropological procedures. In surgical approaches to the posterior cranial fossa, the asterion is of great importance as a reference landmark. Its accurate localization may be impeded by the presence of additional, irregular sutural bones. Dry adult human skulls (n = 113, 60.2% male and 39.8% female) were analyzed for asterion location in relation to the reference points (mastoidale, bregma, porion, inion, lambda, opisthion). The asterion exhibits wide variation in location. The range of ± 2 SD of measured distances demonstrated broad variation intra and interindividually (15.9-27.8 mm for male skulls and 13.1-24.6 mm for female skulls). Distances from the asterion to the reference landmarks were longer for males compared to females (p < 0.05), and some distances were longer for people of lower socioeconomic status. Because of its lesser variation, measurements to three reference landmarks (mastoidale, bregma and frontotemporale) may be particularly important for surgical purposes. Defining accurately the safe area for asterion is important but problematic. Because of the complex relations between bony landmarks, preoperative imaging assistance is required, and the asterion should only be used as auxiliary, not as a key superficial cranial landmark in surgical interventions.

Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016

BackgroundOral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers. MethodsThe authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office. ResultsOverall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline. ConclusionsOral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers. Practical ImplicationsPotential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.

Access to midwifery care for people of low socio-economic status: a qualitative descriptive study

BackgroundDespite public funding of midwifery care, people of low-socioeconomic status are less likely to access midwifery care in Ontario, Canada, but little is known about barriers that they experience in accessing midwifery care. The purpose of this study was to examine the barriers and facilitators to accessing midwifery care experienced by people of low-socioeconomic status.MethodsA qualitative descriptive study design was used. Semi-structured interviews were conducted with 30 pregnant and post-partum people of low-socioeconomic status in Hamilton, Ontario from January to May 2018. Transcribed interviews were coded using open coding techniques and thematically analyzed.ResultsWe interviewed 13 midwifery care recipients and 17 participants who had never received care from midwives. Four themes arose from the interviews: “I had no idea…”, “Babies are born in hospitals”, “Physicians as gateways into prenatal care”, and “Why change a good thing?”. Participants who had not experienced midwifery care had minimal knowledge of midwifery and often had misconceptions about midwives’ scope of practice and education. Prevailing beliefs about pregnancy and birth, particularly concerns about safety, drove participants to seek care from a physician. Physicians are the entry point into the health care system for many, yet few participants received information about midwifery care from physicians. Participants who had experienced midwifery care found it to be an appropriate match for the needs of people of low socioeconomic status. Word of mouth was a primary source of information about midwifery and the most common reason for people unfamiliar with midwifery to seek midwifery care.ConclusionsAccess to midwifery care is constrained for people of low-socioeconomic status because lack of awareness about midwifery limits the approachability of these services, and because information about midwifery care is often not provided by physicians when pregnant people first contact the health care system. For people of low-socioeconomic status, inequitable access to midwifery care may be exacerbated by lack of knowledge about midwifery within social networks and a tendency to move passively through the health care system which traditionally favours physician care. Targeted efforts to address this issue are necessary to reduce disparities in access to midwifery care.

Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults

ObjectivesHealth disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally...

A fractionated analysis of hot and cool self-regulation in cigarette smokers from different socioeconomic backgrounds.

Smoking cigarettes and low socioeconomic status (SES) are both related to impaired cognition. However, it is unknown whether people of lower SES, who comprise most tobacco smokers worldwide, are more susceptible to cognitive impairment associated with smoking. In this non-randomized, cross-sectional study we investigated the effects of cigarette smoking, SES and their interaction on dissociable executive or “cool” and “hot” measures of behavioural self-regulation. Participants (n = 80) were selected among young physically and mentally healthy smokers and non-smokers who had graduated high school and were from different SES backgrounds. Cool self-regulation was measured by executive function tasks that tap inhibition, updating, shifting, dual tasking, planning, access to long-term memory (semantic fluency), and working memory capacity. Hot measures assessed self-reported impulsivity, delay discounting and risk taking. Exposure to tobacco (cotinine, exhaled carbon monoxide, tobacco dependence, cigarette consumption) was assessed to determine to what extent it mediated the cognitive effects of smoking. Nicotine abstinence and its acute effects were controlled, as were sex, age, schooling, and psychiatric symptoms despite the fact that smokers and non-smokers were selected as being as similar as possible in these demographic characteristics. Lower SES (less years of parental schooling) was associated with worse performance on tasks that measured all cool domains except dual tasking and fluency, while smoking status was related to impaired delayed discounting and impulsivity (hot domains), effects that were not mediated by tobacco exposure. Smoking and SES, however, did not interact. In short, impaired performance in measures of most cool skills was associated with SES irrespective of smoking status; in contrast, regardless of SES, smokers showed specific impairment in hot self-regulation domains (more difficulty resisting immediate temptations and weighing future consequences of actions). Possible explanations for the lack of mediation of tobacco exposure on hot skills of smokers are discussed.