Socioeconomic Status Environment Research Articles

Associations between socioeconomic status, home food availability, parental role-modeling, and children’s fruit and vegetable consumption: a mediation analysis

BackgroundRecent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children’s diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children’s diet. This study aimed to determine the associations between family SES and children’s fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations.MethodsCross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children’s FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level (“low”, “middle”, and “high”) and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0.ResultsThe positive association between high parental educational level and children’s FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51–4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10–1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35–1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 – -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children’s FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06–1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40–1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations.ConclusionsParental educational level showed more associations with children’s FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children’s FV consumption. Future interventions to improve children’s dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

Associations between household income and disordered eating differ across sex and racial identity in a population-based sample of adults.

Most research on socioeconomic status (SES) and eating disorders (EDs) has focused on young White women. Consequently, little is known regarding how SES may relate to EDs/disordered eating in older adults, men, or people with different racial identities. We examined whether associations between SES and EDs/disordered eating differed across age, sex, and racial identity in a large, population-based sample spanning early-to-later adulthood. Analyses included 2797 women and 2781 men ages 18-65 (Mage = 37.41, SD = 7.38) from the population-based Michigan State University Twin Registry. We first examined associations between SES and dimensional ED symptoms, binge eating (BE), and self-reported ED diagnoses across age and sex in the full sample. We then examined the impact of racial identity on associations by conducting within- and between-group analyses among Black and White participants. In the full sample, lower SES was associated with significantly greater odds of BE and lifetime EDs in men, but not women, across adulthood. The association between lower SES and greater BE risk was stronger for Black men than for White men, though significant in both groups. Conversely, Black women showed a positive association between SES and dimensional ED symptoms that significantly differed from effects for Black men and White women. Associations between socioeconomic disadvantage and EDs/disordered eating may be particularly robust for men in adulthood, especially men with a marginalized racial identity. Oppositely, Black women may encounter social pressures and minority stress in higher SES environments that could contribute to somewhat heightened ED risk. Little is known regarding how associations between socioeconomic status (SES) and eating disorders (EDs) may differ across age/sex or racial identity. We found lower SES was associated with greater odds of a lifetime ED or binge eating in men only, with a particularly strong association between lower SES and binge eating for Black men. Results highlight the importance of examining how SES-ED associations may differ across other aspects of identity.

KOMPARASI METODE SVM, K-NN DAN NBC PADA ANALISIS SENTIMEN

The beauty of Bali raises many comments about how a trip to Indonesia is not complete without going to Bali. In the tourism industry the application of tourist satisfaction and perspective is very important, but most of them still apply surveys. The survey-based approach has weaknesses such as operational costs, the potential for data duplication, and a lack of comprehensiveness. Sentiment analysis of natural tourism objects is performed by classifying positive and negative comments in the Jatiluwih tourist comment dataset. The focus of this panel's sentiment analysis is on comments related to the Natural Tourism Attractiveness Criteria. According to the Directorate General of Forest Protection and Nature Conservation in 2003, the criteria for natural tourism objects are tourist attraction, market potential, accessibility, socio-economic environmental conditions, public services, climate conditions, supporting facilities and infrastructure, and the availability and safety of clean water. This study compares the SVM, K-NN, and NBC methods. This study aims to provide a comprehensive analysis of the performance of each method using the confusion matrix. The results showed that the K-NN method was superior to SVM and NBC in terms of testing accuracy and precision, where accuracy on K-NN gave a value of 93.4%, SVM 93.1%, and NBC 87.9%.

ASSESSMENT OF OBJECTS AND ATTRACTIONS IN THE KRUENG GEUNIE LHOK KEUTAPANG AREA, PIDIE ACEH REGENCY FOR NATURE TOURISM

Objects and tourist attractions are one of the important elements in the world of tourism. Where objects and tourist attractions can succeed the government's program in preserving the nation's customs and culture as assets that can be sold to tourists and can improve welfare and community participation in preserving the development of a tourist area. The purpose of this study was to determine the potential value of natural tourist attractions. The data collection method was carried out using qualitative methods by conducting in-depth structured interviews, literature studies, field observations and Focus Group Discussions (FGD). Data analysis of the potential objects and natural tourist attractions (ODTWA) is described descriptively and processed using the guidelines for the Analysis of Operation Areas for Natural Tourism Objects and Attractions (ADO-ODTWA). The results showed the ODTWA analysis in the Krueng Geunie area for each criterion of attractiveness 83.33% (adequate), accessibility 91.66% (adequate), socio-economic environmental conditions 58.33% (not feasible), accommodation 66.66% (adequate), 80% (adequate) supporting facilities and infrastructure, and 80% (adequate) clean water availability. Therefore, based on the results of research the Krueng Geunie area deserves to be developed as a natural tourist attraction area.

Family socioeconomic status and young children’s learning behaviors: The mediational role of parental expectation, home environment, and parental involvement

Utilizing a national longitudinal sample from China Family Panel Studies (2018), this study examined how family socioeconomic status (SES) is related to young children’s learning behaviors through parental expectation, parental involvement and home learning environment. A total of 1348 children aged 3–5 years were included. Mediation analysis was conducted to test the hypotheses. The results identified a significant relationship between family SES and home learning environment and parental involvement, whereas family SES was only partially related to parental academic expectations. There were no statistically significant relationships between SES and children’s learning behaviors. Moreover, no indirect effects were found between parental expectation, home learning environment, and children’s learning behaviors. However, parental involvement had an indirect effect on children’s learning behaviors. The present study highlights the need to consider the role of parental involvement in supporting the development of young children’s learning behaviors. The findings and discussions raise implications for researchers and practitioners to provide parental involvement support programs for Chinese families from diverse SES backgrounds.

Early life adversity, inflammation, and immune function: An initial test of adaptive response models of immunological programming.

Much research indicates that exposure to early life adversity (ELA) predicts chronic inflammatory activity, increasing one's risk of developing diseases of aging later in life. Despite its costs, researchers have proposed that chronic inflammation may be favored in this context because it would help promote immunological vigilance in environments with an elevated risk of infection and injury. Although intuitively appealing, the assumption that exaggerated inflammatory activity predicts favorable immunological outcomes among those exposed to ELA has not been tested. Here, we seek to address this gap, examining the links between exposure to ELA, inflammation, and immune function. Consistent with others' work, results revealed that those from low socioeconomic status (SES) childhood environments exhibited exaggerated unstimulated inflammatory activity relative to what was observed among those from higher SES childhood environments. Further, results revealed that - although levels of inflammation predicted the magnitude of immunological responses in those from higher SES backgrounds - for those who grew up in low SES environments, higher levels of inflammation were unrelated to the magnitude of immunological responses. Results suggest that exaggerated inflammatory activity in the context of ELA may not predict improved ability to manage acute immunological threats.

Children's Internet Use, Self-Reported Life Satisfaction, and Parental Mediation in Europe: An Analysis of the EU Kids Online Dataset.

The present research examines how children’s time spent online is associated with their perceived life satisfaction accounting for their age, gender, socio-economic status (SES), emotional problems, country, and family environmental factors. This article is based on the data of the large scale cross-sectional EU Kids Online survey from 16 European countries with nationally representative samples of children aged 9–17 (N = 11,200, Mage = 13.3, SD = 2.36; 50.6% boys, 49.4% girls). The results indicated that the time children spent online appeared to have no considerable negative effect on their self-reported life satisfaction (SRLS). Comparatively, the positive effects of children’s SES and family environment accounted for 43% of the overall 50% of the variance in children’s SRLS scores. Considering that children’s SES alone accounted for 42% of the variance, children’s emotional problems, country of residence, and enabling parental mediation accounted for the remaining 3, 4, and 1% of the variance, respectively. In line with previous studies that urge caution when discussing the negative influence of time spent online on children’s mental health and overall wellbeing, the current findings suggest that social-ecological characteristics and how children use the Internet, need to be examined further.

Daily television exposure, parent conversation during shared television viewing and socioeconomic status: Associations with curiosity at kindergarten.

ObjectiveTo examine the main and interactive effects of the amount of daily television exposure and frequency of parent conversation during shared television viewing on parent ratings of curiosity at kindergarten, and to test for moderation by socioeconomic status (SES).Study designSample included 5100 children from the Early Childhood Longitudinal Study, Birth Cohort. Hours of daily television exposure and frequency of parent screen-time conversation were assessed from a parent interview at preschool, and the outcome of early childhood curiosity was derived from a child behavior questionnaire at kindergarten. Multivariate linear regression examined the main and interactive effects of television exposure and parent screen-time conversation on kindergarten curiosity and tested for moderation by SES.ResultsIn adjusted models, greater number of hours of daily television viewing at preschool was associated with lower curiosity at kindergarten (B = -0.14, p = .008). More frequent parent conversation during shared screen-time was associated with higher parent-reported curiosity at kindergarten with evidence of moderation by SES. The magnitude of association between frequency of parent conversation during television viewing and curiosity was greater for children from low SES environments, compared to children from high SES environments: (SES ≤ median): B = 0.29, p < .001; (SES > median): B = 0.11, p < .001.ConclusionsHigher curiosity at kindergarten was associated with greater frequency of parent conversation during shared television viewing, with a greater magnitude of association in low-SES families. While the study could not include measures of television program content, digital media use and non-screen time conversation, our results suggest the importance of parent conversation to promote early childhood curiosity, especially for children with socioeconomic disadvantage.

Parents for whom school ‘is not that big a deal’. Parental support in home schooling during lockdown in France

The period of confinement in the spring of 2020 is of great interest in highlighting the parental work of educational support. While parental support is usually more diffuse, and is secondary in relation to what is done at school, occurring at different moments of daily life, home schooling during lockdown revealed new ways of helping and framing schoolwork. This article looks at parenting practices in higher socio-economic status (SES) families in France. Based on a massive questionnaire ( N = 31,764) and a series of additional interviews ( N = 15) conducted during lockdown, the aim is to investigate what makes parental assistance specific in high SES environments. Our findings show that such families have less difficulty carrying out schooling at home. What makes them consider this experience as ‘not a big deal’, as they say, is that they have organisational and pedagogical (i.e. objective) resources that enable them to respond to its challenges. In addition, however, we show that home schooling is experienced in these families as less contrived. In effect, they use schoolwork techniques that help to obscure (from others, but also from themselves) the effort that schoolwork requires.

Childhood Socioeconomic Status and Menarche: A Prospective Study

PurposeThe relationship between socioeconomic status (SES) and menarche has implications for understanding social level influences on early life development and adult disease, including breast cancer, but remains ill defined. We report here results from the Breast Cancer and the Environment Research Program, which permitted a longitudinal study of age at menarche in relationship to childhood SES in a diverse cohort of 1,069 girls across three urban areas of the United States. MethodsWe assessed the association of SES index quintiles with age at pubertal onset with breast budding and subsequent tempo to the age at menarche between 2004 and 2015 using multiple-event Cox regression models to estimate hazard ratios and 95% confidence intervals. ResultsIn an unadjusted model, lower SES was predictive of both earlier pubertal onset and tempo and thus earlier age at menarche in trends across quintiles. After adjusting for the potentially mediating effects of body mass index, SES trends remained significant for both outcomes. After adjusting for both body mass index and race/ethnicity, the association with SES remained substantial for pubertal onset but was much diminished and nonsignificant for tempo and thus age at menarche. ConclusionsThese results suggest that a lower SES environment and social adversity affect the age at menarche primarily by hastening pubertal onset rather than by shortening tempo.

KAJIAN POTENSI EKOWISATA DI DESA LILIBOY KECAMATAN LEIHITU BARAT KABUPATEN MALUKU TENGAH

The study aims to identify the potential of natural resources as an object and attraction of ecotourism in Liliboy Village, West Leihitu District and to know community perceptions about the potential of ecotourism. The research method used is a survey method by direct observation to the location of attractions and interviews using questionnaires to the community. Data were analyzed using an analysis of the assessment of ecotourism potential carried out by the assessment of natural tourist objects and attractions (ADO), 2000. The five main components of the assessment are attractiveness, accessibility, socio-economic environmental conditions, accommodation and infrastructure and supporting facilities. The results of the study showed that the ecotourism potential in the village of Liliboy was very diverse including the ship's rock beach, waisamal beach and Hatuasa “rafting” river tourism. This tourism potential attracts a number of tourists with various tourist attractions. Community perception shows that 90.0% of respondents agreed to develop ecotourism activities. The community is willing to participate in the development of the tourism object, they argue that if the State of Liliboy becomes a tourist country then they will get job opportunities and business opportunities through various activities such as selling at tourist sites and also becoming a tour guide. The results of the analysis using object assessment and tourist attraction analysis using the ADO guidelines show that the potential attraction of ecotourism objects in Liliboy village is categorized as "Good", with a score of 2320. This shows that the potential of ecotourism in Liliboy village is good for tourism development.

Ethnicity, Neighborhood and Individual Socioeconomic Status, and Obesity: The Singapore Multiethnic Cohort.

It remains unclear whether ethnicity has an impact on obesity independent of socioeconomic status (SES) and environmental factors. Singapore provides a unique opportunity to address this issue because three major Asian ethnic groups are represented, and government policies prevent ethnic segregation. Therefore this study examined associations between ethnicity, SES, and obesity within neighborhoods in Singapore. Cross-sectional data from 29,819 participants of the Singapore Multiethnic Cohort who were aged 21 to 75 years and of Chinese, Malay, and Indian ethnicity were used. Obesity was defined using Asian criteria. Multilevel models used obesity as the dependent variable and age, marital status, ethnicity, education level, income, and neighborhood SES as independent variables. Education level was more strongly inversely associated with obesity than income level or neighborhood SES. The association between ethnicity and obesity was not substantially explained by measures of individual and neighborhood SES. In females, the fully adjusted odds ratio of obesity was 5.01 for Malay ethnicity and 4.81 for Indian ethnicity as compared with Chinese ethnicity. In males, these odds ratios were 2.61 and 2.07, respectively. Ethnicity was strongly associated with obesity independent of SES and neighborhood environment. More research on sociocultural factors contributing to ethnic differences in obesity is warranted.

Predicted DRD4 prefrontal gene expression moderates snack intake and stress perception in response to the environment in adolescents.

Body weight is substantially determined by eating behaviors, which are themselves driven by biological factors interacting with the environment. Previous studies in young children suggest that genetic influences on dopamine function may confer differential susceptibility to the environment in such a way that increases behavioral obesity risk in a lower socioeconomic status (SES) environment but decreases it in a higher SES environment. We aimed to test if this pattern of effect could also be observed in adolescence, another critical period for development in brain and behavior, using a novel measure of predicted expression of the dopamine receptor 4 (DRD4) gene in prefrontal cortex. In a sample of 76 adolescents (37 boys and 39 girls from Baltimore, Maryland/US, aged 14-18y), we estimated individual levels of DRD4 gene expression (PredDRD4) in prefrontal cortex from individual genomic data using PrediXcan, and tested interactions with a composite SES score derived from their annual household income, maternal education, food insecurity, perceived resource availability, and receipt of public assistance. Primary outcomes were snack intake during a multi-item ad libitum meal test, and food-related impulsivity assessed using a food-adapted go/no-go task. A linear regression model adjusted for sex, BMI z-score, and genetic ethnicity demonstrated a PredDRD4 by composite SES score interaction for snack intake (p = 0.009), such that adolescents who had lower PredDRD4 levels exhibited greater snack intake in the lower SES group, but lesser snack intake in the higher SES group. Exploratory analysis revealed a similar pattern for scores on the Perceived Stress Scale (p = 0.001) such that the low PredDRD4 group reported higher stress in the lower SES group, but less stress in the higher SES group, suggesting that PredDRD4 may act in part by affecting perceptions of the environment. These results are consistent with a differential susceptibility model in which genes influencing environmental responsiveness interact with environments varying in obesogenicity to confer behavioral obesity risk in a less favorable environment, but behavioral obesity protection in a favorable one.

Multivariate analysis of the Scarr-Rowe interaction across middle childhood and early adolescence

Numerous studies have found interactions between socioeconomic status (SES) and the heritability of cognitive ability in samples from the United States, with individuals from lower SES backgrounds showing decreased heritability compared to those reared in higher SES environments. However, nearly all published studies of the Scarr-Rowe interaction have been univariate and cross-sectional. In this study, we sought to maximize statistical power by fitting multivariate models of gene (G) x SES interaction, including longitudinal models. Cognitive ability data collected at up to five time points between ages 7 and 15 years were available for 566 twin pairs from the Louisville Twin Study. We used multilevel and latent factor models to pool intelligence subtest scores cross-sectionally. To examine interactions longitudinally, we fit latent growth curve models to IQ scores. Power analysis results indicated that the multivariate approach substantially boosted power to detect G x SES interaction. The predicted interaction effect was observed at most ages in cross-sectional multivariate analyses. In longitudinal analyses, we found significant G x SES interactions on mean-level (intercept) full scale IQ and performance IQ (ps < .001), but not verbal IQ intercept (p = .08). SES did not significantly moderate the heritability of change in IQ over time (slope). Interaction appeared to be driven by DZ twin correlations decreasing more substantially as a function of higher SES than MZ correlations.

Differences in Febrile and Respiratory Illnesses in Minority Children: The Sociodemographic Context of Restrictive Parenting

ObjectiveTo examine the moderating role of restrictive parenting on the relation of socioeconomic status (SES) to febrile illnesses (FIs) and upper respiratory illnesses (URIs) among ethnic minority and non-minority children. MethodsChildren from diverse ethnic backgrounds (Caucasian, African American, Asian, Latino, other, or multiethnic) were followed across the course of the kindergarten year. Parents reported on SES and parenting. A nurse completed 13 physical exams per child over the year to assess FIs and URIs. ResultsDuring the school year, 28% of children (n = 199, 56% ethnic minority) exhibited one or more FIs (range, 0–6) and 90% exhibited one or more URIs (range, 0–10). No main or moderating effects of SES or restrictive parenting on FIs or URIs were found among Caucasian children; however, among ethnic minority children, the relation of SES to FIs was conditional upon restrictive parenting (β = .66; P = .02), as the fewest FIs were found for lower SES minority children whose parents reported more restrictive practices. Additionally, among minority children, more restrictive parenting was marginally associated with fewer URIs (β = –.21; P = .05). ConclusionsUnexpectedly, among minority children the fewest illnesses occurred among lower SES children whose parents endorsed more restrictive parenting. This may be due to unique appraisals of this rearing style among minority children in lower SES environments and its potential to influence immune functioning. Results suggest variability in the effects of parenting on offspring health and support context-specific evaluations of parenting in efforts to ameliorate early health disparities.

Association of individual and neighbourhood socioeconomic status with physical activity and screen time in seventh-grade boys and girls in Berlin, Germany: a cross-sectional study

ObjectivesFew studies have explored the impact of neighbourhood socioeconomic status (SES) on health behaviours in youths in Germany. Our aim was to investigate the association of individual and neighbourhood SES...

Threat vigilance and socioeconomic disparities in metabolic health.

A quarter of the global population meets diagnostic criteria for metabolic syndrome (MetS). MetS prevalence stratifies by socioeconomic status (SES), such that low SES is associated with higher MetS risk starting in childhood. Despite this trend, some low-SES children maintain good metabolic health across the life span, but the factors responsible for their resilience are not well understood. This study examined the role of threat vigilance as either a moderator or a mediator of the effects of low early life SES on adult metabolic risk. Three hundred twenty-five Canadians aged 15-55 participated (M = 36.4 years, SD = 10.7; 55.4% female). We coded parental occupational status between the ages of 0 and 5 to index early life SES. We used the International Diabetes Federation case definition for MetS based on waist circumference, blood pressure, triglyceride levels, HDL cholesterol, and glycosylated hemoglobin measures. Threat vigilance was assessed using the Weapons Identification Procedure, a visual discrimination paradigm that captures implicit perceptions of threat. Analyses supported the moderator hypothesis: low early life SES was associated with MetS diagnosis exclusively among those with high levels of threat vigilance. This suggests that low early life SES environments that heighten vigilance to threat might be particularly detrimental for metabolic health. Conversely, low threat vigilance may buffer against the metabolic risks associated with socioeconomic disadvantage.

6.33 Factors Associated With Psychiatric Disorder in Children With Epilepsy (CWE): A Systematic Review

The goals of this presentation are to review the literature in a systematic way using previously published guidelines and identify factors associated with psychiatric disorders and psychopathology in children with epilepsy (CWE). Factors included the following: 1) child variables—gender, age, and IQ; 2) epilepsy—seizure frequency (sz freq), epilepsy syndrome, and age of onset of epilepsy; and 3) environmental—socioeconomic status (SES).

Neighborhood built environment and socio-economic status in relation to multiple health outcomes in adolescents

The study aim was to examine associations of neighborhood built environment and neighborhood socio-economic status (SES) with multiple physical activity (PA) behaviors, sedentary time, and obesity indicators among adolescents.Cross-sectional study of 325 adolescents aged 14–18years recruited from schools in Valencia, Spain. Participants' home neighborhoods were classified according to walkability and SES levels. Walkability was defined as an index of three built environment characteristics (i.e., residential density, land use mix, and street connectivity) based on geographic information system data. Moderate-vigorous PA (MVPA) and sedentary time were assessed using accelerometers. Active commuting to school, leisure-time PA, and time in specific sedentary activities were evaluated by questionnaire. Objectively measured weight and height were used to calculate body mass index, and percent body fat was analyzed by bioelectrical impedance. Data were collected in 2013–15. Mixed model regression analyses were performed.Analyses showed an SES-by-walkability interaction for MVPA on weekends. MVPA was highest in high-SES/high-walkable neighborhoods. Another SES-by-walkability interaction was found for sedentary minutes per weekend day. The lowest average sedentary minutes were found in high-SES/high-walkable areas. Neighborhood SES was positively related to participation in sports teams/PA classes and, negatively to time spent in sedentary behaviors. Adolescents living in lower-SES neighborhoods spent more time watching TV and had more obesity and body fat.Present findings strengthen the rationale for targeting neighborhood built and SES environments as health promotion interventions for adolescents.

Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach

BackgroundGround-level ozone is a potent airway irritant and a determinant of respiratory morbidity. Susceptibility to the health effects of ambient ozone may be influenced by both intrinsic and extrinsic factors, such as neighborhood socioeconomic status (SES). Questions remain regarding the manner and extent that factors such as SES influence ozone-related health effects, particularly across different study areas.MethodsUsing a 2-stage modeling approach we evaluated neighborhood SES as a modifier of ozone-related pediatric respiratory morbidity in Atlanta, Dallas, & St. Louis. We acquired multi-year data on emergency department (ED) visits among 5–18 year olds with a primary diagnosis of respiratory disease in each city. Daily concentrations of 8-h maximum ambient ozone were estimated for all ZIP Code Tabulation Areas (ZCTA) in each city by fusing observed concentration data from available network monitors with simulations from an emissions-based chemical transport model. In the first stage, we used conditional logistic regression to estimate ZCTA-specific odds ratios (OR) between ozone and respiratory ED visits, controlling for temporal trends and meteorology. In the second stage, we combined ZCTA-level estimates in a Bayesian hierarchical model to assess overall associations and effect modification by neighborhood SES considering categorical and continuous SES indicators (e.g., ZCTA-specific levels of poverty). We estimated ORs and 95% posterior intervals (PI) for a 25 ppb increase in ozone.ResultsThe hierarchical model combined effect estimates from 179 ZCTAs in Atlanta, 205 ZCTAs in Dallas, and 151 ZCTAs in St. Louis. The strongest overall association of ozone and pediatric respiratory disease was in Atlanta (OR = 1.08, 95% PI: 1.06, 1.11), followed by Dallas (OR = 1.04, 95% PI: 1.01, 1.07) and St. Louis (OR = 1.03, 95% PI: 0.99, 1.07). Patterns of association across levels of neighborhood SES in each city suggested stronger ORs in low compared to high SES areas, with some evidence of non-linear effect modification.ConclusionsResults suggest that ozone is associated with pediatric respiratory morbidity in multiple US cities; neighborhood SES may modify this association in a non-linear manner. In each city, children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying rates of respiratory morbidity.