Socioeconomic Position Research Articles

Association between socioeconomic position of the household head, food insecurity and psychological health: an application of propensity score matching

BackgroundMental health outcomes can be influenced by various factors, one of which has recently gained attention, namely food security. Food security is paramount to maintaining not only physical, but also mental health. There is an increasing need to understand the interplay between food insecurity (FI) and mental health outcomes, especially among vulnerable populations. The objective of this study was to investigate the effect of FI on psychological health (anxiety and depression) as well as to examine the modifying effect of socioeconomic position on this relationship.MethodsA cross-sectional study was conducted in Maputo City, Mozambique, in 1,842 participants. Data were collected through structured interviews using a modified version of the US Department of Agriculture Household Food Security Module to measure FI, and the Hospital Anxiety and Depression Scale to measure anxiety and depression. A composite variable for psychological health was created. Propensity score matching and interaction effect analyses were employed to examine the effects of FI on psychological health and the moderating role of socioeconomic position.ResultsOf the 1,174 participants randomly assigned to propensity score matching, 787 were exposed to FI while 387 were unexposed. The analysis revealed stark disparities in psychological health outcomes associated with FI. The risk of poor psychological health among those exposed to FI was 25.79%, which was significantly higher than the 0.26% in unexposed individuals. The risk difference was 25.54% points (95% CI: 22.44–28.63), with a risk ratio of 99.82. Our assessment of population attributable fractions indicated that nearly all the risk for poor psychological health in the exposed group could be ascribed to FI. The interaction effects analysis revealed that socioeconomic status modifies this relationship. Specifically, heads of food-insecure households with a lower socioeconomic position tended to report poor mental health compared to their food-secure counterparts with a higher position.ConclusionsThe findings underscore the profound impact of FI on the mental health of household heads in Maputo City, socioeconomic position being a significant modifier. Addressing household FI along with the socioeconomic position of household heads could be pivotal to mental health promotion, especially among vulnerable populations.

Socioeconomic Inequalities Worsen the Risk of Death in CKD: A Population-Based Cohort Study in Italy.

Few studies have explored the impact of socioeconomic position on chronic kidney disease (CKD). This study aims to fill this gap using a large Italian cohort of CKD patients. We analyzed a cohort of incident CKD cases from the Lazio regional Health Information System from 1 January 2012 to 31 December 2021. We used the deprivation index (DI), a 5-category census-block indicator that integrates several dimensions of disadvantage. The outcomes were mortality and end-stage kidney disease (ESKD). We characterized the health status of patients in the two years before CKD identification and followed each subject from the index date to the end of follow-up, i.e., the date of the outcome, of emigration, or 31 December 2022, whichever came first. We used Cox proportional hazard models to investigate the association between DI and outcomes (HR, 95% CI). From 2012 to 2021, 127,457 new cases (55.9% men) were diagnosed. The average age was 72.2 (± 13.7) for men and 74.4 (± 14.8) for women. During an average follow-up of 4.3 years (± 3.2), 57,158 patients (45%) died, and 5,994 developed ESKD (5%). The age-adjusted association between DI and mortality was higher in men than in women (p-value interaction = 0.02), HRs for the extreme categories of DI (very high vs. very low) were 1.16, 95% CI 1.12-1.21 for men, and 1.08, 95% CI 1.04-1.13, for women). There was no evidence of association between DI and ESKD. In this population, socioeconomic disadvantage is associated with a higher risk of death but not of ESKD in CKD patients.

The granular landscape of health disparities: a socio-spatial examination of chronic disease prevalence within New York City's community districts

This study investigates the relationship between neighborhood Socioeconomic Position (SEP) and the prevalence of hypertension and coronary heart disease (CHD) across New York City's community districts. By using a composite SEP index derived from multiple socioeconomic indicators, the research seeks to uncover health disparities that may be obscured in broader geographic analyses. A primary objective is to identify community districts where hypertension and CHD prevalence is significantly higher than expected, even after adjusting for SEP. This focus helps pinpoint areas where targeted public health interventions may be urgently required, especially when the anticipated inverse relationship between SEP and health outcomes does not hold. A linear mixed-effects model (LMM) was used to analyze the association between SEP and these health outcomes, incorporating both fixed and random effects to account for variation across the city's 59 community districts. The analysis revealed a significant negative association between SEP and both hypertension and CHD, with higher SEP levels generally correlating with lower prevalence rates. However, some districts exhibited high random effects, indicating a higher-than-expected prevalence of these conditions, even after controlling for SEP. The authors suspect that additional factors-such as environmental exposures, healthcare accessibility, or community infrastructure-may contribute to these unexplained disparities. The findings emphasize the need for public health strategies that are sensitive to local contexts and the multifactorial nature of health inequities. Understanding the complex drivers behind these disparities can inform policies aimed at reducing health inequities in diverse urban environments.

Machine learning to evaluate the relationship between social determinants and diabetes prevalence in New York City

IntroductionDiabetes is a leading contributor to cardiovascular disease and mortality; social determinants of health (SDOH) are associated with disparities in diabetes risk. Quantifying the cumulative impact of SDOH and identifying...

Abstract A029: Age at menarche and risk of young-onset breast cancer subtypes overall and by race/ethnicity and socioeconomic position

Abstract INTRODUCTION: Young-onset breast cancer (YOBC) (i.e., diagnosed < 50 years), accounts for ∼25% of annual U.S. breast cancer (BC) cases, with incidence rates rising. Racial and socioeconomic disparities persist, with Non-Hispanic Black (NHB) women and residents of high-poverty areas facing a higher incidence of aggressive Estrogen Receptor-negative (ER-) BC tumors than Non-Hispanic White (NHW) and wealthier women. Early menarche is linked to increased BC risk, particularly for ER-positive (ER+) tumors, but its association with specific tumor subtypes and in young women is understudied. This study examines the association between age at menarche and YOBC tumor subtype risk among NHB and NHW women and whether race/ethnicity or socioeconomic position (SEP) modifies associations. METHODS: Data are from the Young Women’s Health History Study (YWHHS), a population-based case-control study of NHB and NHW women. Cases (n=1,812) included women diagnosed with invasive YOBC [luminal A, luminal B, HER2, triple-negative BC (TNBC) subtypes] in the Metropolitan Detroit and Los Angeles County SEER registry areas, 2010-15. Area-based controls (n=1,381) were identified from the 2010 Census and frequency matched to cases by study site, age, and race. Age at menarche (<12, 12, 13, and ≥14 years) and covariates, including self-reported race (NHB/NHW) and SEP (<200% vs. ≥200% of the federal poverty level), were assessed via in- person interviews. Multivariate weighted logistic regression was used to estimate YOBC tumor subtype risk and 95% confidence intervals (CIs) overall and stratified by race/ethnicity and SEP. RESULTS: Earlier age at menarche (< 12 years) was more frequent among NHB (39.8%) than NHW (25.9%) women, and among poorer (37.0%) compared to wealthier (24.5%) women. Compared to menarche at age 13 years, menarche before age 12 years was associated with a higher risk of luminal A YOBC [adjusted odds ratio (aOR)=1.63, 95% CI, 1.17-2.27]. No significant associations were found for luminal B, HER2, or TNBC subtypes. Stratified by race/ethnicity, the increased risk of menarche before age 12 years for luminal A YOBC was significant only for NHW women [aOR=1.73, 95% CI, 1.15-2.60] and at 12 years for NHB women [aOR=1.91, 95% CI, 1.14-3.17] with no significant interaction (p=0.37). When stratified by SEP, menarche before age 12 years was consistently associated with increased risk for luminal A YOBC among both SEP <200% [aOR=1.80, 95% CI, 1.04-3.11] and SEP ≥200% [aOR=1.74, 95% CI, 1.13-2.67] with no significant interaction (p=0.81). CONCLUSION: Our findings indicate that early menarche (< 12 years) is associated with an increased risk of only luminal A YOBC, and risk was not significantly modified by race/ethnicity or SEP. Findings provide evidence that etiologic pathways related to age at menarche and BC risk differ by tumor subtypes in young women. Citation Format: Zhenzhen Zhang, Lydia R. Marcus Post, Dorothy R. Pathak, Ann S. Hamilton, Kelly A. Hirko, Richard Houang, L. Karl Olson, Pepper Schedin, Ann G. Schwartz, Ellen M. Velie. Age at menarche and risk of young-onset breast cancer subtypes overall and by race/ethnicity and socioeconomic position [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A029.

Abstract A014: Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women

Abstract Background: Breastfeeding has been associated with a reduced risk of breast cancer (BC), particularly with Triple Negative BC (TNBC). The risk of TNBC is higher among premenopausal women, Black/African American (AA) women, and poorer women. Notably there are significant disparities in breastfeeding, where non-Hispanic Black (NHB) women and poorer women are less likely to breastfeed in the United States. Studies have identified historical racial trauma, unsupportive work and hospital policies, breast milk formula advertising, and knowledge and beliefs about breast feeding as factors that contribute to breast feeding practices. However, there is a paucity of research on pregnancy related medical conditions (PMCs) that potentially impact initiation and duration of breastfeeding. The purpose of this study is to evaluate racial and socioeconomic differences in breastfeeding, and if PMCs impact breastfeeding practices in a population-based sample of non-Hispanic Black and White women. Method: Data are from the Young Women’s History and Health Study (YWHHS), a population- based case-control study of invasive BC among non-Hispanic Black (NHB) and non-Hispanic White (NHW) women aged 20-49 years residing in Metropolitan Detroit and Los Angeles County, 2010-2015. The analytic sample here includes the first pregnancy of control participants with singleton live births (n=675). Area-based control participants were sampled from the 2010 Census. Interviews assessed complete reproductive histories, including breastfeeding history (never, <6 months, and ≥6 months), PMCs experienced during pregnancy, self-reported race, and household financial struggles before age 13 years (to approximate childhood socioeconomic position (chSEP)). PMCs examined included: 1) premature birth, 2) diabetes or pre-diabetes related PMCs, 3) blood pressure-related PMCs, and 4) BMI ≥ 25 kg/m2 at age 18 years. Weighted percentages were evaluated with a chi-square test and considered significant at p < 0.05. Analyses were further stratified by race/ethnicity and chSEP. Result: NHB women were 2.4 times significantly more likely to never breastfeed than NHW women (W% =52.0 (NHB) and 21.3 (NHW), p=<0.0001). Similarly, women with lower compared to higher chSEP were 1.5 times significantly more likely to never breastfeed (W% = 42.7 (lower chSEP) and 28.5 (higher chSEP), p=0.003). Those with BMI ≥ 25 kg/m2 at age 18 years (p<0.001) alone, and with one or more PMCs (p=0.01) were also less likely to breastfeed. When stratified by race/ethnicity the pattern of breastfeeding did not differ significantly by any PMC within NHB and NHW women. When stratified by chSEP, however, BMI ≥ 25 kg/m2 at age 18 years (p = 0.004) and having one or more PMCs (p=0.03) were significantly associated with never breastfeeding among those with higher chSEP. Conclusion: NHB women and women with lower chSEP were substantially less likely to breastfeed. Additionally, BMI ≥ 25 kg/m2 at age 18 and PMCs were associated with lower frequency of breastfeeding overall and among those with higher chSEP. Citation Format: Meheret B. Gebreegziabher, Lydia R. Post, Chris C. Cho, Zhenzhen Zhang, Kelly A. Hirko, Dorothy R. Pathak, Ann S. Hamilton, Ann G. Schwartz, Ellen M. Velie. Racial and socioeconomic disparities in breast feeding and the impact of pregnancy-related medical conditions among a population-based sample of non-Hispanic Black and White women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A014.

Educational differences in years lived with disability due to mental and substance use disorders: a cohort study using nationwide Norwegian and Danish registries

BackgroundFindings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account.MethodsThe study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity.ResultsEducational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level.ConclusionMost of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.

Daily Temperatures and Child Hospital Admissions in Aotearoa New Zealand: Case Time Series Analysis.

The influence of global climate change on temperature-related health outcomes among vulnerable populations, particularly young children, is underexplored. Using a case time series design, we analysed 647,000 hospital admissions of children aged under five years old in New Zealand, born between 2000 and 2019. We explored the relationship between daily maximum temperatures and hospital admissions across 2139 statistical areas. We used quasi-Poisson distributed lag non-linear models to account for the delayed effects of temperature over a 0-21-day window. We identified broad ICD code categories associated with heat before combining these for the main analyses. We conducted stratified analyses by ethnicity, sex, and residency, and tested for interactions with long-term temperature, socioeconomic position, and housing tenure. We found J-shaped temperature-response curves with increased risks of hospital admission above 24.1 °C, with greater sensitivity among Māori, Pacific, and Asian compared to European children. Spatial-temporal analysis from 2013-2019 showed rising attributable fractions (AFs) of admissions associated with increasing temperatures, especially in eastern coastal and densely populated areas. Interactive maps were created to allow policymakers to prioritise interventions. Findings emphasize the need for child-specific and location-specific climate change adaptation policies, particularly for socioeconomically disadvantaged groups.

Financial Stress Amongst People Who Self-Harm in Sri Lanka

Objective Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka. Methods Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected. Results The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors. Conclusion The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

Early adulthood socioeconomic trajectories contribute to inequalities in adult diet quality, independent of childhood and adulthood socioeconomic position

BackgroundDiet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course....

Educational, labour market and relationship outcomes in people with acne.

Although acne is associated with scarring, mental health comorbidities and bullying, little is known about its impact on socio-economic outcomes. To examine the association between acne and educational, labour market and relationship outcomes. We conducted a nationwide registry-based cohort study in Denmark. We included birth cohorts from 1982 to 1988 and compared those with and without acne identified using hospital diagnosis codes and redeemed prescriptions. Our main educational outcome was educational attainment. The main labour market outcomes were earned income at age 30 and long-term unemployment at any time before age 30. The main relationship outcomes were single partnership and childlessness by age 30. Outcomes were assessed using Poisson regression for binary outcomes and linear regression for continuous outcomes, adjusted for sex, calendar year, mother's socio-economic position and hormonal contraception use. Those with acne had a lower risk of not completing upper secondary education (relative risk (RR): 0.79; 95% confidence interval [CI]: 0.76-0.83) and higher education (RR: 0.90; 95% CI: 0.88-0.91), with absolute differences up to 4 percentage points. Persons with acne had slightly higher income (mean percentile difference: 2.6%, 95% CI: 2.2-2.9) and lower risk of long-term unemployment than those without acne (9.8% vs. 11.4%; RR: 0.90; 95% CI: 0.87-0.93). The prevalence of being single until age 30 was similar (19.7% vs. 20.1%; adjusted RR: 0.96; 95% CI: 0.94-0.98) but childlessness was slightly more prevalent (60.5% vs. 57.5%; adjusted RR: 1.03; 95% CI: 1.02-1.04). However, all associations were attenuated or lost in secondary analysis restricted to exposure-discordant siblings to address confounding from family-related factors. Acne during adolescence does not seem to affect long-term educational, labour market or relationship outcomes. However, there is a need for additional studies to validate the findings in untreated patients and different health and social systems.

Health care utilization up to 11years after diagnosis among patients with a hematologic malignancy and its association with socioeconomic position.

To investigate health care utilization among patients with hematologic malignancies and its association with socioeconomic position (SEP) and compare health care utilization with a cancer-free population. Patients with aggressive lymphoma, indolent lymphoma, or multiple myeloma (MM), diagnosed between 1999-2010 and 2015-2019, participated in longitudinal patient-reported outcome research, up to 11years post-diagnosis. Questionnaires assessed health care utilization at the general practitioner (GP), medical specialist, and additional health care. SEP was based on education and income, categorized as low, medium, or high. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry. Mixed models and logistic regression analyses were performed. The study included 2319 patients (71% response rate), who completed on average five measurements. Patients with MM reported the highest health care utilization, both at the GP and medical specialist. Low SEP was associated with higher utilization at the GP (medium education β = - 0.72, p = 0.01; high education β = - 1.15, p < 0.001) and lower utilization of additional physical (OR = 1.7, p = 0.01) and psychosocial (OR = 1.5, p < 0.05) care, among all patients. For patients with MM, high SEP was also associated with higher utilization of health care at the medical specialist (high education β = 2.56, p < 0.05). Hematologic malignancy-related and SEP-related disparities in health care utilization were observed. To ensure equal access to health consumption, attention is needed for patients with a low SEP to provide better guidance in their cancer (survivorship) care. Improving health literacy and involving informal caregivers and nurse-led patient navigation may help reduce disparities in access to (additional) health care.

Addressing Unemployment through the Coir Industry: An Analysis of National Efforts and Challenges

The coir industry in Kerala, the birthplace of Indian coir, is facing significant challenges due to mechanization, leading to widespread labour displacement and migration. This issue is not adequately addressed by government policies, as unemployment affects all segments of the industry and negatively impacts disadvantaged social groups. The decline in the coir industry is causing a shift in the manufacturing sector, with small-scale and household sectors being abandoned and large export firms moving to other states. This article provides insights into the difficulties in finding employment and the rising rate of unemployment in the context of the coir industry, a field often disregarded in national economic policies. Using a mixed-methods approach that incorporates surveys, structured interviews, and secondary data analysis, the study looks at the relationship between unemployment and the modernization of coir enterprises, concentrating on how these changes effect job prospects and the socioeconomic position of workers. According to the findings, despite consistent government support, other initiatives are insufficient, resulting in a significant loss of employment, labour displacement and frequent labour migration.

Social Determinants of Cardiovascular Health in Asian Americans: A Scientific Statement From the American Heart Association.

To achieve cardiovascular health (CVH) equity in the United States, an understanding of the social and structural factors that contribute to differences and disparities in health is necessary. The Asian American population is the fastest-growing racial group in the United States but remains persistently underrepresented in health research. There is heterogeneity in how individual Asian American ethnic groups experience CVH and cardiovascular disease outcomes, with certain ethnic groups experiencing a higher burden of adverse social conditions, disproportionately high burden of suboptimal CVH, or excess adverse cardiovascular disease outcomes. In this scientific statement, upstream structural and social determinants that influence CVH in the Asian American population are highlighted, with particular emphasis on the role of social determinants of health across disaggregated Asian American ethnic groups. Key social determinants that operate in Asian American communities include socioeconomic position, immigration and nativity, social and physical environments, food and nutrition access, and health system-level factors. The role of underlying structural factors such as health, social, and economic policies and structural racism is also discussed in the context of CVH in Asian Americans. To improve individual-, community-, and population-level CVH and to reduce CVH disparities in Asian American ethnic subgroups, multilevel interventions that address adverse structural and social determinants are critical to achieve CVH equity for the Asian American population. Critical research gaps for the Asian American population are given, along with recommendations for strategic approaches to investigate social determinants of health and intervene to reduce health disparities in these communities.

Early life socioeconomic inequalities and type 2 diabetes incidence: Longitudinal analyses in the Maastricht study

AimType 2 diabetes (T2D) is a common chronic disease that disproportionally affects groups with a low socioeconomic position (SEP). This study aimed to examine associations between childhood SEP and incident T2D, independent of adult SEP. MethodsLongitudinal data from The Maastricht Study were used (N=6,727, 55.2 % female, mean (SD) age 58.7(8.7) years). Childhood SEP was determined by asking for the highest completed educational level for the father and mother and childhood income inadequacy. Adult SEP was determined by highest completed educational level, equivalent household income, and occupational position. Incident T2D was self-reported yearly (up to 12 years of follow-up). Associations were studied with Cox regression analyses. ResultsIn participants without T2D at baseline, 3.7% reported incident T2D over 8.2 (median) years of follow-up. Incident T2D was most common in people with low childhood and adult SEP and lowest in those with high childhood and adult SEP (1.7 vs. 7.5 per 1,000 person years). The association between childhood SEP and incident T2D was mainly explained by adult SEP, except for childhood income inadequacy which was independently associated with incident T2D. ConclusionSocioeconomic inequalities in childhood and adulthood are risk factors for incident T2D. More attention is needed to reduce childhood poverty and improve adult SEP to reduce the T2D risk.

Do poor psychosocial resources mediate health inequalities in type 2 diabetes mellitus? Findings from the Maastricht study.

Low socioeconomic position (SEP) has been identified as a risk factor for type 2 diabetes mellitus (T2DM), and psychosocial resources might be on the pathway in this association. We examined two poor psychosocial resources, low control beliefs and inferiority beliefs, that might link low SEP with T2DM. 8292 participants aged 40-75 living in Southern Netherlands participated in The Maastricht Study starting from September 2010 to October 2020 and were followed up to 10 years with annual questionnaires. SEP (education, income, occupation), low control beliefs, inferiority beliefs, and (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum. We analysed the mediating roles of poor psychosocial resources by using counterfactual mediation analysis. People with low SEP had more often prevalent and incident T2DM (e.g. low education: HR = 2.13, 95%CI: 1.53-2.97). Low control beliefs and high inferiority beliefs were more common among people with low SEP. Moreover, low control beliefs and high inferiority beliefs were risk factors for T2DM (e.g. low control beliefs: HR = 1.50, 95%CI: 1.08-2.09). The relationship between SEP and T2DM was partially mediated by control beliefs (8.0-13.6%) and inferiority beliefs (2.2-4.5%). We conclude that poor psychosocial resources are important in socioeconomic inequalities in diabetes. Researchers and practitioners should consider the psychosocial profile of people with lower SEP, as such a profile might interfere with the development, treatment, and prevention of T2DM. Further research should explore how poor psychosocial resources interact with chronic stress in relation to socioeconomic health inequalities.

Roll-your-own tobacco use among people smoking menthol cigarettes in Great Britain, 2020-2023: a population-based survey.

The sale of factory-made cigarettes with menthol as characterising flavour has been prohibited in Great Britain since May-2020. However, menthol accessories like flavoured filters for roll-your-own (RYO) tobacco can be sold legally, possibly undermining the policy. This study aimed to explore the association of RYO and menthol cigarette smoking. Data were collected between October-2020 and October-2023 from a monthly population-based cross-sectional survey, with 82,120 adults (18+) living in Great Britain providing complete data. Logistic regression models assessed the association between predominant RYO tobacco use and menthol cigarette smoking, and whether it differed by sociodemographic characteristics, unadjusted and adjusted for age, gender, ethnicity, nation, and socioeconomic position. Time-trends in RYO tobacco use among people smoking menthol cigarettes were modelled over the study period. There has been no clear decrease in menthol cigarette smoking prevalence among people who smoke (~14%) following the ban. Predominant RYO use increased among people smoking menthol cigarettes from 49.6% (95%CI: 42.2-57.0) in October-2020 to 61.9% (95%CI: 57.5-66.0) in June-2022, after which it remained stable. Predominant RYO use was more common among people smoking menthol than non-flavoured cigarettes overall (adjusted odds ratio (ORadj)=1.30, 95%CI: 1.14-1.49) and across demographic subgroups. This association was most pronounced in middle-aged compared with older people (35 vs. 65 years ORadj=1.18, 95%CI: 1.01-1.35), and in ethnic minorities compared with White people (ORadj=1.56, 95%CI: 1.03-2.36). There was a substantial increase in RYO use among people smoking menthol cigarettes in the first two years after the ban, from approximately 50% to 60%. The availability of menthol accessories may have undermined the ban on factory-made mentholated cigarettes in Great Britain. Roughly one in seven people who smoke cigarettes still report smoking menthol cigarettes and among these, about two thirds predominantly use roll-your-own tobacco. Since there has been no noteworthy change in the prevalence of menthol cigarette smoking since October-2020, new measures will likely be necessary to achieve a further reduction. For example, menthol accessories could be banned or their advertising and availability heavily restricted.

A microsimulation model of smoking prevalence in England: exploring potential impacts of ‘Tobacco 21’ and e-cigarette policy scenarios on socioeconomic and regional inequalities

Background The burden of morbidity and mortality in England, is greater among priority groups such as those with lower income or routine and manual occupations. Using a microsimulation model, we estimate projected changes in smoking prevalence according to socio-economic position under selected policy scenarios that are relevant to ongoing policy implementation and debate. Methods Initiated using real-world data from adult (16+) respondents to the Smoking Toolkit Study (STS), the ‘QuitSimX’ microsimulation model projects individual-level smoking uptake and cessation in England over time. The simulation was run under two separate policy scenarios, raising the age of sale of tobacco products to 21 (simulations run from 2013–2023), and moving a proportion of all individuals quitting using a certain method (such as over the counter nicotine replacement therapy), or no method, to using e-cigarettes instead (simulations run from 2015–2025). Under each scenario, the size of effect were specified, and the outcomes simulated and assessed by indicators of socio-economic position. Absolute and relative inequalities were examined by comparing at the initial and final timepoint the i) absolute difference in smoking prevalence between less and more advantaged groups subgroups and ii) the ratio of smoking prevalence. Results While absolute and relative inequalities in smoking prevalence declined across the simulated period under all policy scenarios and the counterfactual ‘no intervention’ scenario, at the final time point absolute and relative inequalities between social grades and regions were similar across all scenarios, with the exception that the relative (but not absolute) inequality under the most impactful tobacco 21 scenario as marginally higher than under the baseline scenario. Conclusion A microsimulation model of smoking in England illustrates that absolute inequalities are projected to decrease under a Tobacco 21 or quitting with e-cigarettes scenario but that some policy solutions (Tobacco 21) may result in an increase in relative inequalities.

Demographic and socio-economic inequalities in subjective wellbeing: analysis of repeated cross-sectional health surveys in England 2010-2019.

Good subjective wellbeing (SWB) is a key societal aspiration. The study of SWB determinants is of increasing interest. The present study aimed to examine national inequalities in SWB, and trends in these inequalities, for England across five demographic (sex and age) and socio-economic (educational level, household income and living alone) characteristics. The relative index of inequalities (RII) and slope index of inequalities (SII) were calculated from repeated cross-sectional data from the Health Survey for England from 2010 to 2019 (excluding 2017 and 2018 as our outcome variable was not collected in these years), in a total of 90 236 participants aged 16+. SWB was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), treated as a dichotomous variable with high and low levels of SWB>40 and≤40, respectively. There were significant inequalities in SWB by income (RII from 1.086 to 1.116), educational level (RII from 0.893 to 0.941) and between people living alone or not (RII from 0.908 to 0.937). The RII and SII trends were not statistically significant. Higher socio-economic status could play a protective role for SWB, and people in the most deprived socio-economic positions may be at higher risk for low SWB. These associations have remained stable over time.

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences. A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations. In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education. Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.