Socioeconomic Position Research Articles

M87 - Relationships Between Socioeconomic Position and Quitting Smoking Among Pregnant Women: A Longitudinal Assessment From Waves 1–5 of the Population Assessment of Tobacco and Health Study

M87 - Relationships Between Socioeconomic Position and Quitting Smoking Among Pregnant Women: A Longitudinal Assessment From Waves 1–5 of the Population Assessment of Tobacco and Health Study

The associations of socioeconomic position with structural brain damage and connectivity and cognitive functioning: The Maastricht Study

BackgroundSocioeconomic inequalities in cognitive impairment may partly act through structural brain damage and reduced connectivity. This study investigated the extent to which the association of early-life socioeconomic position (SEP) with later-life cognitive functioning is mediated by later-life SEP, and whether the associations of SEP with later-life cognitive functioning can be explained by structural brain damage and connectivity. MethodsWe used cross-sectional data from the Dutch population-based Maastricht Study (n = 4,839; mean age 59.2 ± 8.7 years, 49.8% women). Early-life SEP was assessed by self-reported poverty during childhood and parental education. Later-life SEP included education, occupation, and current household income. Participants underwent cognitive testing and 3-T magnetic resonance imaging to measure volumes of white matter hyperintensities, grey matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SEP, markers of structural brain damage and connectivity, and cognitive functioning. Mediation was tested using structural equation modeling. ResultsAlthough there were direct associations between both indicators of SEP and later-life cognitive functioning, a large part of the association between early-life SEP and later-life cognitive functioning was explained by later-life SEP (72.2%). The extent to which structural brain damage or connectivity acted as mediators between SEP and cognitive functioning was small (up to 5.9%). ConclusionsWe observed substantial SEP differences in later-life cognitive functioning. Associations of structural brain damage and connectivity with cognitive functioning were relatively small, and only marginally explained the SEP gradients in cognitive functioning.

Socioeconomic gradients in 24-hour movement patterns across weekends and weekdays in a working-age sample: evidence from the 1970 British Cohort Study

BackgroundSocioeconomic differences in movement behaviours may contribute to health inequalities. The aim of this descriptive study was to investigate socioeconomic patterns in device-measured 24-hour movement and assess whether patterns differ...

Systematic Review on the Impact of Salt-Reduction Initiatives by Socioeconomic Position to Address Health Inequalities in Adult Populations.

International evidence shows that individuals from low socioeconomic positions (SEPs) consume a greater amount of salt than those from higher SEPs. This health inequality reflects a disproportionate effect of salt-reduction initiatives, and explains a higher prevalence of cardiovascular disease among the most vulnerable populations. Assessing this impact can help tailor implementation strategies in the future for the benefit of the whole population. The aim was to systematically review the literature and assess the impact of salt-reduction initiatives on health and behavioral outcomes of adults by SEP. The search strategy was conducted in 6 databases (CINAHL, Scopus, Embase, MEDLINE, PubMed, and Web of Science) using the terms sodium or salt, social class, policy, intervention or campaign. Peer-reviewed articles assessing salt-reduction interventions in adults reporting dietary or behavioral changes on salt consumption measurements by SEP were considered for inclusion. Articles in which salt intake data were not reported by SEP were excluded. Two reviewers collected data independently using a predesigned electronic form. The AXIS and RoB 2 tools were used for critical appraisal. Eight studies containing data from 111 548 adults were interpreted according to study design following a narrative synthesis approach. Salt-reduction initiatives are effective at reducing the intake of salt and sodium in adults. When reporting the impact of these initiatives, research outcomes are generally not evaluated by SEP, representing a question yet to be explored. A small number of articles that focused on the impact of salt-reduction interventions reported salt consumption measurements by SEP, indicating a critical gap in research. The limited evidence suggests potentially greater health benefits to be gained from the implementation of population-wide initiatives in adults of low SEP. PROSPERO registration no. CRD42021238055.

O-158 Social disparities in achieving a live birth after initiating ART treatment: a national register-based study among women in Denmark

Abstract Study question How are educational level, labor market attachment and income associated with achieving a live birth after initiating ART treatment among women in Denmark? Summary answer Higher educational level, labor market attachment and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already Infertility is increasing in populations worldwide with an estimated lifetime prevalence of 17.5%. Approaches to this issue differs between societies and healthcare systems. In the public Danish healthcare system, three fresh ART treatments are currently offered free of charge. Additional ART treatments are self-financed in the private healthcare sector. Socioeconomic disparities in health are widely recognized. Previous studies have indicated that higher socioeconomic position (SEP) is associated with a greater probability of achieving a live birth after initiating ART treatment. However, there is limited knowledge about SEP and its relation to outcomes of ART treatment. Study design, size, duration This is a national, register-based study based on the DANAC II Cohort. Women undergoing ART treatment during 1994–2017 registered in the Danish IVF register were individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population consisted of 68,738 women treated with ART. The outcome was a live birth. The women were followed until outcome, death, migration, or end of study (31/12/2017). Participants/materials, setting, methods Women included in the analyses were aged 18–45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labor market attachment and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders age and ethnicity. Death was incorporated as a competing risk in all analyses. Main results and the role of chance Adjusted results showed that educational level, labour market attachment and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a first live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education the highest HR was found among women with a research education (HR = 3.02 [95% CI 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (HR = 0.67 [95% CI 0.64; 0.69]) compared to employed women. Women in the highest income group had two times higher HR of achieving a live birth after initiating ART compared to women in the lowest income group. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Subanalyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations, reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007, thus these treatments are not included. Whether severity of infertility/prognosis differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment and, as shown, treatment success differs based on socio-economic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socio-economic background needs to be addressed. Trial registration number Not applicable

Selective Classes and Early Health Inequalities in Comprehensive Schools in Finland.

The origin of inequalities in health outcomes has been explained by health selection and social causation models. Health selection processes operate particularly at school age. We study, if student allocation to teaching groups with aptitude tests (selective vs general class) differentiates adolescents by health behaviors and mental health. Finnish schoolchildren 12-13 years from 12 selective classes, n = 248; 41 general classes, n = 703 answered a questionnaire on addictive products (tobacco, snus, alcohol, and energy drinks), digital media use, and mental health (health complaints, anxiety, and depression). Structural equation modeling was conducted to identify structures between outcomes, SEP (socioeconomic position), class type, and academic performance. Students in the selective classes reported less addictive digital media and addictive products use than students in the general classes. Differences in academic performance or SEP between the class types did not solely explain these differences. Mental health was not related to the class type. SEP was indirectly associated with health behaviors via the class type and academic performance. Selecting students to permanent teaching groups with aptitude tests differentiates students according to risky health behaviors. The impact of education policies using student grouping should also be evaluated in terms of students' health.

O-162 Ethnic disparity in the use of treatment with assisted reproductive technologies in Denmark

Abstract Study question Is ethnic background among 18-45-year-old women associated with initiating ART-treatment in Denmark? Summary answer Results indicate ethnic disparity in the use of ART-treatment, with immigrants and descendants having lower odds of initiating ART-treatment compared to women with Danish origin. What is known already The use of fertility treatment has increased over the past decades. Ethnic disparity exists in the use of health care, but there is limited knowledge about the association between ethnicity and use of fertility treatment. Previous studies have shown that women with lower socioeconomic position (SEP) have lower odds of initiating ART-treatment compared to women with higher SEP. Immigrants and descendants often have lower SEP compared to the general population, but specific mechanisms might be at play when residing and navigating in a new country and healthcare system. Study design, size, duration This is a national, register-based study based on the DANAC II cohort. Women initiating ART-treatment (IVF or ICSI) aged 18–45 were identified in the Danish IVF Register from 1994-2017. According to the time of ART-treatment women were included in the study and randomly age-matched with 10 untreated women in the background population. The study population consisted of 676.355 women. Participants/materials, setting, methods The probability of initiating ART-treatment was compared across ethnic groups and examined in logistic regression analysis. Migration status and country of origin were used as proxies for ethnic group in separate analysis. Age was accounted for by matching, and additional factors of interest such as SEP measures were classified as potential mediators and thus not included in the main analyses. The effect of duration of residence in Denmark was analysed separately among immigrants. Main results and the role of chance The study population consisted of 526.507 (78 %) women of Danish origin, 142.656 (21 %) were immigrants and 7.192 (1 %) descendants of immigrants. Among women of Danish origin 11 % had initiated ART-treatment compared to 5 % of immigrants and 9 % of descendants. Immigrants had 56 % lower odds of receiving first ART-treatment compared to women of Danish origin (OR 0,44, CI 95 % 0,43-0,45), while descendants had 22 % lower odds compared to women of Danish origin (OR 0,78, CI 95 % 0,72-0,84). Regarding the analysis looking at country of origin results showed that 3-4 % of women originating from western countries had received first ART-treatment, compared to 6-8 % of women originating from non-western countries. Women originating from western countries had between 65-78% lower odds for receiving first ART-treatment compared to women of Danish origin. Odds of receiving ART-treatment among women of non-western origin was between 34-47 % lower compared to women of Danish origin. This indicates that disparity in first ART-treatment is particularly distinctive among women of western origin, possibly explained by differences in reasons for migrating. Limitations, reasons for caution Information on the reason for infertility and desire to have children could have provided more insight into the disparity. Data about basis for residence could have provided information on reasons for immigration and duration of residence. Wider implications of the findings Infertility and childlessness can have severe consequences for individuals and society, and equal access to fertility treatment is important, not least in a universal welfare society. The results of this study indicate ethnic disparity in ART-treatment, and we encourage further research regarding the possible causes and barriers to initiate treatment. Trial registration number not applicable

Social disparities in flood exposure and associations with the urban environment in 44,698 neighborhoods in 276 cities in eight Latin American countries.

Climate change is expected to greatly increase exposure to flooding, particularly in urban populations in low- and middle-income countries. We examined within-city social disparities in exposure to flooding in 276 Latin American cities and associated features of the neighborhood urban environment. We used a spatially granular dataset of historical flood events from 2000 to 2018 to describe neighborhood flooding within cities across eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, and Panama). We estimated the percentage of the population living in flooded neighborhoods, described social disparities in flooding based on neighborhood educational attainment, and compared the magnitude of disparities across and within cities. We used multilevel models to examine how city- and neighborhood-level factors are related to neighborhood flooding. We examined 44,698 neighborhoods in 276 cities from eight countries with a total of 223 million residents and 117 distinct flood events from 2000-2018. One in four residents in neighborhoods in the lowest education quintile lived in neighborhoods with flooding, compared to one in 20 residents of the highest neighborhood education quintile. Greater neighborhood flooding was associated with lower neighborhood-level educational attainment and with neighborhoods that were coastal, less dense (population or intersection), further from the city center, greener, and had steeper slopes. There was no association between city-level educational attainment and flooding. There are large social disparities in neighborhood flooding within Latin American cities. Residents of areas with lower education attainment face substantially higher risks of flooding. Policymakers must prioritize flood adaptation and recovery efforts in neighborhoods with lower socioeconomic position.

Real Democracy: A Critical Realist Approach to Democracy and Democratic Theory

This article presents an alternative general model of democracy to traditional minimalist (electoral and liberal) and deliberative theories by drawing from critical realist philosophical thought. Realist or real democracy is proposed as a societal system where preconditions exist to fully empower all citizens to realize their individual capabilities. This includes empowerment opportunities at the ballot box - but also other preconditions such as health, educational and living standards. Real democracy also separates democratic preconditions from democratic outcomes. Democratic outcomes require the absence of inequalities in power as result from the contingent interaction preconditions and human agency. The new approach is argued to provide a more holistic and dynamic concept of democracy which is also more grounded in the everyday experience of the citizen compared to traditional approaches. It reconnects democracy with theories of human development and enables a new classification of political regimes and conception of democratic politics. An initial empirical mapping of patterns of global real democracy shows evidence of rising preconditions since 1990 – but stagnation since 2010 and some signs of decline. Democratic outcomes by socio-economic position saw the most notable decline.

Intergenerational transmission of health inequalities: towards a life course approach to socioeconomic inequalities in health – a review

Adult health inequalities are a persistent public health problem. Explanations are usually sought in behaviours and environments in adulthood, despite evidence on the importance of early life conditions for life...

When in the lifecourse? Socioeconomic position across the lifecourse and biological health score

PurposeEducational attainment is associated with multiphysiological wear and tear. However, associations with measures of socioeconomic position (SEP) across different life-stages are not established. MethodsUsing regression models and data from 8105 participants from the UK Household Longitudinal Study (Understanding Society), we examined associations of lifecourse SEP with an overall biological health score (BHS). BHS is broader than usual measures of biological ‘wear and tear’ and is based on six physiological subsystems (endocrine, metabolic, cardiovascular, inflammatory/immune, liver, and kidney), with higher scores indicating worse health. Lifecourse SEP was based on respondents’ parental, first, and most recent occupations. ResultsAssociations with SEP at all life-stages demonstrated higher BHS with increasing disadvantage (e.g. slope index of inequality (SII) (95 % CI) for most recent SEP: 0.04 (0.02, 0.06)). There was little difference in the magnitude of associations for SEP measured at each life-stage. Cumulative disadvantage across the lifecourse showed a stepped association with increasing BHS (SII (95 % CI): 0.05 (0.04, 0.07)). Associations were largely driven by metabolic, cardiovascular, and inflammatory systems. ConclusionOur results suggest that disadvantaged SEP across the lifecourse contributes cumulatively to poorer biological health, highlighting that every life-stage should be a target for public health policies and intervention.

Is social disadvantage a chronic stressor? Socioeconomic position and HPA axis activity among older adults living in England

IntroductionLiving in socioeconomic disadvantage has been conceptualised as a chronic stressor, although this contradicts evidence from studies using hair cortisol and cortisone as a measure of hypothalamus-pituitary-adrenal (HPA)11HPA axis: Hypothalamus Pituitary Adrenal axis axis activity. These studies used complete case analyses, ignoring the impact of missing data for inference, despite the high proportion of missing biomarker data. The methodological limitations of studies investigating the association between socioeconomic position (SEP)22SEP: Socio-economic Position defined as education, wealth, and social class and hair cortisol and cortisone are considered in this study by comparing three common methods to deal with missing data: (1) Complete Case Analysis (CCA),33CCA: Complete Case Analysis (2) Inverse Probability Weighting (IPW) 44IPW: Inverse Probability Weightingand (3) weighted Multiple Imputation (MI).55MI: Multiple Imputation This study examines if socioeconomic disadvantage is associated with higher levels of HPA axis activity as measured by hair cortisol and cortisone among older adults using three approaches for compensating for missing data. MethodCortisol and cortisone levels in hair samples from 4573 participants in the 6th wave (2012–2013) of the English Longitudinal Study of Ageing (ELSA)66ELSA: English Longitudinal Study of Ageing were examined, in relation to education, wealth, and social class. We compared linear regression models with CCA, weighted and multiple imputed weighted linear regression models. ResultsSocial groups with certain characteristics (i.e., ethnic minorities, in routine and manual occupations, physically inactive, with poorer health, and smokers) were less likely to have hair cortisol and hair cortisone data compared to the most advantaged groups. We found a consistent pattern of higher levels of hair cortisol and cortisone among the most socioeconomically disadvantaged groups compared to the most advantaged groups. Complete case approaches to missing data underestimated the levels of hair cortisol in education and social class and the levels of hair cortisone in education, wealth, and social class in the most disadvantaged groups. ConclusionThis study demonstrates that social disadvantage as measured by disadvantaged SEP is associated with increased HPA axis activity. The conceptualisation of social disadvantage as a chronic stressor may be valid and previous studies reporting no associations between SEP and hair cortisol may be biased due to their lack of consideration of missing data cases which showed the underrepresentation of disadvantaged social groups in the analyses. Future analyses using biosocial data may need to consider and adjust for missing data.

“You are either sporty or you are not” a qualitative exploration of pre-teen girls of low-socioeconomic position experiences of being physically active

BackgroundEighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls’ experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences. MethodsFocus groups were conducted with 107 girls aged 10–12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF). ResultsThemes highlighted how skills and confidence underpin girls’ self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour). ConclusionThis study provides insight into low-SEP pre-teen girls’ experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

Contextual and individual inequalities in breast cancer screening participation and outcomes in Turin (North-West Italy)

Breast cancer incidence and screening participation exhibit an unequal distribution in the population. This study aims to investigate the impact of socioeconomic position (SEP) on three breast screening indicators (participation, recall, and cancer detection rates) among women aged 50–69 in the city of Turin between 2010 and 2019. The study also aims to determine whether contextual factors (deprivation index) or individual factors (educational level) have a greater influence. The data used in this study are sourced from the Turin Breast Screening Program (TBSP) and the Turin Longitudinal Study (TLS). To test the hypothesis and account for the hierarchical structure of the data, multilevel models were used. Both contextual and individual SEP were found to be associated with screening participation. Participation increased with higher levels of deprivation (odds ratio for most deprived: 1.13; 95% CI 1.11–1.16) and decreased with higher educational levels (OR for low educated: 1.37; 95% CI 1.34–1.40). Contextual SEP did not show any association with recall or cancer detection rates, but individual SEP had an impact. Women with lower educational levels had a statistically significant 19% lower odds of being recalled and a statistically significant 20% lower odds of being diagnosed with cancer. Additionally, immigrant women were less likely to participate in screening, be recalled, or receive a cancer diagnosis. Educational level consistently influenced the analyzed screening indicators, while contextual deprivation appeared to have less importance. It is likely that women living in less deprived areas and with higher education have greater access to opportunistic screening.

Social Characteristics and Adherence to Adjuvant Endocrine Therapy in Premenopausal Women With Breast Cancer.

PURPOSESocial characteristics, including cohabitation/marital status and socioeconomic position (SEP)-education level, employment status, and income-influence breast cancer prognosis. We investigated the impact of these social characteristics on adherence to adjuvant endocrine therapy (AET) from treatment initiation to 5 years after diagnosis.METHODSWe assembled a nationwide, population-based cohort of premenopausal women diagnosed in Denmark with stage I-III, estrogen receptor-positive breast cancer during 2002-2011. We ascertained prediagnostic social characteristics from national registries. AET adherence was based on information from the Danish Breast Cancer Group and operationalized as (1) adherence trajectories (from group-based trajectory modeling) and (2) early discontinuation. We computed odds ratios (ORs) and associated 95% CI to estimate the association of cohabitation and SEP with AET adherence using multinomial and logistic regression models adjusted according to directed acyclic graphs.RESULTSAmong 4,353 patients, we identified three adherence trajectories-high adherence (57%), slow decline (36%), and rapid decline (6.9%). Compared with cohabiting women, those living alone had higher ORs of slow (1.26 [95% CI, 1.08 to 1.46]) or rapid decline (1.66 [95% CI, 1.27 to 2.18]) versus high adherence. The corresponding ORs for women not working versus employed women were 1.22 (95% CI, 1.02 to 1.45) and 1.76 (95% CI, 1.30 to 2.38). For early discontinuation (17%), the ORs were 1.48 (95% CI, 1.23 to 1.78) for living alone and 1.44 (95% CI, 1.17 to 1.78) for women not working.CONCLUSIONAdherence to AET was lower among women living alone or unemployed than cohabiting or employed women, respectively. These women may benefit from support programs to enhance AET adherence.

Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

PurposeGuided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. MethodsSecondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. ResultsPoorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65–74 years, younger respondents were less likely to rate their care favourably (16–34 years old ORadj. = 0.55 (0.36–0.84). Compared to White British, Asian (ORadj. = 0.51 (0.39–0.66)) and Black African women (ORadj. = 0.53 (0.33–0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (ORadj. = 0.79 (0.64–0.97)). ConclusionThere is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.

Examining the Psychometric Properties of the Family Affluence Scale in Norwegian Health Behaviour in School-Aged Children Surveys: Implications for Time Trend Analysis

This study assessed the applicability of the Family Affluence Scale II (FASII) for conducting time trend analysis within Norway's “Health Behaviour in School-Aged Children Study” (HBSC), spanning from 2002 to 2018. A dataset comprising 27,470 valid questionnaires was employed to assess the psychometric properties of the FASII with respect to validity and reliability for use at single- and multiple times points. The analytical approach encompassed a range of statistical techniques, including confirmatory factor analysis (CFA), multi-group CFA, polychoric correlation testing between FASII scores and perceived family wealth, a subjective measure of socioeconomic position (SEP), and an assessment of perceived family wealth and FASII scores across time. The results of the study revealed an overall good model fit in CFA and a positive correlation between FASII scores and perceived family wealth. However, the analysis uncovered measurement non-invariance across survey years, sex, and age groups. Measurement non-invariance hampers direct time-to-time comparisons of FASII scores, impeding the assessment of affluence development over time. Despite this limitation, FASII maintains its utility for ranking affluence and measuring health outcomes at single time points. As such, this study offers valuable insight into the suitability of FASII for time trend analysis within the Norwegian HBSC data and broader research on social inequality.

Investigating the relationships between motor skills, cognitive status, and area deprivation index in Arizona: a pilot study.

Previous studies highlight the negative impact of adverse socioeconomic conditions throughout life on motor skills and cognitive health. Factors such as cognitive activity, physical activity, lifestyle, and socioeconomic position significantly affect general health status and brain health. This pilot study investigates the relationships among the Area Deprivation Index (ADI)-a measure of neighborhood-level socioeconomic deprivation, brain structure (cortical volume and thickness), and cognitive status in adults in Arizona. Identifying measures sensitive to ADI could elucidate mechanisms driving cognitive decline. The study included 22 adults(mean age = 56.2 ± 15.2) in Arizona, residing in the area for over 10 years(mean = 42.7 ± 15.8). We assessed specific cognitive domains using the NeuroTrax™ cognitive screening test, which evaluates memory, executive function, visual-spatial processing, attention, information processing speed, and motor function. We also measured cortical thickness and volume in 10 cortical regions using FreeSurfer 7.2. Linear regression tests were conducted to examine the relationships between ADI metrics, cognitive status, and brain health measures. Results indicated a significant inverse relationship between ADI metrics and memory scores, explaining 25% of the variance. Both national and state ADI metrics negatively correlated with motor skills and global cognition (r's < -0.40, p's < 0.05). In contrast, ADI metrics generally positively correlated with motor-related volumetric and cortical thickness measures (r's > 0.40, p's < 0.05). The findings suggest that neighborhood-level social deprivation might influence memory and motor status, primarily through its impact on motor brain health.

Do promotions of healthier or more sustainable foods increase sales? Findings from three natural experiments in UK supermarkets

BackgroundDietary changes are necessary to improve population health and meet environmental sustainability targets. Here we analyse the impact of promotional activities implemented in UK supermarkets on purchases of healthier and more sustainable foods.MethodsThree natural experiments examined the impact of promotional activities on sales of a) no-added-sugar (NAS) plant-based milk (in 199 stores), b) products promoted during ‘Veganuary’ (in 96 stores), and c) seasonal fruit (in 100 non-randomised intervention and 100 matched control stores). Data were provided on store-level product sales, in units sold and monetary value (£), aggregated weekly. Predominant socioeconomic position (SEP) of the store population was provided by the retailer. Analyses used interrupted time series and multivariable hierarchical mixed-effects models.ResultsSales of both promoted and total NAS plant-based milks increased significantly during the promotional period (Promoted:+126 units, 95%CI: 105–148; Overall:+307 units, 95%CI: 264–349). The increase was greater in stores with predominately low SEP shoppers. During Veganuary, sales increased significantly for plant-based foods on promotion (+60 units, 95%CI: 37–84), but not for sales of plant-based foods overall (dairy alternatives: -1131 units, 95%CI: -5821–3559; meat alternatives: 1403 units, 95%CI: -749–3554). There was no evidence of a change in weekly sales of promoted seasonal fruit products (assessed via ratio change in units sold: 0.01, 95%CI: 0.00–0.02), and overall fruit category sales slightly decreased in intervention stores relative to control (ratio change in units sold: -0.01, 95%CI: -0.01–0.00).ConclusionDuring promotional campaigns there was evidence that sales of plant-based products increased, but not seasonal fruits. There was no evidence for any sustained change beyond the intervention period.

The association of maternal factors with the neonatal microbiota and health

The human microbiome plays a crucial role in human health. However, the influence of maternal factors on the neonatal microbiota remains obscure. Herein, our observations suggest that the neonatal microbiotas, particularly the buccal microbiota, change rapidly within 24–48 h of birth but begin to stabilize by 48–72 h after parturition. Network analysis clustered over 200 maternal factors into thirteen distinct groups, and most associated factors were in the same group. Multiple maternal factor groups were associated with the neonatal buccal, rectal, and stool microbiotas. Particularly, a higher maternal inflammatory state and a lower maternal socioeconomic position were associated with a higher alpha diversity of the neonatal buccal microbiota and beta diversity of the neonatal stool microbiota was influenced by maternal diet and cesarean section by 24–72 h postpartum. The risk of admission of a neonate to the newborn intensive care unit was associated with preterm birth as well as higher cytokine levels and probably higher alpha diversity of the maternal buccal microbiota.