District Socioeconomic Status Research Articles

Do Municipal Contexts Matter for Adolescent Mental Health? A Within-Municipality Analysis of Nationwide Norwegian Survey Data Across Six Years.

Despite growing concerns about substantial socio-economic differences between districts in many developed nations, limited attention has been paid to how adolescent mental health may be shaped by district characteristics. A few studies have shown that adolescent mental health is related to contextual factors such as district socio-economic status, neighborhood disorder, and quality of infrastructure. However, prior estimates may be an artifact of unmeasured differences between districts. To address these concerns, we used data from the nationwide Norwegian Ungdata surveys (N = 278,764), conducted across the years 2014 to 2019. We applied three-level hierarchical linear models to examine within-municipality associations between municipal factors and adolescent mental health in the domains of internalizing problems (i.e., depressive symptoms), externalizing problems (i.e., behavioral problems), and well-being (i.e., self-esteem), thereby accounting for all time-invariant municipality-level confounders. Our results showed that municipal-level safety, infrastructure, and youth culture are associated with adolescent mental health problems. Further, cross-level interaction models indicated gender-specific associations, with stronger associations of municipality infrastructure and community belongingness with increased self-esteem and reduced delinquent behaviors among girls than boys. Our findings highlight that municipality-level interventions may be a feasible strategy for adolescent mental health, even in a society characterized by low inequality and high redistribution.

Thyroid Cancer Incidence and Mortality by Socioeconomic Level in the State of São Paulo, Brazil 2001-2017

ObjectiveThyroid cancer is rising largely due to greater detection of indolent or slow-growing tumors; we sought to compare the incidence and mortality profiles of thyroid cancer in the State of São Paulo by socioeconomic status (SES). MethodsData on thyroid cancer cases diagnosed from 2003 to 2017 in the Barretos Region and from 2001 to 2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding death data were obtained from a Brazilian public government database. Age-standardized rates were calculated and presented as thematic maps. The rates were also calculated by SES and spatial autocorrelation was assessed by global and local indices. ResultsThere were 419 cases of thyroid cancer and 21 deaths in Barretos, contrasting with the highly populated São Paulo, with 30 489 cases and 673 deaths. The overall incidence rates in São Paulo (15.9) were three times higher than in Barretos (5.7), while incidence rates in women were close to five times higher in Barretos and four times higher in São Paulo than in men. Mortality rates were, in relative terms, very low in both regions. A clear stepwise gradient of increasing thyroid cancer incidence with increasing SES was observed in São Paulo, with rates in very high SES districts four times those of low SES (31.6 vs 8.1). In contrast, the incidence rates in Barretos presented little variation across SES levels. ConclusionThyroid cancer incidence varied markedly by SES in São Paulo, with incidence rates rising with increasing socioeconomic index. Overdiagnosis is likely to account for a large proportion of the thyroid cancer burden in the capital.

Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001–17

BackgroundCancer is a leading cause of morbidity and mortality in Brazil and the burden is rising. To better inform tailored cancer actions, we compare incidence and mortality profiles according to small areas in the capital and northeast region of the State of São Paulo for the leading cancer types. MethodsNew cancer cases were obtained from cancer registries covering the department of Barretos (2003–2017) and the municipality of São Paulo (2001–2015). Cancer deaths for the same period were obtained from a Brazilian public government database. Age-standardized rates per 100,000 persons-years by cancer and sex are presented as thematic maps, by municipality for Barretos region, and by district for São Paulo. ResultsProstate and breast cancer were the leading forms of cancer incidence in Barretos, with lung cancer leading in terms of cancer mortality in both regions. The highest incidence and mortality rates were seen in municipalities from the northeast of Barretos region in both sexes, while elevated incidence rates were mainly found in São Paulo districts with high and very high socioeconomic status (SES), with mortality rates more dispersed. Breast cancer incidence rates in São Paulo were 30 % higher than Barretos, notably in high and very high SES districts, while corresponding rates of cervical cancer conveyed the opposite profile, with elevated rates in low and medium SES districts. ConclusionsThere is substantial diversity in the cancer profiles in the two regions, by cancer type and sex, with a clear relation between the cancer incidence and mortality patterns observed at the district level and corresponding SES in the capital.

Inclusive Education of Students With Intellectual and Developmental Disabilities and PK-12 Leadership: Introduction to Special Issue

Increasing equity and access to inclusive environments requires a complex intersection of people, policies, practices, and procedures at the state, district, school, and education team level. At the macro level, equitable systems change requires systematic investigation of the structural barriers embedded and perpetuated within the very educational system purported to help close the achievement gap for those who have been marginalized in our PK-12 education systems (Ryndak et al., 2014). At the micro level, change requires an examination of how individuals navigate systemic barriers.Focusing on issues associated with PK-12 education leadership and students with Intellectual and Developmental Disabilities (IDD) has the potential to address the deeply rooted critical inequities that students with disabilities face regarding access to quality education with same age-grade non-disabled peers occurring across the globe. The manuscripts in this special issue represent a multi-level system focus on inclusive practices and provide actionable recommendations for PK-12 leaders as they address issues of access and inclusion for students with IDD.Choiseul-Praslin et al. examine mothers' experiences in the IEP process. The findings indicate that PK-12 education leaders must make systemic efforts to empower mothers (and all parents and families) during the IEP process in order to improve parent-school partnerships. Similarly, three manuscripts in this issue highlight the need for PK-12 leaders to reconsider the content gaps for students with IDD and how access to school-wide structures is or is not provided to all students. Specifically, they highlight the need for instructional content and practices that provide opportunities to gain self-determination skills, access technology, and be a part of system-wide positive behavior supports.Fisher et al. present findings that demonstrate a concerning lack of digital access for students with IDD, which results in greater digital isolation and fewer opportunities for social interaction. Similarly, Zagona et al. address how students with IDD should and could be included in the school-wide positive intervention and behavior support (SWPBIS) systems. These articles include recommendations for how PK-12 educational leaders can support practitioners in providing fidelity in instruction, and access to content and structures that are lacking for students with IDD. They include policy, procedure, and practice recommendations that are particularly pertinent for PK-12 leaders as they focus on expectations for teacher training and school structures, and decision-making around investment approaches.Approaching sustainable change through a multilevel system-wide approach is also reflected in the policy implementation research of Cosier et al. included in this special issue. The authors found relationships between probability of placement and district socioeconomic status and size. These results present items for consideration for policy-makers and district leaders as they consider placement decisions for students with IDD as well as associated factors such as teacher and leader professional learning.Overall, the collection of articles in this special issue represent the multi-level system-wide approach to inclusive practices necessary for education leaders to consider as they move toward increasing equity and access for students with IDD. Considering this finding within the larger context of systemic and structural racism, classism, and ableism in our education systems (Annamma, 2018), it is vital that all components of the education system be scrutinized for structural policies, practices, and procedures that support an unbalanced power dynamic, especially one that continues to deny access to general education classes for students with IDD. This special issue presents approaches for consideration for PK-12 education leaders as they design and implement this important work.

Relationship between childhood obesity and socio-economic status among primary school children in Costa Rica.

This article analyses the relationship between socio-economic status and the prevalence of overweight and obesity in the primary school population in Costa Rica. A National School Weight/Height Census was disseminated across Costa Rica in 2016. The percentage of children who were overweight or obese was calculated by sex, age and socio-economic indicators (type of institution: private, public, mix; type of geographic location: rural, urban and the level of development of the district of residence: quartiles). A mixed-effects multinomial logistic regression model and mixed-effects logistic regression model were used to analyse the association between the prevalence of being overweight or obese and district socio-economic status. The survey was carried out in public and private primary schools across Costa Rica in 2016. In total, 347 366 students from 6 to 12 years were enrolled in public and private primary schools. The prevalence of overweight and obesity among children was 34·0 %. Children in private schools were more likely to be overweight or obese than students in public schools (OR = 1·10 [1·07, 1·13]). Additionally, children were less likely to be overweight or obese if attending a school in a district of the lowest socio-economic quartile compared with the highest socio-economic quartile (OR = 0·79 [0·75, 0·83]) and in a rural area compared with the urban area (OR = 0·92 [0·87, 0·97]). Childhood obesity in Costa Rica continues to be a public health problem. Prevalence of overweight and obesity in children was associated with indicators of higher socio-economic status.

Ultra-processed food advertisements dominate the food advertising landscape in two Stockholm areas with low vs high socioeconomic status. Is it time for regulatory action?

BackgroundUltra-processed food consumption is a risk factor for obesity and has a negative environmental impact. Food companies spend billions of dollars on advertisements each year to increase the consumption of ultra-processed food. In Australia, USA, and New Zealand, most food advertisements around schools and in train stations promote ultra-processed food, but no similar studies have been conducted in Sweden. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES).MethodsTwo independent researchers (per area) mapped all advertisements, including storefronts, in two Stockholm districts. During consecutive days, all advertisements were photographed in Skärholmen (low SES district), and Östermalmstorg (high SES district), on the streets inside and outside the subway stations, as well as inside and outside of local shopping malls. Advertisements promoting food products were identified and a trained dietician categorized whether they promoted ultra-processed foods. Chi-Square test was conducted to test for differences in the proportion of ultra-processed food advertisements between the two study areas.ResultsIn total, 4092 advertisements were photographed in Skärholmen (n = 1935) and Östermalm (n = 2157). 32.8% of all advertisements promoted food, while 65.4% of food advertisements promoted ultra-processed foods. A significantly higher proportion of ultra-processed food advertisements out of total food advertisements was identified in the low SES area, irrespective of the researcher taking the pictures (74.6% vs. 61.8%, p < 0.001 and 70.4% vs. 54.8%, p = 0.001). There was no significant difference in the proportion of food advertisements out of total advertisements between the two areas.ConclusionsThis study provides initial evidence about the scale and the differences in exposure to food advertisements across areas in Stockholm. The observed high proportion of ultra-processed food advertisements is concerning and is in sharp contrast to the Swedish dietary guidelines that recommend reduced consumption of such foods. Based on our results, residents in low SES areas might be more exposed to ultra-processed food advertisements than those in high SES areas in Stockholm. If such findings are confirmed in additional areas, they should be considered during the deployment of food advertisement regulatory actions.

All-cause mortality among three generations of Moluccans in the Netherlands.

Mortality variations have been reported for ethnic minority groups compared with their host populations. It is uncertain how this mortality variations change over time as younger generations become older and mix with the host population. This study aimed to examine all-cause mortality among three generations of Moluccans in the Netherlands, and to compare Moluccans with a mixed and non-mixed ethnic background. We used data from the death and municipality registry for the years 2000 through 2013, including all registered Dutch inhabitants. A list of Moluccan surnames was used to select the Moluccan population. Mortality differences were calculated by Poisson regression, controlling for sex, age and district socio-economic status. High all-cause mortality rates were observed in all generations of Moluccans although the extent of the differences between Moluccans and the Dutch were smaller in second (1.15, 1.07-1.23) and third generation (1.14, 1.00-1.29) compared with the first generation (1.55, 1.49-1.60). Higher all-cause mortality is also reflected in the higher mortality from most causes of death except neoplasms and external causes. Both mixed and non-mixed Moluccans showed high all-cause mortality among the first (child) and second generation compared with the Dutch. Our findings show a higher all-cause mortality in three generations of Moluccans compared with the Dutch. The results show that mortality inequalities may persist, though in an attenuated form, over generations among ethnic minorities.

Trends in the Prevalence of Morbid Obesity among Children and Adolescents in Shandong, China, 1995-2014.

Childhood obesity has increased dramatically during the past decades; however, data on the prevalence of morbid obesity is limited. The present study examined the prevalent trends in morbid obesity among children and adolescents during the past 19 years (1995-2014) in Shandong, China. Data for this study were obtained from five cross-sectional surveys (1995, 2000, 2005, 2010 and 2014) of schoolchildren in Shandong Province, China. A total of 41 500 students aged 7-18 years were included in this study. Body mass index cutoffs recommended by the International Obesity Task Force were used to define morbid obesity. The prevalence of morbid obesity was increasing continuously during the past 19 years (1995-2014), from 0.25% for boys and 0.11% for girls in 1995 to 2.73% for boys and 1.29% for girls in 2014. Boys had higher prevalence of morbid obesity than girls (p<0.01). Regional socioeconomic status (SES) inequalities in morbid obesity were observed; children and adolescents from high SES district had a rapid increase in the prevalence of morbid obesity than their counterparts from moderate SES and low SES districts in the past 19 years. Although the current prevalence of morbid obesity was at a relatively low level, a continuous increasing trend was observed between 1995 and 2014. We should not relax our vigilance, and policymakers and experts should pay more attention to the monitoring and prevention of morbid obesity among children and adolescents in the future decades.

'Seeking affluent neighbourhoods?' a time-trend analysis of geographical distribution of hospitals in the Megacity of Tehran.

Access to hospitals in megacities in low and middle income countries might be hampered by travel barriers and distance. We assessed the 'inverse care law' hypothesis: whether hospitals tended to be built in the relatively better-off areas through the time. A longitudinal time-series study (1966 to 2011) in Tehran to measure inequality in the distribution of hospital beds. We assessed correlations between the district socioeconomic status and availability of hospital beds via regression analyses, estimated correlation, Gini and concentration indices, and used GIS models to map hospital distributions through time. We found a clear relationship between socioeconomic status and number of hospital beds per capita ( P -values <0.05). Gini coefficients were about 0.6 and 0.8 for public and private beds, respectively. A third of the variations in hospital bed distribution was explained by the welfare status of the district. For every extra residential room per capita, 130 to 280 extra beds were observed per ten thousand population at the district level. In 2011, out of 162 hospitals, 110 were located in six districts around the centre and northern part of the city. During the time period only two private hospitals were built in relatively disadvantaged districts. Over a period of about fifty years new hospitals had been established in the relatively affluent areas of the city and the relationship between socioeconomic status of district with total, private and public beds were direct and intensive. Results indicate the problem of inequality may remain over time and be resistant to policy initiatives and major political changes.

The current prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China

BackgroundChildhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. MethodsA total of 30,459 students (15,249 boys and 15,210 girls) aged 7–18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR≥0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity. ResultsThe overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls (P<0.01). Substantial urban-rural and regional disparities exist in childhood obesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts (P<0.01). ConclusionThe widespread prevalence of obesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice.

Physical activity pattern, cardiorespiratory fitness, and socioeconomic status in the SCAPIS pilot trial - A cross-sectional study.

Living in a low socioeconomic status (SES) area is associated with an increased risk of cardiovascular events and all-cause mortality. Previous studies have suggested a socioeconomic gradient in daily physical activity (PA), but have mainly relied on self-reported data, and individual rather than residential area SES. This study aimed to investigate the relationships between residential area SES, PA pattern, compliance with PA-recommendations and fitness in a Swedish middle-aged population, using objective measurements. We included 948 individuals from the SCAPIS pilot study (Gothenburg, Sweden, 2012, stratified for SES, 49% women, median age: 58 years), in three low and three high SES districts. Accelerometer data were summarized into intensity-specific categories: sedentary (SED), low (LIPA), and medium-to-vigorous PA (MVPA). Fitness was estimated by submaximal ergometer testing. Participants of low SES areas had a more adverse cardiovascular disease risk factor profile (smoking: 20% vs. 6%; diabetes: 9% vs. 3%; hypertension: 38% vs. 25%; obesity: 31% vs. 13%), and less frequently reached 150 min of MVPA per week (67% vs. 77%, odds ratio [OR] = 0.61; 95% confidence interval [95% CI] = 0.46–0.82), from 10-minute bouts (19% vs. 31%, OR = 0.53, 95% CI = 0.39–0.72). Individuals in low SES areas showed lower PA levels (mean cpm: 320 vs. 348) and daily average MVPA (29.9 vs. 35.5 min), and 12% lower fitness (25.1 vs. 28.5 mL × min− 1 × kg− 1) than did those in high SES areas. Reduced PA and fitness levels may contribute to social inequalities in health, and should be a target for improved public health in low SES areas.

Who is retained in school, and when? Survival analysis of predictors of grade retention in Luxembourgish secondary school

Based on a large longitudinal sample (N = 9031) of Luxemburgish secondary school students, this study examined whether variables reflecting the sociodemographic background of the students (gender, nationality and socioeconomic status) as well as the school track proved to be predictors of grade retention. These possible predictors of grade retention were tested against the effect of students’ achievements, represented by their grade point average (GPA). By using Cox regression analysis, we could show that even when the effects of sociodemographic variables were qualified by students’ achievement, male students, immigrant students, students from schools of lower socioeconomic status (SES) districts and students attending the lower track were shown to have a higher risk of experiencing grade retention in comparison to female students, native students, students from schools of higher SES districts or students attending the higher track. The results obtained are discussed with regard to theories of judgment formation drawn from social psychology.

Percentiles and regional distribution of skinfold thickness among children and adolescents in Shandong, China.

Skinfold thicknesses (SFT) have long been considered important and valid measurements of subcutaneous fat. The present study reported the percentiles and regional distribution of SFT among children and adolescents in Shandong, China. Data for this study were obtained from a large cross-sectional survey of schoolchildren. A total of 42,268 students (21,200 boys and 21,068 girls) aged 7-18 years from 16 districts participated in this study. Triceps, subscapular, and abdomen SFT of all subjects were measured. Shandong children and adolescents had a high SFT level and substantial regional disparities in SFT were observed. Boys and girls resident in high socioeconomic status (SES) districts had higher SFT level than those living in moderate and low SES districts. The SFT level of children and adolescents is associated with regional SES in Shandong, China. This may be interpreted as a result of geographic variation between the districts in the process of urbanization, living standards, nutritional conditions, dietary patterns, and public health.

Internal Accountability and District Achievement: How Superintendents Affect Student Learning

This quantitative survey study was designed to determine whether superintendent accountability behaviors or agreement about accountability behaviors between superintendents and their subordinate central office administrators predicted district student achievement. Hierarchical multiple regression and analyses of covariance were employed, controlling for district socioeconomic status. Superintendents who agreed with subordinate administrators about their accountability behaviors or underestimated these behaviors led districts with significantly higher student achievement in mathematics and reading than did superintendents who overestimated their accountability behaviors. Effect sizes were strong, with the self–other rating agreement category explaining 22% of the variance in mathematics scores and 19% of the variance in reading scores.

Differences in development and the prevalence of obesity among children and adolescents in different socioeconomic status districts in Shandong, China

Background: There are wide-ranging differences in human growth, not only between ethnic groups but also between regions. Shandong is one of the most populous provinces in China, with inequalities of regional economic status. However, no studies on the differences in development among children and adolescents in different districts have been reported.Aim: This study assessed the differences in height, weight and prevalence of obesity among children and adolescents of different socioeconomic status (SES) districts in Shandong, China.Subjects and methods: Data for this study were obtained from a large cross-sectional survey of schoolchildren. A total of 42 286 students (21 222 boys and 21 064 girls) aged 7–18 years from 16 districts participated in this study. Height and weight of all subjects were measured and BMI was calculated from their height and weight. Prevalence rates of obesity and overweight were determined by comparing calculated BMIs (kg/m2) to International Obesity Task Force (IOTF) cut-offs. Each of the 16 districts was assigned an SES ranking (low, moderate, high) based on per capita GDP and income in urban and rural areas. Comparisons of height, weight and the prevalence of overweight and obesity among different groups were made.Results: Significant differences between SES groups were observed for height, weight and the prevalence of overweight and obesity. Boys and girls from high SES group were taller, heavier and more likely to be obese than their peers from moderate and low SES groups. The prevalences of combined overweight and obesity in the three SES groups were 18.46%, 21.08% and 27.31% in boys and 10.43%, 12.42% and 15.18% in girls, respectively.Conclusion: There have been obvious regional variations in development and the prevalence of obesity in children and adolescents in Shandong, China, These variations in development and prevalence of obesity in children and adolescents among different SES districts being related to the local SES, process of urbanization, living environments, nutritional status, dietary pattern, physical activity and public health.

'Mosjon på Romsås' (MoRo) - et helsefremmende intervensjonsprosjekt for å fremme fysisk aktivitet i et multi-etnisk lokalsamfunn i Oslo øst

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Allocating Quality: Collective Bargaining Agreements and Administrative Discretion Over Teacher Assignment

Background: School leaders argue that to make the improvements in both quality and equity that government mandates demand, they need more flexibility with regard to personnel management—specifically, teacher assignment. According to some, such flexibility is constrained by collective bargaining between teachers unions and school districts. Purpose: To examine how collective bargaining agreements govern the assignment of teachers to schools and classrooms and whether any observed variation among the agreements is due to district demographics and/or performance. Research Methods: Sixty-six collective bargaining agreements between teachers unions and Florida's school districts were collected and analyzed for provisions germane to teacher assignment. The authors looked for contrasts among the contracts by district size, district socioeconomic status, district race, and district Florida Comprehensive Assessment Test performance with data from the Florida Department of Education. Findings: Although staffing rules often favor seniority, contracts also grant administrators more discretion over transfers, reductions, and reassignments than critics have suggested. In addition, contracts are no more likely to restrict administrators' decisions about assignment in large, poor, minority, or low-performing districts than they are in other districts. Implications for Research and Practice: Future research should consider whether teacher assignment looks any different in districts where contracts grant administrators discretion over teacher assignment. If so, what norms have replaced seniority as the primary basis for transfers, reductions, and reassignments, and do these norms hold promise for school improvement and equity? The authors encourage the development and testing of new systems that use teachers' past performance with different types of students to make evidence-based assignments.

Facilitating Elementary Principals' Support for Instructional Teacher Leadership

Purpose: This exploratory study examines conditions that lead elementary principals to support the work of school-based instructional teacher leaders. The study asks, How do principals' knowledge of teacher leadership and their interaction with teacher leaders contribute to principals' support for teacher leadership? And, How might district communication structures influence principal support? Research Methods: Data collected in 2003-2004 came from five districts, four of which were low− socioeconomic status districts. Interviews with 15 principals, 12 math teacher leaders, and six supervisors focused on the nature and scope of the teacher leader's work and the role of the principal and/or supervisor with regard to the teacher leader. Findings: The study provides evidence of a link between principals' knowledge of the position, their interaction with teacher leaders, and their support for teacher leadership. The research further demonstrates that districts can influence principals' level of support for teacher leaders by increasing communication about the role. Implications: Evidence suggests that districts should build principals' knowledge of teacher leadership and foster principal-teacher leader interaction as a way to promote support. A second implication is the need for further research on other conditions that can influence principals' support.

Inclusive Teachers' Attitudinal Ratings of Their Students With Disabilities

The purpose of this investigation was twofold: (a) to explore the use of a new rating scale that measures teachers' attitudes toward their students and (b) to investigate the attitudes of inclusive teachers toward their students with disabilities using the rating scale. Fifty inclusive elementary teachers in 12 north-east Ohio schools rated all of their students with disabilities ( N = 156) and 4 students without disabilities in each of their classrooms in the attitudinal categories of attachment, concern, indifference, and rejection. Results indicated that (a) the rating procedure exhibited modest test—retest reliability and moderate concurrent validity with a previously validated nomination procedure; (b) in comparison to students without disabilities, included students with disabilities received significantly higher ratings of teacher concern, indifference, and rejection, and significantly lower attachment ratings; and (c) average teacher indifference ratings toward their included students related positively and significantly to presence of paraprofessionals, and average teacher rejection ratings of included students were inversely and significantly related to school district socioeconomic status. Implications for practice and policy are discussed.

Cardiovascular disease risk factors among children of different socioeconomic status in Istanbul, Turkey: Directions for public health and nutrition policy

ObjectivesThe aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul.DesignCross sectional study.SettingOne private school and two public schools from different SES districts in Istanbul.Participants510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls).ResultsThe prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/ high SES group for both genders. Regarding biochemical indices, middle/ high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001).ConclusionThe findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/ high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life.