Socioeconomic Status Gaps Research Articles

Price promotions on healthier compared with less healthy foods: a hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain

Background: There is a growing concern, but limited evidence, that price promotions contribute to a poor diet and the social patterning of diet-related disease.Objective: We examined the following questions: 1) Are less-healthy foods more likely to be promoted than healthier foods? 2) Are consumers more responsive to promotions on less-healthy products? 3) Are there socioeconomic differences in food purchases in response to price promotions?Design: With the use of hierarchical regression, we analyzed data on purchases of 11,323 products within 135 food and beverage categories from 26,986 households in Great Britain during 2010. Major supermarkets operated the same price promotions in all branches. The number of stores that offered price promotions on each product for each week was used to measure the frequency of price promotions. We assessed the healthiness of each product by using a nutrient profiling (NP) model.Results: A total of 6788 products (60%) were in healthier categories and 4535 products (40%) were in less-healthy categories. There was no significant gap in the frequency of promotion by the healthiness of products neither within nor between categories. However, after we controlled for the reference price, price discount rate, and brand-specific effects, the sales uplift arising from price promotions was larger in less-healthy than in healthier categories; a 1-SD point increase in the category mean NP score, implying the category becomes less healthy, was associated with an additional 7.7–percentage point increase in sales (from 27.3% to 35.0%; P < 0.01). The magnitude of the sales uplift from promotions was larger for higher–socioeconomic status (SES) groups than for lower ones (34.6% for the high-SES group, 28.1% for the middle-SES group, and 23.1% for the low-SES group). Finally, there was no significant SES gap in the absolute volume of purchases of less-healthy foods made on promotion.Conclusion: Attempts to limit promotions on less-healthy foods could improve the population diet but would be unlikely to reduce health inequalities arising from poorer diets in low-socioeconomic groups.

Foundations of Mathematics Achievement

Analyzing Early Childhood Longitudinal Survey—Kindergarten (ECLS-K) data, we examine how exposure to instructional practices influences math test scores at the end of kindergarten for children from different racial/ethnic and socioeconomic backgrounds, and for children with different levels of math skills at kindergarten entry. We also analyze the relationship between socioeconomic background and math academic readiness within racial/ethnic categories. Our results demonstrate that race/ethnicity and levels of math academic readiness moderate the relationship between instructional practices and math achievement. While we find that interactive group activities enhance students’ mathematics achievement in kindergarten and that drills enhance math academic achievement of students with high math academic preparedness in kindergarten, we also find that use of manipulatives as well as music and movement have significant negative effects on mathematics achievement of Black students. Given the importance of kindergarten for launching children onto successful academic trajectories, the findings have implications for addressing racial/ethnic and socioeconomic status gaps in mathematics achievement.

The role of schools in bridging within-school achievement gaps based on socioeconomic status: a cross-national comparative study

Since the publication of the Coleman report in 1966, research on the role of schools in influencing student achievement relative to the role of family background has generated considerable interest and controversy. A large volume of international and comparative research has also been devoted to studying school effects on student achievement. Relatively few studies have examined international differences in the importance of schools in bridging achievement gaps based on socioeconomic status (SES). Using PISA 2012 data, this study examines the role of schools in bridging within-school SES gaps in achievement and compares findings across 61 countries. Contrary to prior research, we find that schools may have limited ability in bridging SES gaps that exist within schools. We also find that across all countries included in the study, specific factors such as the school’s learning environment and school context are not systematically associated with within-school SES gaps.

School effects and ethnic, gender and socio-economic gaps in educational achievement at age 11

There are long-standing achievement gaps in England associated with socio-economic status (SES), ethnicity and gender, but relatively little research has evaluated interactions between these variables or explored school effects on such gaps. This paper analyses the national test results at age 7 and age 11 of 2,836 pupils attending 68 mainstream primary schools in an ethnically diverse inner London borough. The groups with the lowest educational achievement and poorest progress were both Black Caribbean and White British low SES pupils. White British middle and high SES pupils made substantially more progress than White British low SES pupils, significantly increasing the SES gap over time. However low and high SES Black pupils made equally poor progress age 7–11. School effects on pupil progress were large, but there was no evidence of differential school effectiveness in relation to SES, ethnicity or gender. Low SES pupils in the more effective schools performed significantly better than high SES pupils in the less effective schools, but all pupils (both low and high SES) benefit from attending the more effective schools and so these schools do not eliminate the SES gap. The limits to change that may be achieved by schools alone are discussed.

An increasing socioeconomic gap in childhood overweight and obesity in China.

We used a new conceptual framework that integrates tenets from health economics, social epidemiology, and health behavior to analyze the impact of socioeconomic forces on the temporal changes in the socioeconomic status (SES) gap in childhood overweight and obesity in China. In data from the China Health and Nutrition Survey for 1991 to 2006, we found increased prevalence of childhood overweight and obesity across all SES groups, but a greater increase among higher-SES children, especially after 1997, when income inequality dramatically increased. Our findings suggest that for China, the increasing SES gap in purchasing power for obesogenic goods, associated with rising income inequality, played a prominent role in the country's increasing SES gap in childhood obesity and overweight.

Socio-economic inequality in childhood and beyond: an overview of challenges and findings from comparative analyses of cohort studies.

The growing number of countries with large child cohort studies offers an unprecedented opportunity for comparative research. A topic of central interest in my research is, to what extent the sizable gaps in development that exist between children from different socioeconomic status (SES) groups in the US are also present in other countries, and to what extent the mechanisms explaining these gaps are similar or different across countries. This overview draws on the results of comparative analyses of birth cohort study data collected in Australia, Canada, the United Kingdom, and the United States, to illustrate the challenges that arise in carrying out this kind of research and the way these challenges were met - in particular those having to do with data access and comparability, and those having to do with causal inference. I conclude that this type of research also offers great promise as shown by findings on SES gaps in child development in the four countries.

Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence?

Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14–1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups.

To Thrive, Survive, and Prosper as an Ordinary Urbanite

To Thrive, Survive, and Prosper as an Ordinary Urbanite William Jankowiak (bio) Xuefei Ren. Urban China. Cambridge: Polity Press, 2013. xx, 218 pp. Paperback $22.95, isbn 978-0-7456-5359-4. China, one of the world’s oldest agrarian civilizations, will very soon become one of the world’s youngest urban civilizations. In this brief, albeit impressive, overview, Xuefei Ren has provided a much needed comparative framework for understanding the range of the urban scale and, more important, shows how ordinary Chinese are trying to thrive, survive, and prosper. He focuses on fifteen cities and tries, when possible, to include smaller and mid-range cities, where China is seeing its most rapid growth. The country’s rapid urbanization is helping to lift hundreds of millions of rural Chinese out of poverty. At the same time, the new second-tier cities are locked into a ferocious competition and spawning ambitious development plans. Today, it seems as if every Chinese city wants to develop into a world city with an international airport, six-lane highways, and export zones. The concept of integrated growth, however, appears to be a foreign concept. China has 129 cities with a population over one million, compared to nine in the United States. The Chinese urban population is growing at 2.5 percent a year, making it one of the fastest growing rates in the world. Most of this growth is pushed at the local level, beyond the guidance of central government. The result is often wasteful replication as well as exciting creative innovation. How can we make sense of this enormous social change? Ren argues that the neoliberal model is overly materialistic in its power to explain. It ignores the persistence of historical forces, such as the socialist legacy (e.g., high literacy rates, good education, long adult life expectancy) and its postsocialist institutional arrangements (e.g., creation of township and village enterprises) that laid the structural foundation for China’s economic takeoff. The neoliberal model cannot explain the short period of time in which China has become the second largest economy in the world, nor why other emergent economies—India, Russia, [End Page 38] and Brazil—that also embrace neoliberal policies have not grown at a similar pace. Ren points out that socialist urban policies were characterized as industrialization without urbanization, while in the reform era urbanization was funded through large-scale capital accumulation. In this way, China’s economic boom is an urban boom, and its economic miracle is an urban marvel. Ren discusses how urban sites are governed. He notes that Chinese cities are embedded in a complex system of hierarchical and horizontal authorities. He finds that decision-making power has shifted from central ministries to territorial authorities, especially to its municipal governments. The expansion of cities is directly linked to control over rural land. Nearly three hundred counties have been converted into cities, by order from the central government. This resource of power has provided government officials with the ability to undertake massive urban construction that has changed the urban landscape. This process has further resulted in an expansion of the outward acquisition of more land. The relocation of heavy industries from the inner cities relieves population pressure and encourages property development. Together, these policies have produced a hybrid land market with public ownership and private use rights. Why do Chinese cities look the way they do? An examination in settlement types finds that the state plays a critical role in remaking the city. By pushing policies such as “master plans, sponsorship of international architects, partnerships with private capital, and repression of popular demands” (p. 115), the central government contributed to the creation of numerous satellite towns found on the outskirts of every large Chinese city. The satellite towns serve as entry points for rural migrant workers to transition from the farm to the city. China’s urban transformation has also resulted in a huge socioeconomic status gap: migrants account for only a third of urban residents. China’s antiquated hukou system turns 221 million migrant workers into second-class citizens in their own country. Migrants live in villages in the city (ViCs) (chengzhongcun) that supply them with cheap lodging and proximity...

The Influence of Dual Enrollment on Academic Performance and College Readiness: Differences by Socioeconomic Status

I examine the influence of dual enrollment, a program that allows students to take college courses and earn college credits while in high school, on academic performance and college readiness. Advocates consider dual enrollment as a way to transition high school students into college, and they further claim that these programs benefit students from low socioeconomic status (SES). However, few researchers examine the impact of dual enrollment on academic performance and college readiness, in particular, whether SES differences exist in the impact of dual enrollment. Even fewer researchers consider the extent to which improved access to dual enrollment reduces SES gaps in academic performance and college readiness. I find that participation in dual enrollment increases first-year GPA and decreases the likelihood for remediation. I conduct sensitivity analysis and find that results are resilient to large unobserved confounders that could affect both selection to dual enrollment and the outcome. Moreover, I find that low-SES students benefit from dual enrollment as much as high-SES students. Finally, I find that differences in program participation account for little of the SES gap in GPA and remediation.

Socioeconomic status and prevalence of congenital heart defects: Does universal access to health care system eliminate the gap?

A twofold increase in the prevalence of congenital heart defects (CHDs) has been reported since the early 1970s with higher rates among children from low socioeconomic status (SES). This increase and the observed SES gap are postulated to be reflective of higher ascertainment, especially increased use of ultrasound and echography. The purpose of this study was to examine if trends over time in the prevalence of CHD were the same for high and low SES groups. Using the child's health number as a unique identifier and through record linkage, children born in Ontario between 1994 and 2007 were followed for the diagnosis of CHD. Using postal codes and census information, SES quintiles were assigned to each child. We used adjusted rates and used multivariate models to compare trends in the prevalence rate among children born in different SES groups. Children born in low SES areas (23% of all births) had significantly higher rates of CHDs (rate ratio = 1.20; 95% confidence interval [CI] = 1.15-1.24). While prevalence of nonsevere CHDs declined in all SES groups since 2000, severe CHDs, especially atrial septal defects were on the rise during the study period. It is assumed that increased ascertainment is responsible for observed increase in the prevalence of CHD, especially minor defects. While the trend and pattern over time changed for severe and nonsevere CHDs, the SES gap remained consistent during the study period. Our results indicate that even free and universal access to a health care system does not eliminate the SES gap observed in the prevalence of CHD.

Intergenerational family predictors of the Black–White achievement gap.

The authors examined intergenerational family predictors of the Black-White achievement gap among 4,406 adolescents from the National Longitudinal Survey of Youth. An intergenerational model of the process by which family factors contribute to the achievement gap was also tested. The results showed that the ethnic gaps in socioeconomic status (SES) and achievement had significantly reduced over the past few generations. Moreover, measures of grandparent SES, mothers' achievement, parent SES, and a comprehensive set of reliable parenting practices explained all of the ethnic differences in achievement scores. Parenting practices such as creating a school-oriented home environment, allowing adolescents to make decisions, and not burdening them with too many chores had particularly important effects on the achievement gap. The authors conclude that adjusting for these differences would eliminate the ethnic achievement gap.

Age, socioeconomic status and obesity growth

We use panel data from the National Longitudinal Survey of Youth (NLSY) to examine how body weight changes with age for a cohort moving through early adulthood, to investigate how the age-obesity gradient differs with socioeconomic status (SES) and to study channels for these SES disparities. Our results show first that weight increases with age and is inversely related to SES during childhood. Second, the obesity gradient widens over the lifecycle, consistent with research on other health outcomes. Third, a substantial portion of the “effect” of early life conditions operates through race/ethnicity and the translation of advantaged family backgrounds during childhood into higher levels of subsequent education. By contrast, little of the SES gap appears to propagate through household composition, family income or health behaviors. Fourth, adult SES has independent effects after controlling for childhood status.

DEAR MR. PRESIDENT: REFORM HEALTH CARE, AND KEEP IT SIMPLE

Dear Mr. President, Congratulations on your election. We, the nation’s departments of family medicine, look forward to giving you a hand with health care reform. Compared to other rich nations, we know that our health outcomes fall far short, our health care costs are very high, and access to care is altogether inequitable. Rectifying these problems seems a daunting task, but when attention is paid to the abundant evidence, the solution boils down to 2 simple essentials—universal access to healthcare for all Americans, and much more emphasis on primary care, preventive medicine, and public health. You may ask: “How will we pay for greater access and for more primary care?” Solid evidence shows that the initial cost for this type of reform is recouped within 2 years and then there are substantial savings. Just ask Senator Richard Burr of North Carolina. He can tell you about his state’s great Community Care of North Carolina program.1 Like oil companies, we in academic family medicine are concerned about pipelines. For the best health care system, we need to train more family physicians. Ask Senator Edward Kennedy of Massachusetts. His state introduced a program of universal health care coverage in 2006, but it failed to flourish because there were not enough primary care physicians to care for all of the people suddenly insured.2 And guess what? It’s going to get worse. Currently, 32% of US physicians practice primary care. Over the last 3 years, the number of medical school graduates who will practice primary care is only 16%, and federal programs that will reverse the trend have been eviscerated. Here’s an example: Since 2000, the funding for Federally Qualified Health Centers (FQHCs) has nearly doubled to almost $2 billion. This is laudable. However, over the same time period, the funding for the programs that train the physicians most likely to practice in FQHCs (Title VII, Section 747) has been cut by 55%. This is appalling. Ask Senator Evan Bayh of Indiana if the new Lucas Oil Stadium would have been built if Indianapolis didn’t have a pipeline of loyal Colt fans or the promise of a pipeline of conventions. The pipeline of family physicians is running dry. Would you like some good reading? We recommend an article by Barbara Starfield, pediatrician and one of the nation’s foremost clinical epidemiologists. Her comprehensive review of the literature on systems of effective health care is in The Milbank Quarterly.3 Here’s what our country needs: Patient-Centered Medical Homes. Ubiquitous physician-directed practices that emphasize first-contact care, patient-centered care over time, comprehensive care, integration of care among health care disciplines and within communities, family and community orientation, and cultural competence. (You don’t need to measure much here; practices like these improve outcomes and lower costs by their very nature.) Universal access to care guaranteed by publicly accountable bodies. We don’t necessarily need a single payer; we just need public accountability for those who do pay. Low or no copays or deductibles for primary health services. Led by the growth of Health Savings Accounts (HSAs), out-of-pocket expenses are soaring. The GAO found that HSAs are nothing more than veiled tax shelters.4 Similar professional earnings for primary care physicians relative to other specialists. Recent RVU updates, care coordination payments and pay-for-performance are right on target. Make sure they measure and reward practices that in reality improve the health care system. Here’s what is really amazing: These things naturally occur when there is an adequate workforce of family physicians. If you want an illustration, ask Leiyu Shi of the Johns Hopkins Bloomberg School of Public Health. His studies consistently find that poor health care outcomes due to gaps in socioeconomic status are eliminated by high concentrations of primary care physicians.5 Well, that’s about it. In the long run, these changes will pay for themselves many times over. And the measurements won’t be nearly as cumbersome as you might think. It will take some guts to take on the special interests that will be resistant to such change, but family medicine is ready to step up to the plate.

Poverty, Race, and the Contexts of Achievement: Examining Educational Experiences of Children in the U.S. South

This article considers issues of educational inequality in the U.S. South from a social work/ social justice perspective. After a review of existing literature and discussion of cultural versus structural explanations for race and socioeconomic status gaps in academic achievement, findings are presented from a study examining child-, classroom-, and school-level factors that influence academic achievement among public school children in the South. Although a sizeable minority of southern children attend schools that are segregated along racial and socioeconomic lines, and although these schools are different in various aspects of educational environment, once family structure, parental characteristics, the use of ability grouping, and rural school location were taken into account, no influence of race on achievement remained. Implications for social work policy and practice are discussed.

Dental Service Utilization among Urban and Rural Older Adults in China – A Brief Communication

China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Results suggest that urban-rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables.

Age and Self-Rated Health in Korea

I examine age variation in the effects of socioeconomic status (SES) on self-rated health in Korea by including three alternative indicators of SES-liquid assets, home ownership, and real estate ownership-as well as two standard measures of education and household income. Furthermore, I consider the SES-health relationship and its variation by age for men and women separately. The empirical findings in general do not support the hypothesis that the SES gap in health converges with age. Most SES effects on self-rated health remain constant across age groups or even increase with age. However, there is evidence of the converging effects of household income and liquid assets for women. Differences in self-rated health by household income or liquid assets diverge and then converge as age advances.

A case of IgA multiple myeloma: Nutritional perspective in diagnostic testing

A 64-year-old security guard and longstanding known hypertensive presented with hypertensive heart disease (HHD), weight loss, an enlarged prostate, and a spontaneously fractured rib. Malignancy of the prostate with possible metastases to the ribs was strongly suspected. Biochemical profiling revealed a paraprotein. Other biochemical and hematological correlates that were on hand before serum protein electrophoresis were rather atypical. Paraprotein studies by immunofixation revealed IgA myelomatosis. Unlike previous reports from Caucasians there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC, cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory picture.The need to appreciate the influence of nutritional status on the laboratory (especially biochemical) features of a disease and thus interpretation of diagnostic tests appears of exceptional current importance, given the widening gap in socioeconomic status and the level of poverty between the resource poor and developed countries from which the classical, clinical and laboratory features of most diseases were first described.This case report reminds of the need not only to recognize theoretically the impact of nutritional status on the laboratory characteristics of a disease but of the practical application of the nutritional perspective in the interpretation of diagnostic investigations, especially in nutritionally disadvantaged communities.

The Familiar but Curious Economics of Higher Education: Introduction to a Symposium

Despite the involvement of two-thirds of economists in it, the higher education industry remains incompletely understood. Among the topics related to higher education that invite further research are the rapid increase in college costs, the interaction of tenure and the end of mandatory retirement, and the effects of college enrollment on income inequality. Data from surveys of freshmen suggests that the gap in socioeconomic status between students in private universities and other young people has grown over time.

Trends in Whites' Explanations of the Black-White Gap in Socioeconomic Status, 1977-1989

Whites' explanations for the black-white gap in socioeconomic status are examined using General Social Survey data for 1977 to 1989. While there has been a significant decline in the percentage of whites attributing the gap to innate inferiority of blacks, individualistic explantions of the gap still predominate. Most individualistic explanations stress lack of motivation among poor blacks, and are widely held among whites who otherwise express little or no traditional prejudice. Whites' explanations for the racial economic gap influence their attitudes toward government policies to improve the status of blacks, independent of sociodemographic characteristics and prejudice. These results help explain a paradox of contemporary racial attitudes, and suggest that white public opinion has reached an era of stable acceptance of the black-white economic gap.