Going for broke

Educational attainment of parents will be used as the indicator of socioeconomic status, but it’s not the whole story, says Trevor Gale.

Projected socioeconomic disparities in the prevalence of obesity among Australian adults

Objective: To project prevalence of normal weight, overweight and obesity by educational attainment, assuming a continuation of the observed individual weight change in the 5-year follow-up of the national population survey, the Australian Diabetes, Obesity and Lifestyle study (AusDiab; 2000–2005).

Methods: Age-specific transition probabilities between BMI categories, estimated using logistic regression, were entered into education-level-specific, incidence-based, multi-state life tables. Assuming a continuation of the weight change observed in AusDiab, these life tables estimate the prevalence of normal weight, overweight and obesity for Australian adults with low (secondary), medium (diploma) and high (degree) levels of education between 2005 and 2025.

Results: The prevalence of obesity among individuals with secondary level educational attainment is estimated to increase from 23% in 2000 to 44% in 2025. Among individuals with a degree qualification or higher, it will increase from 14% to 30%. If all current educational inequalities in weight change could be eliminated, the projected difference in the prevalence of obesity by 2025 between the highest and lowest educated categories would only be reduced by half (to a 6 percentage point difference from 14 percentage points).

Conclusion: We predict that almost half of Australian adults with low educational status will be obese by 2025. Current trends in obesity have the potential to drive an increase in the absolute difference in obesity prevalence between educational categories in future years.

Implications: Unless obesity prevention and management strategies focus specifically on narrowing social inequalities in obesity, inequalities in health are likely to widen.

Incidence of cardiovascular risk factors by education level 2000-2005 : the Australian diabetes, obesity and lifestyle (AusDiab) cohort study

Lower socioeconomic status (SES) is associated with a higher prevalence of major risk factors for cardiovascular disease (CVD). However, few longitudinal studies have examined the association between SES and CVD risk factors over time. We aimed to determine whether SES, using education as a proxy, is associated with the onset of CVD risk factors over 5 years in an Australian adult cohort study.

Participants in the Australian Diabetes, Obesity and Lifestyle study (AusDiab) study aged 25 years and over who attended both baseline and 5-year follow-up examinations (n=5 967) were categorised according to educational attainment. Cardiovascular risk factor data at both time points were ascertained through questionnaire and physical measurement.

Women with lower education had a greater risk of progressing from normal weight to overweight or obesity than those with higher education (age-adjusted OR 1.57, 95% CI 1.06-2.31). Both men and women with lower education were more likely to develop diabetes (age-adjusted OR from higher education 1.75, 95% CI 1.14-2.71 and 3.01, 95% CI 1.26-7.20, respectively). A lower level of education was associated with a greater number of risk factors accumulated over time in women (OR of progressing from having two or less risk factors at baseline to three or more at follow up, 2.04, 95% 1.32-3.14).

In this Australian population-based study, lower educational attainment was associated with an increased risk of developing both individual and total CVD risk factors over a 5-year period. These findings suggest that SES inequalities in CVD will persist into the future.

Demographic differences in public attitudes towards sex offenders

Emotionally fueled public responses to news of released sex offenders have the potential to jeopardize the re-entry process, for example, hindering access to stable housing and employment opportunities. Influencing change in public attitudes towards sex offenders so that they are conducive to successful community re-entry is important in efforts to prevent recidivism. Maximizing the effectiveness of attempts to change public attitudes first requires identifying whether specific demographic groups are more prone to negative attitudes, so that attempts to change attitudes can be appropriately targeted. In the present study, 401 community members completed an online questionnaire designed to assess the affective, cognitive and behavioral dimensions of attitudes towards sex offenders. Differences in attitudes towards sex offenders based on respondent sex, age, educational attainment, occupation, parental status and familiarity with victims and perpetrators of sexual assault were investigated. Females demonstrated more-negative attitudes on affective and behavioral measures compared with males, and respondents with low levels of educational attainment demonstrated more-negative attitudes than respondents with higher levels of educational attainment on cognitive and behavioral measures; however, all groups demonstrated negative attitudes towards sex offenders to some extent. Implications for community-level interventions that promote effective re-entry, and hence reduce the likelihood of sexual reoffending are discussed.

Walking for recreation and perceptions of the neighbourhood environment in older chinese urban dwellers

Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.

Correlates of change in adults’ television viewing time : a four-year follow-up study

Purpose: Adults tend to increase their television (TV) viewing time as they age, but little is known about attributes associated with change in TV viewing over time. This study examined individual, social, and environmental correlates of change in TV viewing time for 4 yr.

Methods: Adult participants (n = 897) from a longitudinal epidemiological study in Adelaide, Australia, reported TV viewing time at baseline (2003–2004) and at follow- up (2007–2008). Generalized linear modeling was used to examine correlates of change in TV viewing time.

Results: The mean TV viewing time increased from 112 to 116 min·d-1 from baseline to follow-up. Adjusted for TV viewing time at baseline, having a tertiary education was associated with a 13% lower TV time at follow-up (P = 0.007). Each additional hour of occupational and transport physical activity at baseline was associated with a 2% and 7% lower TV viewing at follow-up (P = 0.031 and P = 0.023, respectively). For men, an additional hour of domestic physical activity was associated with a 7% higher TV viewing time at follow-up (P = 0.006). A significant neighborhood walkability × working status interaction (P = 0.035) indicated that, for those who were not working, living in a highly walkable neighborhood was associated with a 23% lower TV viewing time at follow-up (P = 0.003).

Conclusions: Adults with lower educational attainment, adults with lower occupational and transport physical activity, men with higher domestic physical activity, and nonworking adults living in lowly walkable neighborhoods were at higher risk of increase in TV viewing time. Interventions should target multiple variables at the individual, social, and environmental levels to address age-related increases in TV viewing time.

Sitting time and socio-economic differences in overweight and obesity

Objectives: To examine (1) the inter-relationships between socio-economic status (SES), physical activity, three different domains of sitting time (weekday, weekend day and leisure-time sitting), and being overweight or obese (body mass index25 kg/m2); and (2) the potential mediation effects of sitting time in the relationship between socio-economic factors and being overweight or obese in working Australian adults.

Design: Observational epidemiological study.

Subjects: One thousand forty eight working adults. Using a multistage sampling design on neighbourhood SES, participants were from high and low SES neighbourhoods of an Australian capital city.

Measurements: Neighbourhood SES was assessed using census data; individual SES was based on self-reported educational attainment and household income. There were three sitting time variables: sitting time on weekdays, weekend days and in leisure time. Overweight and obesity were determined using self-reported body weight and height.

Results: Gender, age, neighbourhood SES, education, working hours and physical activity were independently associated with weekday, weekend day and leisure-related sitting time. With the exception of education and working hours, these variables were also independently associated with being overweight or obese. Leisure-time sitting was found to be a mediator in the relationships between gender, education and being overweight or obese.

Conclusion: Strategies to promote less sitting in leisure time are required to combat overweight and obesity in Australian adults, especially among those from low SES neighbourhoods, and among those with high levels of education and income who work long hours.

Neighborhood and individual socio-economic variations in the contribution of occupational physical activity to total physical activity

Background: There is an inverse relationship between individual socio-economic status (SES) and amount of occupational physical activity. The role of the socio-economic environment is, however, less clear. This study examined the independent influences of neighborhood and individual SES on absolute and relative amount of occupational physical activity. It also examined the moderating effects of neighborhood SES on the relationship between individual SES and occupational physical activity.

Methods: Employees (n = 1236) resident in high or low SES neighborhoods were assessed on socio-demographic factors, including educational attainment and household income, and physical activity.

Results: Neighborhood SES and individual SES were independently inversely related to absolute and relative amount of occupational physical activity. Significant interactions between neighborhood SES and level of educational attainment in the contribution of total and vigorous occupational physical activity to total physical activity were found.

Conclusions: Neighborhood SES can function as a moderator in the relationship between individual SES and occupational physical activity.

Assessment of public attitudes towards sex offenders in an Australian population

Public attitudes towards sex offenders are believed to play a key role in the development of legislation and public policy designed to manage the risks posed by known sex offenders who live in the community. There have, however, been few previous attempts to validate methods by which public attitudes can be measured. The current study aims to address this issue by establishing the factor structure of the Community Attitudes Towards Sex Offenders (CATSO) scale with an Australian community sample and examine the extent to which demographic variables and support for sex offender management policies influence these attitudes. A sample of 552 participants recruited through online social media sites completed the CATSO as well as a number of items developed by the researchers designed to assess individuals’ support for specific sex offender policies. Results of an exploratory factor analysis suggested the presence of four distinct factors which were labelled ‘social tendencies’, ‘treatment and punishment’, ‘crime characteristics’ and ‘sexual behaviour’. Individuals with higher levels of educational attainment rated sex offenders less negatively than those with lower educational attainment, while those who reported being supportive of community notification reported more negative attitudes towards sex offenders.

Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study clinical guidance

Objective
Diet quality is related to the risk for depression and anxiety in adults and adolescents; however, the possible impact of maternal and early postnatal nutritional exposures on children’s subsequent mental health is unexplored.

Method
The large prospective Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and 2008. Data were collected from mothers during pregnancy and when children were 6 months and 1.5, 3, and 5 years of age. Latent growth curve models were used to model linear development in children’s internalizing and externalizing problems from 1.5 to 5 years of age as a function of diet quality during pregnancy and at 1.5 and 3 years. Diet quality was evaluated by dietary pattern extraction and characterized as “healthy” or “unhealthy.” The sample comprised 23,020 eligible women and their children. Adjustments were made for variables including sex of the child, maternal depression, maternal and paternal age, maternal educational attainment, household income, maternal smoking before and during pregnancy, mothers’ parental locus of control, and marital status.

Results
Higher intakes of unhealthy foods during pregnancy predicted externalizing problems among children, independently of other potential confounding factors and childhood diet. Children with a high level of unhealthy diet postnatally had higher levels of both internalizing and externalizing problems. Moreover, children with a low level of postnatal healthy diet also had higher levels of both internalizing and externalizing problems.

Conclusion
Among this large cohort of mothers and children, early nutritional exposures were independently related to the risk for behavioral and emotional problems in children.

Socioeconomic status, neighborhood characteristics, and walking within the neighborhood among older Hong Kong Chinese

Objective: 

Do schools promote social inclusion? The experiences of intercountry adoptees in Australia

Intercountry adoption programs have brought children from racially and culturally diverse backgrounds to live as Australians, including 30 children from Rangsit Children’s Home who arrived in South Australia in the late 1980s and early 1990s. As part of a project which explored the life experiences of 12 adults who had arrived as children aged between 4 and 9 from Rangsit, this paper explores the role of schools in facilitating their inclusion into life in Australia. The school experience was often critical in learning English and was pre-requisite for acceptance in the school yard but also a place in which most of these Thai-born intercountry adoptees experienced racism. More than half of the participants did not complete secondary school but all had employment. However, many of these jobs were low-paying and this precluded them from participating in opportunities to return to Thailand to learn more about their Thai origins or participating as adoptive parents in intercountry adoption programs. Hence, while schools can play an important role in facilitating social inclusion, the school system alone may be unable to address the multiple dimensions of exclusion experienced by intercountry adoptees.

The association between socio-economic position and diet quality in Australian adults

Objective: We aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population. Design: Cross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years). Setting: A large randomly selected sample of the Australian adult population. Subjects: Australian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study. Results: A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage. Conclusions: A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.

A longitudinal study of the association of adolescent polydrug use, alcohol use and high school non-completion

AIMS: Failure to complete high school predicts substantial economic and social disadvantage in adult life. The aim of this study was to determine the longitudinal association of mid-adolescent polydrug use and high school non-completion, relative to other drug use profiles. DESIGN: A longitudinal analysis of the relationship between polydrug use in three cohorts at grade 9 (age 14-15 years) and school non-completion (reported post-high school). SETTING: A State-representative sample of students across Victoria, Australia. PARTICIPANTS: A total of 2287 secondary school students from 152 high schools. The retention rate was 85%. MEASUREMENTS: The primary outcome was non-completion of grade 12 (assessed at age 19-23 years). At grade 9, predictors included 30-day use of eight drugs, school commitment, academic failure and peer drug use. Other controls included socio-economic status, family relationship quality, depressive symptoms, gender, age and cohort. FINDINGS: Three distinct classes of drug use were identified-no drug use (31.7%), mainly alcohol use (61.8%) and polydrug use (6.5%). Polydrug users were characterized by high rates of alcohol, tobacco and cannabis use. In the full model, mainly alcohol users and polydrug users were less likely to complete school than non-drug users [odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.17-2.03) and OR = 2.51, 95% CI = 1.45-4.33), respectively, P < 0.001]. These effects were independent of school commitment, academic failure, peer drug use and other controls. CONCLUSIONS: Mid-adolescent polydrug use in Australia predicts subsequent school non-completion after accounting for a range of potential confounding factors. Adolescents who mainly consume alcohol are also at elevated risk of school non-completion.