Adolescent home food environments and socioeconomic position

Many adolescents have diets that are less than optimal, particularly adolescents of low socioeconomic position (SEP). The determinants of SEP differences in adolescent dietary intake are poorly understood. This study examined the home food environments of adolescents and specifically investigated whether low SEP adolescents have less supportive home local environments, fewer eating rules and poorer home availability of fruit and vegetables than adolescents of high SEP. A cross-sectional, self-reported survey was administered to 3,264 adolescents in years 7 and 9, from 37 secondary schools in Victoria, Australia. Adolescent perceptions of the home meal environment, eating rules and home food availability were described and compared across SEP, which was measured using maternal education. Maternal education was linked to various aspects of the home meal environment, as well as home food availability, but not to eating rules. Low SEP adolescents were more likely to report that they were always allowed to watch television during meal times, and that unhealthy foods were always or usually available at home. In contrast, high SEP adolescents were more likely to report that vegetables were always served at dinner, that the evening meal was never an unpleasant time and always or usually a time for family connectedness, and that fruit was always or usually available at home. This study highlights aspects of the home food environment that might explain SEP variation in adolescent diets. Feasible ways of increasing home availability of healthy foods, and encouraging home meal environments to be supportive of healthy eating should be explored, particularly in households of low SEP adolescents.

Socioeconomic influences on women's eating behaviours

This thesis investigated the socioeconomic influences on women's eating behaviours. Results showed that women of low socioeconomic position not only perceived higher direct financial costs as a predominant barrier for consuming a healthy diet, but also a number of indirect or non-financial cost factors such as the perceived additional time costs involved in preparing and cooking healthy foods.

Factors in youth physical activity participation : from psychological aspects to environmental correlates

Understanding influences on children's physical activity and how these vary by activity and subgroup, such as age and sex of the child, is important for informing the development of effective and targeted interventions. Two cohort studies were conducted across socioeconomic areas of Melbourne, Australia, between 2001 and 2008 among a combined sample of more than 2,700 children aged 5-6 years and 10-12 years at baseline. Data were collected via surveys, and children wore the Actigraph accelerometer for 8 days. Five individual, 10 social, and 17 physical environmental factors were significantly associated with children's physical activity. Patterns of association varied according to the age and sex of the child and also according to the type of activity. These studies provide some insights into the various levels of influence on children's physical activity. More longitudinal and intervention research is needed to better understand the mechanisms of change in children's physical activity behaviour.

Breastfeeding mothers consume more vegetables and a greater variety of fruits and vegetables than non-breastfeeding peers : the influence of socioeconomic position

Aim:  This study compared the diets of breastfeeding and non-breastfeeding mothers from socioeconomically diverse regions of Melbourne to determine whether breastfeeding is a marker for healthier maternal dietary intakes.

Methods:  This cross-sectional study obtained information via self-reported questionnaire from 529 first-time Melbourne mothers. Breastfeeding status was determined when the children were 3.9 months. Diet information was obtained using a validated Food Frequency Questionnaire. Maternal diet was assessed by seven indicators: average daily intake of fruit, vegetables, non-core drinks, non-core sweet snacks, non-core savoury snacks, variety of fruit and variety of vegetables eaten in the preceding 12 months. Associations between breastfeeding status and each dietary variable were assessed using linear regression analyses. Socioeconomic position, maternal body mass index and the cluster-based sampling design were controlled for.

Results:  Of the 529 subjects, 70% were breastfeeding their child. Compared with non-breastfeeding mothers, breastfeeding mothers were found to consume more serves of vegetables (P= 0.001), a greater variety of fruit and vegetables (P= 0.001 and P≤ 0.001 respectively), and sweet snacks were consumed more frequently (P= 0.006). Differences were observed between low and high socioeconomic position mothers for fruit serves (P= 0.003), vegetable serves (P= 0.010) and fruit variety (P= 0.006). These associations persisted after controlling for socioeconomic position and maternal body mass index.

Conclusions:  The association between infant feeding (breastfeeding) and some aspects of maternal diet provides further evidence suggesting a link between maternal and child diets from a younger age than previously examined.

Area-level socioeconomic status and incidence of abnormal glucose metabolism : the Australian diabetes, obesity and lifestyle (AusDiab) study

OBJECTIVE--To examine the role of area-level socioeconomic status (SES) on the development of abnormal glucose metabolism (AGM) using national, population-based data.

RESEARCH DESIGN AND METHODS--The Australian Diabetes, Obesity and Lifestyle (AusDiab) study is a national, population-based, longitudinal study of adults aged [greater than or equal to] 25 years. A sample of 4,572 people provided complete baseline (1999 to 2000) and 5-year follow-up (2004 to 2005) data relevant for these analyses. Incident AGM was assessed using fasting plasma glucose and 2-h plasma glucose from oral glucose tolerance tests, and demographic, socioeconomic, and behavioral data were collected by interview and questionnaire. Area SES was defined using the Index of Relative Socioeconomic Disadvantage. Generalized linear mixed models were used to examine the relationship between area SES and incident AGM, with adjustment for covariates and correction for cluster design effects.

RESULTS--Area SES predicted the development of AGM, after adjustment for age, sex, and individual SES. People living in areas with the most disadvantage were significantly more likely to develop AGM, compared with those living in the least deprived areas (odds ratio 1.53; 95% CI 1.07-2.18). Health behaviors (in particular, physical activity) and central adiposity appeared to partially mediate this relationship.

CONCLUSIONS--Our findings suggest that characteristics of the physical, social, and economic aspects of local areas influence diabetes risk. Future research should focus on identifying the aspects of local environment that are associated with diabetes risk and how they might be modified.

Evolution of adolescent mental health in a rapidly changing socioeconomic environment: a review of mental health studies in adolescents in India over last 10 years

Background: Significant changes in the economic, familial and social support aspects in India have occurred in recent times, making it an interesting naturalistic setting to observe the effects of a dynamic socioeconomic environment on behavioral and emotional disorders in adolescents. Objective: This systematic review attempts to synthesize and evaluate the available evidence on mental health disorders and interventions in adolescents in India in last 10 years as well as identify conceptual trends and methodological lacunae in these studies. Method: A systematic search of electronic databases was performed in March 2014 and 27 school and community based studies evaluating behavioral problems, psychiatric morbidity, stress, suicide-related behaviors, depression, anxiety, aggression, self concept in adolescents in India were reviewed. Conclusion: There is a wide variation in the reported prevalence of psychiatric morbidity and behavioral problems in Indian adolescents. Some of the risk and protective factors are similar to those identified by other International studies in this age group. These include female gender, academic difficulties, parental fights, strained familial relationships, school absenteeism, school dropout and other school related factors. However, there are certain variables that appear to be context specific and need further investigation. These are mother's working status, studying in Government institutions or belonging to a nuclear family as risk factors and praying as a coping skill, parental involvement as a protective factor for psychiatric disorders. The suspected upward trend in the psychiatric morbidity in this age group needs more studies to be established. © 2014 Elsevier B.V.

A review of the relationship between socioeconomic position and the early-life predictors of obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments

Introduction: Rheumatic fever (RF), a systemic illness that may occur following Group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, is a major problem in countries with limited resources. Because of its long track record and low cost, an injection of benzathine penicillin G (BPG) suspension every 3 or 4 weeks has been used as secondary prophylaxis. Despite its excellent in vitro efficacy, the inability of BPG to eradicate GABHS has been frequently reported.Areas covered: This work reviews the possible causes of failure, as well as the inconvenience of the current prophylactic treatment of acute RF and suggests a new pharmacotherapeutic system that could replace the current one.Expert opinion: RF is a major problem concerning only countries with limited resources and could be considered as a neglected disease. The dose regimen using BPG suspension results in failures, which could be avoided by the use of nanocarrier-based systems. To meet this ultimate goal, the research should be transposed from the laboratory scale to an industrial and clinical application level. This research should be conducted to produce a pharmaceutical dosage form that will be commercially available, consumed by and affordable for patients. However, health, environmental and socioeconomic hazards should be considered.

Injuries and envenoming by aquatic animals in fishermen of Coxim and Corumbá municipalities, state of Mato Grosso do Sul, Brazil: identification of the causative agents, clinical aspects and first aid measures

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Intestinal parasitic infections in HIV/AIDS patients: epidemiological, nutritional and immunological aspects

This study applied a socioeconomic questionnaire designed to evaluate the frequency of intestinal parasites and characterize epidemiological, nutritional, and immunological variables in 105 HIV/AIDS patients - with and without parasitic infections, attending the Day Hospital in Botucatu, UNESP, from 2007 to 2008. Body mass index was calculated and the following tests performed: parasitological stool examinations; eosinophil, IgE, CD4(+) T and CD8(+) T lymphocyte cell counts; albumin test; viral load measure; and TNF-alpha, IFN-gamma, IL-2, IL-5 and IL-10 cytokine levels. Results were positive for parasitic intestinal infections in 12.4% of individuals. Most patients had good socioeconomic conditions with basic sanitation, urban dwellings, treated water supply and sewage, good nutritional and immunological status and were undergoing HAART. Parasites were found at the following frequencies: Entamoeba - five patients (38.5%), Giardia lamblia-four (30.7%), Blastocystis hominis-three (23.0%), Endolimax nana-two (15.4%), and Ascaris lumbricoides - one (7.7%). There were no significant differences between the two groups for eosinophils, albumin, IgE, CD4(+) T and CD8(+) T lymphocytes, INF-gamma, IL-2, or IL-10. Most patients also showed undetectable viral load levels. Significant differences were found for TNF-alpha and IL-5. These results show the importance of new studies on immunodeficient individuals to increase understanding of such variables.

Epidemiological aspects of enteroparasitosis at daycare centers in the city of Botucatu, State of São Paulo, Brazil

Estimou-se a prevalência e a incidência de parasitas intestinais em crianças e funcionários de 5 creches municipais em Botucatu/SP. Foram realizados dois estudos seccionais em 2002 (N=379) e 2003 (N=397) e um estudo longitudinal observacional, onde as crianças de 2002 e 2003 foram seguidas por um ano. Foram aplicados questionários nos funcionários e nos pais das crianças, onde foram coletadas as seguintes variáveis: nível sócio-econômico, hábitos sanitários, moradia, idade, sexo e presença de animais domésticos. Foram realizados exames coproparasitológicos nas crianças das creches. A prevalência de enteroparasitas em 2002 foi de 76,74% e 34% em 2003. As variáveis associadas à presença de enteroparasitas no ano de 2002 foram: localização das creches (OR=0,27 IC=0,15-0,47), renda familiar (OR=4,38 IC=1,91-10,04), sexo (OR=0,52 IC=0,32-0,85), faixa etária (OR=2,08 IC=1,06-4,08) e presença de animais domésticos na casa (OR=1,85 IC=1,10-3,11); em 2003, as variáveis foram: creche localizada em bairro periférico (OR=0,49 IC=0,31-0,78), renda familiar (OR=3,69 IC=2,19-6,24), nível educacional da mãe (OR=6,19 IC=1,81-21,21), sexo (OR=0,36 IC=0,36-0,93) e presença de animais domésticos (OR=1,68 IC=1,01-2,79). A coorte foi integrada por 253 crianças apresentando incidência de 23,22%. Os dados deste estudo evidenciam situações de risco em populações específicas (creches) e poderiam ser utilizados por Instituições que promovem o cuidado com as crianças.

Epidemiology and genetics of endemic goiter. I. Epidemiological aspects

This study dealt with approximately 2,000 children and their parents living in a hyperendemic goiter area in Central Brazil, which is bounded by the jungle to the north and by a large plain to the south. The determination of goiter was made according to the methods and classification adopted by WHO. Conspicuous forms of goiter were found in 41% of the children examined. Multiple linear regression analysis showed an increase with age in the frequency of goiter in both sexes. Although data from the literature show that Mulattoes and Negroes have statistically higher frequencies of goiter than do Whites, our multiple linear regression analysis revealed no evidence for an effect of race on the endemism. There was no significant association with socioeconomic level. The presence of goiter in parents was shown to be statistically associated with its occurrence in the children.

Hodgkin disease in adult and juvenile groups from two different geographic regions in Brazil: Characterization of clinicopathologic aspects and relationship with Epstein-Barr virus infection

We analyzed clinicopathologic data, immunophenotype, and Epstein-Barr virus (EBV) status in 96 cases of Hodgkin disease (HD) in juveniles (younger than 20 years) and adults (20 years or older) from 2 distinctive states in Brazil. We studied 34 juvenile (group 1) and 16 adult (group 2) cases from Ceara and 31 juvenile (group 3) and 15 adult (group 4) cases from São Paulo. Ceara has a socioeconomic profile similar to a developing country; São Paulo is in better economic condition. Mixed cellularity (MC) was the major histologic subtype among groups 1 (22 [65%]), 3 (21 [68%]), and 4 (7 [47%]); nodular sclerosis (NS) was more frequent in group 2 (8 [50%]). EBV infection was observed in 61 cases (64%), including the following (among others): group 1, MC, 22 (65%) and NS, 4 (12%); group 2, NS, 3 (19%) and MC, 2 (12%); group 3, MC, 16 (52%) and NS, 1 (3%); and group 4, MC, 7 (47%). There was predominance of EBV+ HD cases in group 1 compared with group 3. HD in Brazilian patients is highly associated with EBV infection, but geographic differences reflect histologic subtypes and age distribution.

The association of area socioeconomic status and cancer screening: A systematic review and multilevel study

Background. The gap between actual and ideal rates of routine cancer screening in the U.S., particularly for colorectal cancer screening (CRCS) (1;2), is responsible for an unnecessary burden of morbidity and mortality, particularly for disadvantaged groups. Knowledge about the effects of individual and area influences is being advanced by a growing body of research that has examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES. The findings from this emerging and heterogeneous research in the cancer screening literature have been mixed. Moreover, multilevel studies in this area have not yet adequately explored the possibility of differential associations by population subgroup, despite some evidence suggesting gender-specific effects. ^ Objectives and methods. This dissertation reports on a systematic review of studies on the association of area SES and cancer screening and a multilevel study of the association between area SES and CRCS. The specific aims of the systematic review are to: (1) describe the study designs, constructs, methods, and measures; (2) describe the association of area SES and cancer screening; and (3) identify neglected areas of research. ^ The empiric study linked a pooled sample of respondents aged ≥50 years without a personal history of colorectal cancer from the 2003 and 2005 California Health Interview Surveys with a comprehensive set of census-tract level area SES measures from the 2000 U.S. Census. Two-level random intercept models were used to test 2 hypotheses: (1) area SES will be associated with adherence to two modalities of CRCS after controlling for individual SES; and (2) gender will moderate the relationship between area socioeconomic status and adherence to both modalities of CRCS. ^ Results. The systematic review identified 19 eligible studies that demonstrated variability in study designs, methods, constructs, and measures. The majority of tested associations were either not statistically significant or significant and in the positive direction, indicating that as area SES increased, the odds of CRCS increased. The multilevel study demonstrated that while multiple aspects of area SES were associated with CRCS after controlling for individual SES, associations differed by screening modality and in the case of endoscopy, they also differed by gender. ^ Conclusions. Conceptual and methodologic heterogeneity and weaknesses in the literature to date limit definitive conclusions about the underlying relationships between area SES and cancer screening. The multilevel study provided partial support for both hypotheses. Future research should continue to explore the role of gender as a moderating influence with the aim of identifying the mechanisms linking area SES and cancer prevention behaviors. ^