Double disadvantage : the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children

Objective: To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background.

Design: Cross-sectional survey of children aged 4–13 years.

Setting: A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia.

Participants: A total of 2685 children aged 4–13 years and their parents.

Main exposure measures: Ethnicity/cultural background – maternal region of birth; socioeconomic position (SEP) indicators – maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status.

Main outcome measure: Prevalence of overweight/obesity.

Results: Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12–2.19) and 1.88 (95%CI 1.24–2.85), respectively.

Conclusions: There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.

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.

Muslim active citizenship in Australia: socioeconomic challenges and the emergence of a Muslim elite

The most recent national Census demonstrated that Australian Muslims continue to occupy a socioeconomically disadvantaged position. On key indicators of unemployment rate, income, type of occupation and home ownership, Muslims consistently under-perform the national average. This pattern is evident in the last three Census data (2001, 2006 and 2011). Limited access to resources and a sense of marginalisation challenge full engagement with society and the natural growth of emotional affiliation with Australia. Muslim active citizenship is hampered by socioeconomic barriers. At the same time, an increasingly proactive class of educated Muslim elite has emerged to claim a voice for Muslims in Australia and promote citizenship rights and responsibilities.

National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

Proposal on indicators for follow-up to the goals of the International Conference on Population and Development in Latin America and the Caribbean

Includes bibliography

Association between risk behaviors and adiposity indicators in adolescents from Southern Brazil: A methodological approach

The aim of this study was to analyze the association between risk behaviors and adiposity indicators in adolescents and to discuss some methodological aspects related to this relationship. We evaluated 1,321 adolescents (55.2% female) aged 10-16 years. Relative body fat (%fat) by measurement of triceps and subscapular skinfold thickness and waist circumference (WC) were used as total and central adiposity indicators, respectively. Physical inactivity, time spent in front of the TV, the consumption of soda and/or chocolate, alcohol, and tobacco smoking were analyzed as risk behaviors. Information about the socioeconomic status (categorized into three levels) and nutritional status of the mother (overweight or normal weight) were used as adjustment factors in the analyses of prevalence ratio (PR) of the outcomes and their associated 95% confidence intervals (95% CI). The chi-square test and Poisson regression were used for statistical analyses. Low associations were found between risk behaviors and adiposity indicators. Tobacco smoking was the most positively correlated behavior with adiposity in girls (%fat: PR = 1.61; 95% CI = 1.04-2.47; WC: PR = 1.90; 95% CI = 1.17-3.08) and in adolescents whose mothers were normal weight (%fat: PR = 2.31; 95% CI = 1.33-4.03; WC: PR: 2.31; CI: 1.19-4.46). Additionally, as an important methodological issue, we highlighted the assessment of risk behaviors in adolescents as crucial to producing more robust evidence on the subject. Of the investigated behaviors, we concluded that tobacco smoking is the behavior most associated with adiposity indicators.

Regional and socioeconomic distribution of household food availability in Brazil, in 2008-2009

OBJECTIVE: To describe the regional and socioeconomic distribution of household food availability in Brazil. METHODS: Data from the 2008-2009 Household Budget Survey on food and beverage acquisition for household consumption, conducted by the Instituto Brasileiro de Geografia e Estatistica (Brazilian Institute of Geography and Statistics), were analyzed. The amounts of foods, recorded during seven consecutive days in the 55,970 sample households, were converted into calories and nutrients. Food quality indicators were constructed and analyzed according to the regional and socioeconomic strata of the Brazilian population. RESULTS: The amount of energy from protein was adequate in all regional and socioeconomic strata. On the other hand, an excess of free sugars and fats was observed in all regions of the country, especially in the Southern and Southeastern regions. The proportion of saturated fats was high in urban areas and consistent with the greater contribution of animal-derived products. Limited availability of fruits and vegetables was found in all regions. An increase in the fat content and reduction in carbohydrate content of the diet were observed with the increase in income. CONCLUSIONS: The negative characteristics of the Brazilian diet observed at the end of the first decade of the 21(st) century indicate the need to prioritize public policies for the promotion of healthy eating.

Sugar intake is correlated with adiposity and obesity indicators and sedentary lifestyle in Brazilian individuals with morbid obesity

Obesity is a chronic disease characterized by increased accumulation of body fat. We evaluated the socioeconomic aspects, body composition, risk of metabolic complications associated with obesity, eating habits and lifestyle in both women and men adults and elderly with body mass index (BMI) 40 kg/m(2). Among the subjects studied, 79% (n = 32) are female, 5% (n = 2) smokers, 39% (n = 16) use alcohol and only 24% (n = 10) are practitioners of physical exercise. The higher food intake was breads, followed by rice. The daily intake of fruits and vegetables is low. Positive correlation between consumption of sugar and BMI and abdominal circumference (AC) was observed. In summary, was found that morbidly obese patients that looking for nutritional counseling presents increased body fat, poor eating habits and sedentary lifestyle.

Trends in the Association Between Socioeconomic Status and Obesity in U.S. Adults: 2002-2012

Since the 1980s, the prevalence of obesity has more than doubled to over 30 percent of the adult population (Thorpe, 2004). Obesity is a key contributing factor to continually rising national healthcare costs. Addressing its negative implications is essential not only from a cost perspective, but also for the betterment of our nation¿s general health and wellbeing. Obesity is reportedly associated with a 35% increase in inpatient and outpatient spending, as well as a 77% increase in related necessary medications (Sturm, 2002). Obesity, which some have argued should be classified as a disease in itself, has roughly the same association with the development of chronic health conditions as does 20 years of aging (Sturm, 2002). Defined as ambulatory care-sensitive conditions, these obesity-related chronic health diagnoses ¿ like diabetes, cardiovascular disease, and hypertension ¿ are in turn the primary drivers of current healthcare spending, as well as future predicted health expenditures. It is well established that lower socioeconomic status (SES) is associated with higher rates of obesity and the subsequent development of aforementioned obesity-related conditions. Socioeconomic status has traditionally been defined by education, income, and occupation (Adler, 2002); however, this study found empirical evidence for education being the most fundamental of these three SES indicators in determining obesity outcomes. For both men and women, as education levels increased, the likelihood of an individual being obese decreased. However, with less education, there was increased disparity between the obesity rates for men and women. Women consistently saw higher rates of obesity and were more impacted in terms of obesity onset by belonging to a lower SES category than men. In addition, this study assessed whether the impact of one¿s socioeconomic status on obesity-related health outcomes (specifically the negative impact low-SES as measured by education level) has changed over time. Results deriving from annual data from the National Health Interview Survey (NHIS) for all years from 2002 to 2012 indicate that the association between low-socioeconomic status and negative health outcomes has not increased in magnitude over the past decade. Instead, obesity rates have increased across the overall U.S. adult population, most likely due to a number of larger external societal factors resulting in increased caloric intake and decreased energy expenditure across every SES group. In addition, while the association between low-SES and obesity has not worsened, a consequence of the Great Recession has been a larger percentage of the U.S. population in lower-SES, which is still consistently subject to the same worse health outcomes.

Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.

Socioeconomic disparities in childhood cancer survival in Switzerland.

In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991-2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75-79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28-0.81) to 0.71 (95%CI: 0.44-1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival. This article is protected by copyright. All rights reserved.

Metabolic syndrome in Mexican American females---prevalence and impact of age, socioeconomic status, and family history of type II diabetes

This thesis presents an analysis of data from Molecular Epidemiology of Type II Diabetes Mellitus in Mexican Americans. The study included 294 families. Among the participating families were 500 Mexican American females aged 19 to 86 who provided information on characteristics such as height, weight, and a variety of biochemical indicators. The research questions for this thesis are: (1) How strong is the association between indicators of the metabolic syndrome in study participants and their family histories of type II diabetes; and (2) How is an individual's family history of type II diabetes, age and socioeconomic status associated with the metabolic syndrome? In this thesis education status of the participants is used as an indicator of socioeconomic status. Answers to these questions are provided through the analysis of women's responses to written questionnaires and biochemical data. ^

Relationships among epilepsy self-management, health outcomes, and socioeconomic status

The purpose of this study was to investigate the association between epilepsy self-management and disease control and socio-economic status. Study participants were adult patients at two epilepsy specialty clinics in Houston, Texas that serve demographically and socioeconomically diverse populations. Self-management behaviors- medication, information, safety, seizure, and lifestyle management were tested against emergency room visits, hospitalizations, and seizure occurrence. Overall self-management score was associated with a greater likelihood of hospitalizations over a prior twelve month time frame, but not for three months, and was not associated with seizure occurrence or emergency room visits, at all. Scores on specific self-management behaviors varied in their relationships to the different disease control indicators, over time. Contrary to expectations based on the findings of previous research, higher information management scores were associated with greater likelihood of emergency room visits and hospitalizations, over the study's twelve months. Higher lifestyle management scores were associated with lower likelihood of any emergency room visits, over the preceding twelve months and emergency room visits for the last three months. The positive associations between overall self-management scores and information management behaviors and disease control are contrary to published research. These findings may indicate that those with worse disease control in a prior period employ stronger self-management efforts to better control their epilepsy. Further research is needed to investigate this hypothesis.^

Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007

Background: While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods: All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results: Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions: Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.