Socio‐economic gradients in self‐reported diabetes for Indigenous and non‐Indigenous Australians aged 18–64

Objective : To examine and compare socio‐economic gradients in diabetes among Indigenous and non‐Indigenous Australians. Methods : I analysed weighted data on self‐reported diabetes and a range of socio‐economic status (SES) measures for 5,417 Indigenous and 15,432 non‐Indigenous adults aged 18–64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004–05. Results : After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non‐Indigenous populations. The age‐ and sex‐adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3–5 combined) was 2.3 (95% CI 1.6–3.4) for the Indigenous population and 2.0 (95% CI 1.5–2.8) for the non‐Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non‐Indigenous people on every SES measure examined. Conclusion : Socio‐economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non‐Indigenous Australians. Other factors that may operate across the socio‐economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. Implications : Indigenous Australians do not constitute a homogeneous group with respect to socio‐economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage.     

Maternal Early Life Risk Factors for Offspring Birth Weight: Findings from the Add Health Study

The aim of this study was to examine the pathways that link mothers’ early life socio economic status (SES) and mothers’ experience of childhood maltreatment with birth weight among their later born offspring. Data were drawn from a nationally representative longitudinal survey of school-aged respondents, initially enrolled during adolescence in Wave I (1994–1995) and Wave II (1996) of the National Longitudinal Study of Adolescent Health and followed-up in adulthood in Wave III (2001–2002). Data on offspring birth weight were obtained from nulliparous females (N = 1,897) who had given birth between Waves II and III. Analyses used structural equation modeling to examine the extent to which early life maternal risk predicted offspring birth weight, and demonstrated that maternal childhood SES and maternal childhood maltreatment predicted offspring birth weight through several mediated pathways. First, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood SES and offspring birth weight. Second, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Third, adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Fourth, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood maltreatment and offspring birth weight. Finally, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood maltreatment and offspring birth weight. To our knowledge, this is the first study to identify maternal childhood maltreatment as an early life risk factor for offspring birth weight among a nationally representative sample of young women, and to demonstrate the mechanisms that link childhood SES and maltreatment to offspring birth weight. These findings suggest the importance of designing and implementing prevention and intervention strategies to address early life maternal social conditions in an effort to improve inter generational child health at birth.     

A geographic comparison of the prevalence and risk factors for postnatal depression in an Australian population

Objective: This study sought to compare the contribution of demographic and psychosocial variables on the prevalence of, and risk for, PND in urban and rural women. Methods: Demographic, psychosocial risk factor and mental health data was collected from urban (n=908) and rural (n=1,058) women attending perinatal health services in Victoria, Australia. Initial analyses determined similarities and significant differences between demographic and psychosocial variables. The association between these variables and PND case/non‐case was evaluated using logistic regression analysis. Results: There were a number of significant differences between the two cohorts in terms of socio‐economic status (SES), age, marital status and past history of psychopathology Antenatal depression was more common in the urban group compared to the rural group (8.5% vs 3.4%, p=0.006); there was no significant difference in the prevalence of PND (6.6% vs 8.5%, p=0.165). For urban mothers, antenatal EPDS score was the best predictor of PND. For rural mothers antenatal EPDS score, SES and psychiatric history had a significant influence on postnatal mood. Conclusions: Findings confirm the contribution of established risk factors such as past psychopathology, antenatal EPDS score and SES on the development of PND and reiterate the need for procedures to identify and assess psychosocial risk factors for depression in the perinatal period. Other predictors such as efficacy of social support and perceived financial burden may strengthen statistical models used to predict PND for women living in a rural setting.     

Early-life and adult socioeconomic status and inflammatory risk markers in adulthood

BACKGROUND: Associations between childhood and adult socioeconomic status (SES) and adult levels of inflammatory markers (C-reactive protein [CRP], fibrinogen, white blood cell count [WBC], and von Willebrand factor [vWF]) were examined in the Atherosclerosis Risk in Communities (ARIC) Study cohort. METHODS: A total of 12,681 white and African-American participants provided information on SES (via education and social class) and place of residence in childhood and adulthood. Residences were linked to census data for neighborhood SES information. Multiple imputation was used to impute missing data. Hierarchical and linear regression were used to estimate the effects of SES and possible mediation by adult cardiovascular disease (CVD) risk factors. FINDINGS: Low childhood social class and education were associated with elevated levels of CRP, fibrinogen, WBC, and vWF (increments of 17%, 2%, 4% and 3% for lowest versus highest education in childhood, respectively) among whites. Findings were less consistent among African-Americans. Adult SES was more strongly associated with inflammation than childhood SES. Individual-level SES measures were more consistently associated with inflammation than neighborhood-level measures. Fibrinogen and WBC showed the most consistent associations with SES; the largest changes in inflammation by SES were observed for CRP. Covariate adjustment strongly attenuated these associations. Mediation of the SES-inflammation associations by BMI, smoking and HDL cholesterol (HDL-C) are suggested by these data. CONCLUSION: Low individual- and neighborhood-level SES in childhood and adulthood are associated with modest increments in adult inflammatory burden. These associations may operate through the influence of low SES on traditional CVD risk factors, especially BMI, smoking and HDL-C.     

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.     

The Influence of Family Income Trajectories From Birth to Adulthood on Adult Oral Health: Findings From the 1982 Pelotas Birth Cohort

Objectives. We assessed whether 3 models of life course socioeconomic status (critical period, accumulation of risk, and social mobility) predicted unsound teeth in adulthood among a Brazilian cohort.Methods. Life course data were collected on the 5914 live-born infants in the 1982 Pelotas Birth Cohort study. Participants'' oral health was assessed at 15 (n = 888) and 24 (n = 720) years of age. We assessed family income trajectories and number of episodes of poverty in the life course through Poisson regressions, yielding unadjusted and adjusted prevalence ratios for number of unsound teeth at age 24 years.Results. The adjusted prevalence ratio for participants born into poverty was 30% higher than for those who were not. Participants who were always poor had the highest prevalence of unsound teeth; those who were downwardly or upwardly mobile also had more unsound teeth than did other participants, after adjustment for confounders. More episodes of poverty were associated with greater prevalence of unsound teeth in adulthood.Conclusions. Poverty at birth and during the life course was correlated with the number of unsound teeth at 24 years of age.The relationship between adults'' socioeconomic position and their health is well known. However, the majority of studies addressing this issue have used measurements of adulthood socioeconomic position or relied on adults'' retrospective reports about their childhood.¹Adult health may be affected by socioeconomic position during different periods in the life course, and at least 3 major theories have been proposed to explain how and when life course socioeconomic factors influence adult health. One theory proposes that during a critical period of development in early life, exposures to deprivation have long-term effects on adult health, independent of adult circumstances.² Galobardes et al. updated a systematic review of the association between childhood socioeconomic conditions and cause-specific mortality; they confirmed that mortality risk for all causes was higher among those who experienced poorer socioeconomic status (SES) during childhood, although not all causes of death were equally related to childhood socioeconomic circumstances.³Others theorize that the intensity and duration of exposure to unfavorable or favorable physical and social environments throughout life affect health status in a dose–response relationship; this has been termed the accumulation-of-risk hypothesis.⁴ For example, the number of episodes of being in the manual social class (a cumulative harmful exposure) measured at 3 life stages was strongly and positively associated with mortality from cardiovascular disease among Scottish men.⁵A third theory, the social mobility hypothesis, postulates that the importance of the early life environment lies in its effect on the socioeconomic trajectories of individuals. Circumstances in early life are identified as the first step in the pathway to adult health, but with an indirect effect, influencing adult health through social mechanisms such as restricting educational opportunities, thus shaping socioeconomic circumstances and health in later life.⁶ In a New Zealander birth cohort, Poulton et al. investigated the association between socioeconomic trajectories during the life course and aspects of health in adulthood; they found that upward mobility did not mitigate or reverse the adverse effects of low childhood SES on adult health.¹Globally, the burden of common oral conditions is high: one of the most common chronic diseases worldwide is dental caries, severe periodontitis affects between 5% and 15% of most populations, and oral cancer is the eighth most common cancer worldwide.⁷ This evidence led the World Health Assembly to call for oral health to be integrated into chronic disease prevention programs.⁸Despite substantial evidence showing that SES is strongly associated with oral health,^9,10 the dynamics of how SES over time affects adults'' oral health remain unclear. We assessed whether 3 hypotheses about life course SES (critical period, accumulation of risk, and social mobility) predicted an important oral health outcome in early adulthood.     

Impact of interpersonal adversity in childhood on adult mental health: how much is mediated by social support and socio-economic status in Japan?

Objectives

To examine the extent to which social support and socio-economic status (SES) in adulthood mediate the impact of interpersonal adversity in childhood on adult mental health using large-scale population data in Japan.

Study design

Cross-sectional survey.

Methods

Data were derived from the Japanese Study of Stratification, Health, Income and Neighbourhood, which was conducted from October 2010 to February 2011 in four municipalities in and around the Tokyo metropolitan area. Survey participants were community residents aged 25–50 years who were selected at random from voter registration lists. The total sample size was 3292. The self-reported experience of parental maltreatment (physical abuse and/or neglect) and bullying in school and their impacts on adult mental health (in terms of K6 = 5+, K6 = 13+ and suicide ideation) were examined using multivariate logistic models.

Results

Interpersonal adversity in childhood has a negative impact on adult mental health even after controlling for childhood SES. For example, the odds ratio for K6 = 5+, responding to parental maltreatment, was 2.64 (95% confidence interval 2.04–3.41). Perceived social support and adult SES mediated the impact of interpersonal adversity in childhood, but a substantial proportion of the impact was unexplained by their mediating effects; social support and adult SES only mediated 11–24% and 6–12%, respectively. It was also found that social support and adult SES (except educational attainment) did not moderate the negative impact of interpersonal adversity in childhood.

Conclusions

This analysis highlighted that the impact of interpersonal adversity in childhood is relatively independent of social support and SES in adulthood. This result has clear policy implications; more focus should be placed on policies that aim to reduce incidents of childhood maltreatment and bullying per se, both of which have a long-lasting direct impact on mental health.     

Maternal smoking during pregnancy among Aboriginal women in New South Wales is linked to social gradient

Objective: Social gradients in Aboriginal health are seldom explored. This study describes social gradients and trends in smoking during pregnancy among Aboriginal mothers in NSW. Methods: This was a secondary analysis of the NSW Midwives Data Collection (MDC) 1994–2007, covering all births in NSW. Analyses examined associations between socio‐demographic characteristics and smoking during pregnancy. Results: Data from 1,214,206 pregnant women showed that 17.4% smoked during pregnancy. The rate of smoking during pregnancy among all NSW women declined from 22.3% in 1994 to 12.8% in 2007; the rate among Aboriginal women remained high, declining from 61.4% in 1994 to 50.2% in 2007. Smoking was substantially higher among Aboriginal mothers compared to non‐Aboriginal mothers. Socio‐economic analyses showed that the smoking rate among low SES Aboriginal mothers was approximately two and a half times that of high SES Aboriginal women, a similar gradient to non‐Aboriginal women. Conclusions: Indicators of socio‐economic position are a consistent, independent correlate of smoking during pregnancy for Aboriginal and non‐Aboriginal women. Implications: There is a need for a social inequalities approach to smoking during pregnancy, specifically targeting more disadvantaged Aboriginal mothers and all teenage mothers for smoking prevention. Strategies to access more disadvantaged mothers should not be missed through broadly focused Aboriginal tobacco control strategies.     

Investigating socio-economic disparities in preterm birth: evidence for selective study participation and selection bias

Selective study participation can theoretically lead to selection bias. We explored this issue in the context of a multicentre cohort study of socio‐economic disparities in preterm birth. Women with singleton pregnancies were recruited from four large Montreal maternity hospitals and invited to return for an interview, vaginal examination and venepuncture at 24–26 weeks of gestation. We compared the observed preterm birth rate (ultrasound confirmed) among the 5146 cohort women to that expected based on all 108 724 Montreal Census Metropolitan Area (CMA) singleton births for 1998–2000. The observed preterm birth rate in the study cohort was 5.1%, compared with 6.3% in the CMA (P < 0.001) (unadjusted morbidity ratio [95% CI] = 0.80 [0.71, 0.90]). Within each stratum of maternal education and neighbourhood income (the latter based on postal code matched links to the 2001 Canadian census), cohort women had substantially lower rates of preterm birth than women from the CMA. No significant association between socio‐economic status (SES) and preterm birth was observed in the study cohort, except among ‘indicated’ (non‐spontaneous) cases. The association between neighbourhood income and preterm birth was biased to the null in the study cohort, with adjusted odds ratios in the poorest vs. richest quintiles of 1.01 [0.63, 1.64] in the cohort vs. 1.28 [1.18, 1.39] in the CMA, although no such bias was observed for the association with maternal education assessed at the individual level. We speculate that the lower‐than‐expected preterm birth rate and attenuated association between neighbourhood income and preterm birth may be related to selective participation by women more psychologically invested in their pregnancies. Investigators should consider the potential for biased associations in pregnancy/birth cohort studies, especially associations based on SES or race/ethnicity, and carry out sensitivity analyses to gauge their effects.     

Representations of childhood obesity in Australian newsprint media and academic literature

Objective: To examine how the issue of childhood obesity is represented in Australian newsprint media and academic literature. Method: Australian newsprint media coverage and academic literature on childhood obesity during the first three months of 2009 was analysed using Bacchi's method of problem representation. Results: The two types of literature examined offered two dominant paradigms for childhood obesity treatment and prevention solutions: the individual and the social‐structural. The individual behaviour change account emphasises the role of parents in providing children with healthy food and physical activity, placing them at fault for their obese children. The account focusing on the circumstances within which people live – such as the physical environment, lifestyle, socio‐economic status, access to services and advertising/marketing of food aimed at children – places responsibility on the government to respond with policy change. Conclusion: While both the individual and social‐structural paradigms are found in each source, newsprint media favours the individual responsibility account while the academic literature favours the social‐structural account. Implications: Public health professionals may need to be more media savvy to shift this focus.     

Development of general and central obesity from childhood into early adulthood in African American and European American males and females with a family history of cardiovascular disease

BACKGROUND: Obesity is associated with multiple health problems, often originating in childhood. OBJECTIVE: The objective was to investigate differences in the development of adiposity from childhood to adulthood as related to race, sex, and socioeconomic status (SES). DESIGN: Individual growth curve modeling for waist circumference, body mass index, and sum of skinfold thicknesses (triceps, subscapular, and suprailiac) was performed in an 11-y cohort study of 622 African Americans and European Americans aged 4.2-27.5 y. We examined the development of adiposity in 2 ways: 1) differences related to race, sex, and parents' education (SES), and 2) differences between obese, overweight, and normal-weight persons at the end of their childhood (> 17 y of age). RESULTS: The sum of skinfold thicknesses was greater in females than in males, with a larger increase with age. Race, sex, and SES showed a complex relation with body mass index and the sum of skinfold thicknesses. The low-SES group showed the fastest increase in waist circumference with age. The obese group showed the most rapid increase in the 3 measures of adiposity. Growth curves for the obese group were distinguishable from those for the normal-weight persons at an earlier age for African Americans than for European Americans. CONCLUSIONS: The development rate of adiposity from childhood into early adulthood is influenced by sex and SES but not by race. However, race, sex, and SES had joint effects on adiposity levels. The development of obesity can begin to be distinguished in midchildhood, but the age at which this distinction becomes apparent depends on race.     

A matched case–control study comparing the health status of youth village alumni in Israel to the general population

Recent studies have noted that disproportionately adults with histories of childhood out‐of‐home placements, compared to adults without, suffer adulthood psychological and physical problems; however, these findings were based mostly on research investigating adults who were in the US foster care system. Building on this foundation, this study examined adults with histories of living in another type of childhood out‐of‐home placement, called youth villages, a situation in Israeli society reserved for youths who come from impoverished families with the added challenge of being immigrants, from single‐parent families, or having parents who struggle with mental health problems or substance abuse. This study's aim was to examine the longer term adulthood impact of having lived in youth villages on health status, by making comparisons to the general population using a sample matched by age and gender. Youth villages provided lists of alumni, ages 21–55, and telephone questionnaires were administered from November 2014 to December 2015. The adult youth village alumni (n = 152) were compared to a matched sample of the general population (n = 304) drawn from an existing Israeli nationwide data set. Conditional logistic regression was used to compare the health status of the two groups. Youth village alumni were found to have experienced many of the same adverse childhood events as did graduates from the US foster care system; however, after adjusting for confounders, the health status between the two groups did not differ. This dramatically different finding compared to studies on US foster care graduates suggests that the precursors of out‐of‐home placement and out‐of‐home placement itself may not always be devastating experiences with adulthood health repercussions. Future studies are needed to examine the context and process of out‐of‐home placement including: events preceding placement, context of assigning placement, placement itself, stability of placement, placement's fit for the youth's temperament and preparation for exit from the placement.     

Comparison of the effects of low childhood socioeconomic position and low adulthood socioeconomic position on self rated health in four European studies

BACKGROUND: Socioeconomic inequalities in health are a persistent feature throughout Europe. Researchers and policy makers are increasingly using a lifecourse perspective to explain these inequalities and direct policy. However, there are few, if any, cross national lifecourse comparisons in this area. METHODS: Associations between socioeconomic position (SEP) in childhood and in adulthood and poor self rated health among men and women at midlife were tested in four European studies from England (n = 3615), France (n = 11 595), Germany (n = 4183), and the Netherlands (n = 3801). RESULTS: For women, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in England and the Netherlands, only low childhood SEP in Germany and neither childhood nor adulthood SEP in France. For men, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in France and the Netherlands, only with adult SEP in England and only with childhood SEP in Germany. CONCLUSION: In most countries adult SEP showed stronger associations with self rated health than childhood SEP. There are both gender and national differences in the associations between childhood and adulthood SEP. Policies designed to reduce inequalities in health need to incorporate a lifecourse perspective that is sensitive to different national and gender issues. Ultimately, more cross national studies are required to better understand these processes.     

Mental health and hostility as predictors of temporary employment: evidence from two prospective studies

We used two studies to examine whether mental health and hostility predicted temporary employment. Study 1 involved a cohort of 970 Finnish hospital employees (102 men, 868 women) who had temporary job contracts at baseline. After adjustment for demographics, organisational tenure and part-time work status, doctor-diagnosed psychiatric disorder predicted continuing in temporary employment instead of receiving a permanent job by the end of the 2-year follow-up. A higher level of hostility was also associated with temporary employment, but only among employees in low socioeconomic positions. In Study 2, anxiety and aggressive behaviour were measured in a cohort of 226 Finnish school children (116 boys, 110 girls) at 8 years of age. Anxiety in childhood predicted temporary employment at age 42. Aggressive behaviour in childhood was related to ongoing temporary employment status in adulthood among individuals in low socioeconomic positions. Our findings suggest that selection by individual characteristics operates between the temporary and permanent workforces. Mental health problems, a part of which are already seen in childhood, seem to restrict individuals' possibilities to gain secure labour market positions. Hostility and aggressiveness seem to be related to labour market prospects only among individuals in low socioeconomic positions.     

Socioeconomic risk, parenting during the preschool years and child health age 6 years

BACKGROUND: Parent child relationships and parenting processes are emerging as potential life course determinants of health. Parenting is socially patterned and could be one of the factors responsible for the negative effects of social inequalities on health, both in childhood and adulthood. This study tests the hypothesis that some of the effect of socioeconomic risk on health in mid childhood is transmitted via early parenting. METHODS: Prospective cohort study in 10 USA communities involving 1041 mother/child pairs, selected at birth at random with conditional sampling. Exposures: income, maternal education, maternal age, lone parenthood, ethnic status and objective assessments of mother child interaction in the first 4 years of life covering warmth, negativity and positive control. Outcomes: mother's report of child's health in general at 6 years. Modelling: multiple regression analyses with statistical testing of mediational processes. RESULTS: All five indicators of socioeconomic status (SES) were correlated with all three measures of parenting, such that low SES was associated with poor parenting. Among the measures of parenting maternal warmth was independently predictive of future health, and among the socioeconomic variables maternal education, partner presence and 'other ethnic group' proved predictive. Measures of parenting significantly mediated the impact of measures of SES on child health. CONCLUSIONS: Parenting mediates some, but not all of the detectable effects of socioeconomic risk on health in childhood. As part of a package of measures that address other determinants, interventions to support parenting are likely to make a useful contribution to reducing childhood inequalities in health.     

A matter of life and breath: childhood socioeconomic status is related to young adult pulmonary function in the CARDIA study

BACKGROUND: Socioeconomic status (SES) may contribute to the trajectory of pulmonary function over the life course. Studies suggest that people with lower (versus higher) SES during childhood subsequently have lower levels of adult pulmonary function. But prospective studies are sparse across young adulthood, an important phase in pulmonary development. METHODS: Participants were from the Coronary Artery (Disease) Risk Development in (Young) Adults (CARDIA) study: 5113 young adults ages 18-30 at baseline, approximately balanced within centres across gender, self-identified race/ethnicity (Black, White), and current SES. Childhood SES was ascertained from baseline self-reports of parents' highest completed education. Pulmonary function in young adulthood was measured using FEV(1) (forced expiratory volume in one second) and FVC (forced vital capacity), assessed on three occasions over a period of 5 years. RESULTS: Longitudinal analyses suggested that rates of change in both FEV(1) and FVC differed in a gradient fashion by childhood SES. As shown by significant childhood SES by time interaction terms, these associations with FEV(1) were robust for men (b = 1.59E-3, SE = 5.21E-4, P < 0.001) and women (b = 1.93E-3, SE = 4.80E-4, P < 0.001), and adjusted for multiple potential confounders including smoking. Results were similar for FVC. Subsequent examination of the interaction terms suggested that FEV(1) and FVC declined for participants in the lowest childhood SES group, showed continued plateau or growth for those in the highest group, and were intermediate for the middle group. CONCLUSIONS: Childhood SES may influence men's and women's young adult pulmonary function in two ways. First, individuals with lower childhood SES may not attain as high levels of pulmonary function in early adulthood relative to individuals with higher childhood SES. Second, pulmonary function may decline earlier and faster for individuals with lower childhood SES.     

Evidence on equalisation in health in youth from the West of Scotland

Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child-youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur.     

Oral health studies in the 1982 Pelotas (Brazil) birth cohort: methodology and principal results at 15 and 24 years of age

The aim of this study was to describe the methodology and results of oral health studies nested in a birth cohort in Pelotas, Southern Brazil. For the oral health studies a sub-sample (n = 900) was selected from the cohort and dental examinations and interviews were performed at ages 15 (n = 888) and 24 years (n = 720; 81.1%). Data collection included dental outcomes, dental care, oral health behaviors, and use of dental services. Mean DMF-T varied from 5.1 (SD = 3.8) to 5.6 (SD = 4.1) in the study period. The proportion of individuals with at least one filled tooth increased from 51.9% to more than 70%. Individuals who had always been poor used dental services less and had fewer healthy teeth on average than those who had never been poor. Individuals with decreasing or increasing family income trajectories showed intermediate values. An increase was seen in the number of healthy teeth from age 15 to 24 only among those who had never been poor. A history of at least one experience with poverty had a negative impact on oral health in adulthood.     

Survey of Neonates in Pomerania (SNiP): a population‐based birth study – objectives,design and population coverage

Ebner A, Thyrian JR, Lange A, Lingnau M‐L, Scheler‐Hofmann M, Rosskopf D, Zygmunt M, Haas J‐P, Hoffmann W, Fusch C. Survey of Neonates in Pomerania (SNiP): a population‐based birth study – objectives, design and population coverage. Paediatric and Perinatal Epidemiology 2010; 24: 190–199. Neonatal health is of major concern to parents, midwives, physicians and society as a whole, yet a prospective population‐based birth cohort to collect comprehensive data on multiple issues including medical, social, environmental and genetic aspects remains to be established in Germany. The survey of newborns in Pomerania (SNiP) described in this paper attempts to take up this goal. The objectives of SNiP are to establish (a) a population‐based birth cohort providing detailed information about neonatal health, morbidity and mortality, (b) a biobank with newborn DNA and serum from cord blood, placenta tissue samples and DNA obtained from oral mucosal swabs of the mothers, (c) a prospective study design by re‐examination of the SNiP population prior to attendance at primary school. From March 2003 until November 2008 all childbearing mothers in a well‐defined region in North‐Eastern Germany were asked to participate with their newborns. Detailed data on health status of the newborn, pregnancy, medical and family history, socio‐economic status and maternal life style were obtained via face‐to‐face interview, standardised questionnaires and medical records. Placental tissue samples, cord blood plasma and DNA were continuously collected; sampling of maternal DNA from mouth swabs started in 2007. As a result, during the study period n = 6747 births and n = 6828 babies were enrolled. A population coverage of 95% was achieved. The active participation rate was 75%. A non‐responder analysis revealed no meaningful selection bias. Thus, SNiP is a population‐based, representative study in Germany that is able to describe the health and living conditions of newborns and their families comprehensively. It can contribute to existing knowledge and to similar cohort studies since data are accessible by researchers.     

Childhood abuse and neglect and the risk of STDs in early adulthood

CONTEXT: Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS: Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self‐reported recent and test‐identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS: Among females, even after adjustment for socioeconomic and demographic characteristics, self‐report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test‐identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test‐identified STD (1.6). CONCLUSIONS: Young women who experienced physical neglect as children are at increased risk of test‐identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self‐reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.