Vaccination coverage among young homeless children compared to US national immunization survey data

IntroductionComprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children.Materials and methodsA cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child’s healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor).ResultsMost of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child’s age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05).ConclusionChildren experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.     

Oral health behaviour and self-esteem in Swedish children

This study focus on the socio-psychological concept of self-esteem and examines its association with oral health behaviour and with some background variables that have been shown to be of importance in previous studies. In 1995, 3370 12-year-olds answered a questionnaire on social and demographic factors. Questions on attitudes and behaviour were also included. After reducing the number of variables and constructing new variables, multivariate analyses were performed. A polytomous regression on self-esteem showed that having very poor self-esteem as opposed to poor, good and very good self-esteem was associated with being a girl, not living with one's biological parents, poor social support, having less interest in politics, poor adaptation in school and poor oral health behaviour. The results also showed that being a boy, choosing statements reflecting less exemplary behaviour, and being less well adapted in school increased the risk of having poor oral health behaviour, as did ethnic group affiliation and having poor self-esteem. Our results showed that self-esteem is a crucial intervening variable between variables measuring social background and outcome variables, especially oral health behaviour.     

Social determinants of child and adolescent traffic-related and intentional injuries: A multilevel study in Stockholm County

Several significant developmental and socialisation processes in the life of children and adolescents take place in the area where they live. The extent to which they can feel and be safe in this environment is an important component of the success of those processes. This study highlights the independent contribution of neighbourhood and individual-level demographic and socioeconomic attributes to child and adolescent injuries. All individuals between the ages of 7 and 16 years living in Stockholm County in January 1998 (n = 184?545) were followed up for their injuries during a five-year period considering injuries sustained as a pedestrian/cyclist/motor-vehicle rider and intentional injuries (violence-related and self-inflicted). A series of two-level logistic regressions were conducted to examine the association between the occurrence of injuries and individual (compositional) characteristics nested into parish of residence as well as contextual characteristics. For children and adolescents living in Stockholm County, contextual socioeconomic and social attributes of their place of residence were significant for injuries sustained as motor-vehicle riders but not for those sustained as pedestrians/cyclists or those inflicted intentionally. In the latter case, only the highest concentration of social benefit recipients was associated with significantly higher odds ratios. This emphasises that each injury mechanism has its own socioeconomic and social pathway, where contextual and compositional factors come into play to varying degrees.     

The gradient in health inequalities among families and children: a review of evaluation frameworks

Public health policies and interventions that seek to tackle the social gradient in health need to be more adequately evaluated. The GRADIENT Project sets out to recommend public health policy options which effectively tackle health inequalities and address the gradient in health determinants among families and children in Europe. This work is underpinned by the development of a dedicated evaluation framework—a scheme that elaborates steps in a process of assessment which can act as a useful guide for decision makers. This paper presents the results from a narrative review, based on realist review principles, of 34 evaluation frameworks. It uses a set of analytical criteria, drawn from the EUHPID health development model, the Ottawa Charter for Health Promotion, and the wider literature on health inequalities, to analyse these frameworks. The findings reveal that no one suitable evaluation framework exists to evaluate whether policies and/or interventions targeting children and families reduce the health gradient. It is suggested that this work will be useful in assessing the complex nature of public health interventions and their evaluation. It will be used to develop an evaluation framework to guide decision makers to begin to understand the key drivers at each stage of the policy development and implementation cycle.     

Suppression of racial disparities for children with special health care needs among families receiving Medicaid

This study examines whether the US public health insurance program Medicaid suppresses racial disparities in parental identification of service needs of their children with special health care needs (CSHCN). We analyze data from the 2001 US National Survey of CSHCN (n = 14,167 children). We examine three outcomes which were parental identification of (a) the child's need for professional care coordination, (b) the child's need for mental health services, and (c) the family's need for mental health services. A suppression analysis, which is a form of mediation analysis, was conducted. Our results show a disparity, reflected in a negative direct effect of race for all three outcomes: Black parents of CSHCN are less likely to report a need for services than White parents of CSHCN and Medicaid coverage was associated with reduced racial disparities in reporting the need for services. These analyses suggest receipt of Medicaid is associated with a suppression of racial disparities in reported need for services.     

Social inequalities in COVID-19 vaccine acceptance and uptake for children and adolescents in Montreal,Canada

BackgroundThe success of current and prospective COVID-19 vaccine campaigns for children and adolescents will in part depend on the willingness of parents to accept vaccination. This study examined social determinants of parental COVID-19 vaccine acceptance and uptake for children and adolescents.MethodsWe used cross-sectional data from an ongoing COVID-19 cohort study in Montreal, Canada and included all parents of 2 to 18-year-olds who completed an online questionnaire between May 18 and June 26, 2021 (n = 809). We calculated child age-adjusted prevalence estimates of vaccine acceptance by parental education, race/ethnicity, birthplace, household income, and neighbourhood, and used multinomial logistic regression to estimate adjusted prevalence differences (aPD) and ratios (aPR). Social determinants of vaccine uptake were examined for the vaccine-eligible sample of 12 to 18 year-olds (n = 306).ResultsIntention to vaccinate children against COVID-19 was high, with only 12.4% of parents unlikely to have their child vaccinated. Parents with younger children were less likely to accept vaccination, as were those from lower-income households, racialized groups, and those born outside Canada. Children from households with annual incomes <$100,000 had 18.4 percent lower prevalence of being vaccinated/very likely vaccinated compared to household incomes ≥$150,000 (95% CI: 10.1 to 26.7). Racialized parents reported greater unwillingness to vaccinate vs. White parents (aPD = 10.3; 95% CI: 1.5, 19.1). Vaccine-eligible adolescents from the most deprived neighbourhood were half as likely to be vaccinated compared to those from the least deprived neighbourhood (aPR = 0.48; 95% CI: 0.18 to 0.77).Interpretation.This study identified marked social inequalities in COVID-19 vaccine acceptance and uptake for children and adolescents. Efforts are needed to reach disadvantaged and marginalized populations with tailored strategies that promote informed decision making and facilitate access to vaccination.     

Developmental screening scores among preschoolaged children: The roles of poverty and child health

Objectives To investigate, using a nationally representative sample of preschool-aged children, the relationship among poverty history, child health, and risk of an abnormal developmental screening score. Methods Data were derived from the 1988 National Maternal and Infant Health Survey and 1991 Longitudinal Follow-up. Family income in the child’s prenatal year and at 2 years old defined a poverty history for each child. Multivariate logistic regression was used to estimate the effects of poverty history on risk of an abnormal screening score or delays in large-motor, personal-social, or language subscales. Results Poor and near-poor children were 1.6 to 2.0 times as likely as nonpoor children to be classified as abnormal, even when maternal and household characteristics and the child’s health history were taken into account. Preterm birth, chronic illness, dearth of reading materials in the home, and maternal depression were also associated with elevated risks of abnormal scores. Conclusions Poverty is the largest single predictor of an abnormal developmental screening score. The implications of inadequate medical care among poor children for the interpretation of individual screening scores and for amelioration of problems are also discussed.     

Racial and ethnic differences in general health status and limiting health conditions among American children: parental reports in the 1999 national survey of America's families

Objectives . This research investigates the association between race/ethnicity and child health, and examines the role of family structure, family socioeconomic status (SES), and healthcare factors in this association. Five major racial/ethnic groups in the US are studied. Two child health outcomes, including parent-rated health and limiting health condition, are examined. The analysis is stratified into three age groups: age 0–5, age 6–11, and age 12–17.

Design . Cross-sectional study using data from a large, nationally representative sample collected in 1999 in the US.

Results . Older age groups tend to exhibit larger racial/ethnic disparities in child health. Except for some age groups of Asian youths, minority children and adolescents generally show higher risks of fair or poor parent-rated health and limiting health condition relative to Whites. Family SES partly explains the effects of Black, Hispanic, and Native American groups, but significant amount of residual effects remain. Family structure explains some Black effects, but not for other minority groups. Healthcare factors do not contribute much to the racial/ethnic differences. Both family structure and healthcare factors are important factors of child health in their own right. None of the social factors examined can explain the effects of the Asian group. Data also show that economic resources play a more salient role in child health than parental education, especially in young children. In addition, healthcare factors, to some extent, can explain why children from higher SES families fare better in health.

Conclusion . Racial/ethnic disparities in health start early in life. Except for Asians, class explains a substantial amount, but not all, of these disparities. Healthcare factors play some role in explaining health disparities by class. Structural solution seems to be needed to reduce disparities by race/ethnicity among youths.     

Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas

OBJECTIVE: The objective of this study was to test whether the association between primary care and income inequality on all-cause, heart disease and cancer mortality at county level differs in urban (Metropolitan Statistical Area-MSA) compared with non-urban (non-MSA) areas. STUDY DESIGN: The study consisted of a cross-sectional analysis of county-level data stratified by MSA and non-MSA areas in 1990. Dependent variables included age and sex-standardized (per 100,000) all-cause, heart disease and cancer mortality. Independent variables included primary care resources, income inequality, education levels, unemployment, racial/ethnic composition and income levels. METHODS: One-way analysis of variance and multivariate ordinary least squares regression were employed for each health outcome. RESULTS: Among non-MSA counties, those in the highest income inequality category experienced 11% higher all-cause mortality, 9% higher heart disease mortality, and 9% higher cancer mortality than counties in the lowest income inequality quartile, while controlling for other health determinants. Non-MSA counties with higher primary care experienced 2% lower all-cause mortality, 4% lower heart disease mortality, and 3% lower cancer mortality than non-MSA counties with lower primary care. MSA counties with median levels of income inequality experienced approximately 6% higher all-cause mortality, 7% higher heart disease mortality, and 7% higher cancer mortality than counties in the lowest income inequality quartile. MSA counties with low primary care (less than 75th percentile) had significantly lower levels of all-cause, heart disease and cancer mortality than those counties with high primary care. CONCLUSIONS: In non-MSA counties, increasing primary physician supply could be one way to address the health needs of rural populations. In MSA counties, the association between primary care and health outcomes appears to be more complex and is likely to require intervention that focuses on multiple fronts.     

Meal skipping children in low-income families and community practice implications

We examined dietary habits, food intakes, health status, and school and community life of meal skipping children, and investigated factors predicting meal skipping of children. A sample was composed of 944 children in low-income families who were provided with public meal service. The sample was obtained from the Survey of Meal Service for Poor Children conducted by the Korea Institute for Health and Social Affairs in 2007. Meal skipping was significantly associated with a lower nutrition and health status, and poor school performance of children, as hypothesized. The school age of child, family structure, region, job of caretaker, concern about diet, and the child''s visit to welfare center significantly predicted frequency of meal skipping. We suggested a few implications for community practice to reduce meal skipping of children.     

Health intervention in social context: understanding social networks and neighbourhood

Recruiting lay people from the neighbourhoods of target communities as Community Health Educators (CHEs) is an increasingly popular strategy for health interventions in the UK. CHEs are assumed to have a distinct advantage in reaching 'difficult to reach' groups by virtue of their network membership. However, results obtained from a recent intervention study [Chiu (2002). Straight talking: Communicating breast screening information in primary care. Leeds: Nuffield Institute for Health, University of Leeds] raised concerns about the much-asserted efficacy of networks and suggested that neighbourhood was a contextual factor that would potentially affect the results of health interventions. In addition, it suggested that the concept of social networks and other related concepts i.e. 'social embeddedness', 'social capital', and 'neighbourhoods' that underpin CHE interventions needed to be better understood. In order to examine these concepts in relation to CHE interventions, we conducted a pilot study involving 53 CHEs (26 White, 27 Black and Minority Ethnic) in seven health organisations across the UK. The CHEs took part in focus group interviews to explore their perceptions of social networks and neighbourhood. Quantitative information on their personal networks was also mapped using three proformas. This paper explores CHEs' networks with a specific focus on the concept of 'social embeddedness' and the effect of neighbourhood. Implications of these findings on the effectiveness of intervention are discussed.     

新疆4405名妇女妇幼卫生保健知识和卫生行为调查分析

目的 了解新疆维吾尔自治区各族妇女妇幼卫生保健知识、态度和行为，为世行贷款卫Ⅸ项目开展有针对性的健康教育提供依据。方法 采用整群随机分层抽样方法对新疆24个县的新婚、怀孕、哺乳期妇女4450人进行问卷调查。结果 未经培训的人员接生可造成新生儿破伤风和产褥感染知晓率占10．2％；孕妇出现阴道出血必须立即去医院检查知晓率为46．8％，烟酒、农药、重金属、放射性物质对孕妇有害知晓率占30．3％；因食物不洁或喂养不当可造成孩子腹泻知晓率占22．7％；孕妇缺碘会引起早产流产、先天畸形、影响胎儿大脑正常发育知晓率占4．9％。在家分娩率占45．7％；27．6％的产妇由末学过新法接生的家人接生。汉族妇女在县以上医疗机构分娩为67．0％，维族妇女为20．6％。结论 新疆各族新婚、怀孕、哺乳期的妇女卫生知识水平偏低、住院分娩率低，健康教育势在必行。     

Indoor environment and children's health: recent developments in chemical, biological, physical and social aspects

Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.     

Socio-economic risk factors for injuries in Swedish children and adolescents: A national study over 15 years

Abstract

Few studies have assessed if Sweden's injury prevention work has been equally effective for children of different socio-economic backgrounds. The goal of this paper is to review the country's injury rates for children over time, stratified by socio-economic status (SES), to see if the effects are similar across SES levels. This study employs a retrospective case-control study design, using data from the hospitalisation records of 51,225 children, which were linked to family socio-economic data. Children and adolescents in families receiving social welfare benefits, and those living with single parents and mothers with less education had higher risks of injuries leading to hospitalisation. The population-based safety work over the past decades seems to have had only minor effects on reducing the impact of socio-economic based difference in injury risks to younger Swedes.     

江苏省国家卫生城市中小学生健康知识水平调查

目的了解江苏省国家卫生城市中小学生的健康知识知晓情况。方法对江苏省中小学生的健康知识进行了问卷抽样调查。结果中学生的健康知识知晓率为90.40%,小学生健康知识知晓率为91.07%,中小学生平均知晓率为90.48%。苏南城市小学生健康知识知晓率高于苏北城市(P<0.01),中学生无显著差异。结论国家卫生城市学生的健康知识知晓率较低,学生应知的健康知识内容及知晓率标准缺乏统一性、系统性,中小学校健康教育教育课未得到落实。     

Job quality and inequality: Parents’ jobs and children’s emotional and behavioural difficulties

In the context of high and rising rates of parental employment in Australia, we investigated whether poor quality jobs (without security, control, flexibility or paid family leave) could pose a health risk to employed parents’ children. We examined the extent to which both mothers’ and fathers’ jobs matter, and whether disadvantaged children are more vulnerable than others. Multiple regression modelling was used to analyse cross-sectional data for 2004 from the Growing Up in Australia study, a nationally representative sample of 4–5 year old children and their families (N = 2373 employed mothers; 3026 employed fathers). Results revealed that when parents held poor quality jobs their children showed more emotional and behavioural difficulties. The associations with child difficulties were independent of income, parent education, family structure and work hours, and were evident for both mothers’ and fathers’ jobs. Further, the associations tended to be stronger for children in low-income households and lone-mother families. Thus job quality may be another mechanism underlying the intergenerational transmission of health inequality. Our findings also support the argument that a truly family-friendly job must not erode children’s health.     

Social class across the life course and physical activity at age 34 years in the 1970 British birth cohort

PurposeTo examine the associations between social class at ages 0, 5, 10, 30, and 34 years and physical activity at age 34 years using a novel approach to analysis of life course data.MethodsWe used structural equation modeling to compare three competing models in life course epidemiology: the accumulation of risk model with additive effects, the accumulation of risk model with trigger effect, and the critical period model. Data were from a nationally representative prospective cohort of 16,571 British men and women born in 1970. Outcomes were physical activity during leisure time, during transports, and at work.ResultsFor all three domains of physical activity, for men and women, the accumulation of risk model with additive effects fit the data best. In this model, social class at ages 0, 5, 10, 30, and 34 years were associated with physical activity at age 34 years, although the magnitude and the direction of the associations for social class at each age varied by physical activity outcome and by sex.ConclusionsStructural equation modeling appears to be a helpful tool in selecting among competing models in life course epidemiology.