Community inequality and smoking cessation in New Zealand, 1981–2006

The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981–2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Māori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Māori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality.     

Childhood socioeconomic status and racial differences in disability: Evidence from the Health and Retirement Study (1998–2006)

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998–2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N = 14,588), were used in nonlinear multilevel models. Parental education and father's occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.     

Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study

Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n = 3549, aged 37–55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females.     

Nutritional and socioeconomic factors in motor development of Santal children of the Purulia district, India

Aims

The aim of this study was to characterize the motor development of 5-12 year-old Santal children of the Purulia district of West Bengal, India. The effect of socioeconomic and nutritional status on motor development was also examined.

Study design

841 (427 boys and 414 girls) Santal children were examined in this cross-sectional study. The nutritional status of each child was assessed by height-for-age z-score based on WHO reference data. Socioeconomic status (SES) was measured by the updated Kuppusswami scale. Motor development was measured using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Short Form (BOT-2).

Results

Sex had a significant (p < 0.05) effect on children's score of running speed and agility, upper-limb coordination and strength with higher scores for boys than girls. Children with a height-for-age z-score of − 2 or less were significantly more likely to have a total BOT-2 z-score of − 2 or less compared with children at a healthier height-for-age range (Χ² = 271.136, p < 0.0001). Well-nourished children scored significantly higher (p < 0.05) than undernourished children in total BOT-2 score and in all individual motor subtests. Regression analysis showed that nutritional status, socioeconomic status and height have a significant impact on total BOT-2 score (p < 0.001). Age and sex were found to be influencing factors in motor development.

Conclusion

Santal children's motor proficiency is around the 1st percentile when compared with normative BOT-2 data. This may be, in part, a result of nutritional and economic disparities between children on who the BOT-2 was normed and Santal children, supporting the role of nutrition in motor development. Additionally, Santal children with lower SES and poorer nutritional status have lower motor proficiency compared with Santal children with comparatively higher SES and nutritional status.     

Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials

Background Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even more pronounced among STEMI patients. The aim of the current study was to perform a meta-analysis to evaluate the benefits and safety of Sirolimus-Eluting Stent (SES) as compared to BMS in patients undergoing primary angioplasty for STEMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following keywords were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results A total of 9 trials were included in the meta-analysis, involving 2,769 patients (1389 or 50.2% randomized to DES and 1,380 or 49.8% randomized to BMS). At 12 months follow-up, SES was associated with a significant reduction in TVR (4.9% vs. 13.6%, p < 0.0001), with a trend in benefits in mortality (2.9% vs. 4.2%, p = 0.08) and reinfarction (3.0% vs. 4.3%, p = 0.06), without any significant difference in stent thrombosis (1.9% vs. 2.5%, p = 0.36). Safety and efficacy of DES were confirmed at 2–3 years follow-up (data available from 4 trials including 569 patients). Conclusions This meta-analysis shows that among selected STEMI patients undergoing primary angioplasty, SES as compared to BMS is safe and associated with a significant reduction in TVR at 1 and 2–3 years follow-up.     

To assess, to control, to exclude: Effects of biobehavioral factors on circulating inflammatory markers

Behavioral scientists have increasingly included inflammatory biology as mechanisms in their investigation of psychosocial dynamics on the pathobiology of disease. However, a lack of standardization of inclusion and exclusion criteria and assessment of relevant control variables impacts the interpretation of these studies. The present paper reviews and discusses human biobehavioral factors that can affect the measurement of circulating markers of inflammation. Keywords relevant to inflammatory biology and biobehavioral factors were searched through PubMed. Age, sex, and hormonal status, socioeconomic status, ethnicity and race, body mass index, exercise, diet, caffeine, smoking, alcohol, sleep disruption, antidepressants, aspirin, and medications for cardiovascular disease are all reviewed. A tiered set of recommendations as to whether each variable should be assessed, controlled for, or used as an exclusion criteria is provided. These recommendations provide a framework for observational and intervention studies investigating linkages between psychosocial and behavioral factors and inflammation.     

Physical Activity Resource Attributes and Obesity in Low-Income African Americans

More than two thirds of Americans are overweight or obese, and African Americans are particularly vulnerable to obesity when compared to Caucasians. Ecological models of health suggest that lower individual and environmental socioeconomic status and the built environment may be related to health attitudes and behaviors that contribute to obesity. This cross-sectional study measured the direct associations of neighborhood physical activity resource attributes with body mass index (BMI) and body fat among low-income 216 African Americans (Mean (M) age = 43.5 years, 63.9% female) residing in 12 public housing developments. The Physical Activity Resource Assessment instrument measured accessibility, incivilities, and the quality of features and amenities of each physical activity resource within an 800-m radius around each housing development. Sidewalk connectivity was measured using the Pedestrian Environment Data Scan instrument. Ecological multivariate regression models analyzed the associations between the built environment attributes and resident BMI and body fat at the neighborhood level. Sidewalk connectivity was associated with BMI (M = 31.3 kg/m²; p < 0.05). Sidewalk connectivity and resource accessibility were associated with body fat percentage (M = 34.8%, p < 0.05). Physical activity resource attributes and neighborhood sidewalk connectivity were related to BMI and body fat among low-income African Americans living in housing developments. This research was funded by the Robert Wood Johnson Foundation’s Active Living Research program.     

The influence of sense of coherence on the relationship between childhood socioeconomic status and adult oral health-related behaviours

Abstract – Objectives: To assess the role of adulthood socioeconomic status (SES) and sense of coherence (SOC) in the relationship between childhood SES and adult oral health‐related behaviours. Methods:  This study analysed responses of 5318 dentate subjects aged 30 years and over who participated in the Finnish Health 2000 Survey. Participants provided information on their demographic characteristics (sex, age, marital status and urbanization), childhood SES (parental education), adulthood SES (years of education and household income), the SOC scale and four oral health‐related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). Structural equation modelling was used to test a model including adult SES and SOC as mediating factors of the relationship between childhood SES and adult oral health‐related behaviours. Multi‐group comparison was conducted to test the model within each sex and age group. Results: Childhood SES was related to adult oral health‐related behaviours (P < 0.001) but only indirectly, via adulthood SES (P < 0.001) and adult SOC (P = 0.001). However, the relationship via adulthood SES was much stronger than that via SOC (standardized path coefficients were 0.24 and 0.01 respectively). In the multi‐group comparison, the model was invariant across sex and age groups. Conclusions: The relationship between childhood SES and adult oral health‐related behaviours was mainly mediated by adulthood SES, and to a much less extent by SOC. A stronger SOC was significantly associated with better adult oral health‐related behaviours, after controlling for the effect of adulthood SES and demographic characteristics of the participants.