Predictors of emergency medical transport refusal following opioid overdose in Washington, DC.

BACKGROUND AND AIMS: Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care. DESIGN: In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model. SETTING: Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023. PARTICIPANTS: Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses. MEASUREMENTS: Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined. FINDINGS: The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1 year (-36%), had a variable association with transport. CONCLUSIONS: Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research.

Dietary Patterns by Level of Maternal Education and Their Contribution to BMI, Fat Mass Index, and Fat-Free Mass Index at Age 5 and the Longitudinal Association with BMI at Age 10.

BACKGROUND: Our aim was to identify dietary patterns by the level of maternal education that contribute to BMI, fat mass index (FMI), and fat-free mass index (FFMI) in children at age 5 and to assess if these dietary patterns are related to BMI at age 10. METHODS: Per group (low/middle/high level), Reduced Rank Regression (RRR) was used to derive dietary patterns for the response variables BMI z-score, FMI, and FFMI in 1728 children at age 5 in the Amsterdam Born Children and their Development (ABCD) cohort. Regression analyses were then used to determine the association with BMI at age 10. RESULTS: In each group, pattern 1 was characterized by its own cluster of food groups. Low: water/tea, savory snacks, sugar, low-fat meat, and fruits; middle: water/tea, low-fat cheese, fish, low-fat dairy, fruit drink, low-fat meat, and eggs; and high: low-fat cheese, fruits, whole-grain breakfast products, and low-fat and processed meat. Additionally, in each group, pattern 1 was positively associated with BMI z-scores at age 10 (low: ß ≤ 0.43 [95% CI ≤ 0.21; 0.66], p < 0.001, middle: ß ≤ 0.23 [0.09; 0.36], p ≤ 0.001, and high: ß ≤ 0.24 [0.18; 0.30], p < 0.001). CONCLUSIONS: The dietary patterns stratified by the level of maternal education are characterized by different food groups. But in all the groups, pattern 1 is positively associated with BMI at age 10.

Mediterranean Diet Adherence in Italian Children: How much do Demographic Factors and Socio-Economic Status Matter?

OBJECTIVES: . This cross-sectional study aimed to evaluate the degree of children's adherence to the Mediterranean Diet (MD), to estimate the weekly cost of MD, and to assess the role of food cost and demographic/socio-economic factors as potential barriers to comply with a healthy dietary model. METHODS: . Data collection was conducted through an online questionnaire sent to parents of children (6-11 years old) living in Italy. This survey allowed the collection of demographic/socio-economic information about the family and their dietary habits. Adherence to the MD in children was assessed through the KIDMED index. The weekly diet cost was calculated based on the food prices of two Italian supermarket chains. Descriptive statistics and inferential tests were run to evaluate the sample's characteristics and correlations between diet cost, socio-demographics, and adherence to MD. RESULTS: . Data highlighted that 31.5% of the children achieved high compliance with the MD, whereas 22.2% showed low adherence. The average diet cost increased significantly with the increasing level of adherence to the MD (Spearman's Rho = 0.322, p = 0.018). Moreover, results showed that a high parent educational level was positively associated with the KIDMED score (Spearman's Rho = 0.323, p = 0.017). No significant correlations were found between dietary cost and other characteristics such as economic status and house type. CONCLUSIONS FOR PRACTICE: . Despite the small sample size, our results suggest that nutrition education interventions targeted at children and their parents/caregivers might favour more conscious dietary choices, which in turn will help reduce the differences in diet quality caused by the educational level gaps existing in families.

Like mama always said: family socio-economic status, maternal attitudes and leader role occupancy in adulthood.

Leadership research has always recognised the importance of childhood factors for the occupation of formal or informal leader positions later in life. Still, empirical research in the field has mainly been based on retrospective accounts from selective and small samples. Such research has also concentrated on individual traits and experiences, less on characteristics of the family. Our aim is to fill this void by prospectively examining the role of the family of origin on educational attainment and holding a managerial position in adulthood. Analyses were based on the Stockholm Multigenerational Study, including register and survey data, regarding 3,088 males born between 1950 and 1976 and their mothers' attitudes to education and child-rearing in the late 1960s. Our results showed a significant effect of family socio-economic status (SES) on managerial role occupancy in late adulthood. This effect was mainly mediated through educational level. However, a noteworthy share of the total effect of family SES was channelled through maternal attitudes towards education. Positive attitudes towards education in the home environment accounted for an equally large share of the total indirect effect of family SES as the offspring's cognitive capacity did. Authoritarian attitudes to child-rearing among mothers were also found to have a negative impact on cognitive capacity and educational level - two well-known antecedents to leader emergence. Parental attitudes may boost or modify structural characteristics and individual traits associated with holding formal leader roles such as a managerial position - but also showed an independent effect several decades later.

The relationship between childhood SES and health in middle and old age: evidence from China.

Objective: Drawing from the extended Grossman health capital and demand theory and the life course theory, this study examined whether childhood SES has direct and significant correlation with health in middle and old age in a specific historical context in China. Methods: A sample of 9,861 respondents was obtained from the China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was measured by objective indices of recall. Health was assessed by self-reported, physician diagnosis and the Center for Epidemiologic Studies Depression Scale (CESD). The Propensity Score Matching (PSM) was used to estimate the treatment effect between childhood SES and later life health. The Karlson-Holm-Breen (KHB) method was employed to examine the associative mediation effects. Results: Compared to respondents with low SES in childhood, respondents with high SES in childhood had, on average, 5.1% more likely to report their health as good, an average 2.4% lower prevalence of chronic diseases and an average 7.6% lower in the score of depression in middle and old age. The indirect relationships of childhood health, adulthood SES and adulthood lifestyle with health in middle and old age were all significant. SES upward mobility in adulthood can diminish the association between childhood disadvantage and poor health in middle and old age. Conclusion: The health effects of childhood SES can persist into middle and old age, this is more noticeable in rural areas, particularly in females. The critical period, cumulative risk and social mobility models produce synergistic effects in China. Our results also promote a paradigm shift in health interventions from old age to early life for health-vulnerable populations.

Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle (LIVELY) for Childhood Obesity Prevention: Study Protocol.

BACKGROUND: Childhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits. OBJECTIVE: The LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children. METHODS: During the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement. RESULTS: Data collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024. CONCLUSIONS: The study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue. TRIAL REGISTRATION: ClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57509.

Academic orientation and alcohol-related harm among adolescents : Does the inclusion of a disadvantaged group add to the social gradient?

BACKGROUND: This study aimed to examine the social gradient in self-reported alcohol-related harm (ARH) among young alcohol consumers by including a largely overlooked group of adolescents. We also explored the extent to which such a gradient could be attributed to differential exposure or differential vulnerability to risk factors. METHOD: Cross-sectional survey of upper-secondary students (n = 2996) in Sweden. Negative binomial regressions estimated the relationship between academic orientation (higher education preparatory; HEP, vocational; VP and introductory; IP) and ARH. To assess the contribution of explanatory factors, we estimated models that included risk factors such as heavy episodic drinking (HED). RESULTS: A graded association was observed between academic orientation and ARH, with more ARH among students in IP (IRR = 1.79) and VP (IRR = 1.43) than in HEP. Adjustments for risk factors attenuated the estimates by approximately half, but there was still 14% more ARH in VP and 50% more in IP than in HEP. The additive interaction test indicated a positive and significant interaction for students in VP who engaged in HED, versus students in HEP, who did not. CONCLUSION: The findings suggest a negative gradient in the association between academic orientation and ARH, where the students in IP experienced the highest levels of ARH. While differential exposure and vulnerability to HED account for a significant proportion of the excess risk among VP students, HED seems to be less important relative to other risk factors among IP students. More research is needed to identify the mechanisms underlying the elevated levels of ARH among the most disadvantaged group-students enrolled in IP.

Impact of net zero policy scenarios on air pollution inequalities in England and Wales.

BACKGROUND: The UK is committed to achieve net zero greenhouse gas emissions by 2050. The suite of policies needed to reach net zero will lead to improvements in air quality and, consequently, could lessen air pollution inequalities. We assessed air pollution inequalities across different sociodemographic groups in England and Wales and explored how these might be differentially impacted by future air pollution projections in 2030 and 2040 under net zero policies. METHODS: We employed a geodemographic classification approach to categorise neighbourhoods into five distinct clusters based on 2021 UK Census sociodemographic variables. We modelled fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations for the year 2019, and predicted concentrations in 2030 and 2040. We compared a business-as-usual (BAU) scenario and two policy pathways to achieve net zero currently considered by the UK government. We aggregated air pollution concentrations to the neighbourhood level and assessed differential neighbourhood-level concentrations across the geodemographic groups using descriptive statistics and box plots. RESULTS: The Urban Central Professionals group experienced 14 µg/m3 higher average NO2 concentrations compared with the Rural Elderly group in 2019. Despite substantial improvements to air quality in 2030 and 2040 of up to 6.3 µg/m3 for NO2 based on BAU, and further reductions of up to 2.4 µg/m3 NO2 under net zero policies, the overall pattern of inequality persists, but is predicted to be less pronounced. CONCLUSIONS: Our findings demonstrate the effectiveness of targeted policies and innovations in reducing both air quality and greenhouse gas emissions and in bridging the environmental inequality gap. Our findings are essential to develop targeted communication campaigns to secure acceptance and willingness across the sociodemographic spectrum to support the significant behavioural changes needed to achieve net zero, by highlighting the wider co-benefits to the environment and health of such policies.

Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis.

Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.

Interactive roles of preterm-birth and socioeconomic status in cortical thickness of language-related brain structures: Findings from the Adolescent Brain Cognitive Development (ABCD) study.

Preterm-born (PTB) children are at an elevated risk for neurocognitive difficulties in general and language difficulties more specifically. Environmental factors such as socio-economic status (SES) play a key role for Term children's language development. SES has been shown to predict PTB children's behavioral developmental trajectories, sometimes surpassing its role for Term children. However, the role of SES in the neurocognitive basis of PTB children's language development remains uncharted. Here, we aimed to evaluate the role of SES in the neural basis of PTB children's language performance. Leveraging the Adolescent Brain Cognitive Development (ABCD) Study, the largest longitudinal study of adolescent brain development and behavior to date, we showed that prematurity status (PTB versus Term) and multiple aspects of SES additively predict variability in cortical thickness, which is in turn related to children's receptive vocabulary performance. We did not find evidence to support the differential role of environmental factors for PTB versus Term children, underscoring that environmental factors are significant contributors to development of both Term and PTB children. Taken together, our results suggest that the environmental factors influencing language development might exhibit similarities across the full spectrum of gestational age.

Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia.

BACKGROUND: Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics. METHODS: The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index. RESULTS: The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820-15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (-0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education. CONCLUSION: These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China.

BACKGROUND: High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM. METHODS: Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels. RESULTS: We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts. CONCLUSIONS: Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

The trajectories of free sugar intake during childhood, their main sources and its association with socio-economic factors: generation XXI birth cohort.

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries (n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children's sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year2 until 13 years. At all ages, the main food source was sweets. Some item's consumption declined (sweets 25-21 % and yoghurts 22-7 %) as children grew older. Inversely, soft drink intake increased (9-18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal-SES was associated with lower children's FS intake: occupational status (ß = -3·5; 95 % CI: -4·97, -1·94), years of education (ß = -3·7; 95 % CI: -4·93, -2·40) and household income (ß = -4·9; 95 % CI: -6·50, -3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term ß = -1·04; CI 95 % (-1·50, -0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children's FS intake was always higher when their mothers had a lower SES.

A Comprehensive Insight into the Economic Profile of People Receiving Metabolic and Bariatric Surgery Use in France.

BACKGROUND: The use of metabolic and bariatric surgery (MBS) is not uniformly distributed within the population, even if it is governed by established guidelines. This disparity seems to be associated, among other factors, with the economic profile of people receiving this surgery. OBJECTIVES: We investigated the disparities in the use of MBS with respect to the socio-economic level in France based on socio-economic status (SES). MATERIALS AND METHODS: A descriptive observational study was conducted to compare the population of individuals with obesity who underwent MBS (MBS group) with individuals with obesity with no history of MBS (obese group). Data were extracted from the French National Hospital discharge database ("Programme De Médicalisation des Systèmes d'Information," PMSI). Socio-economic status (SES) was assessed through the French Deprivation Index (FDep). RESULTS: The use of MBS was significantly lower in patients having a higher SES compared to those having a lower one. There was no statistically significant difference in the use of MBS between individuals within the 4th and 5th SES quintiles compared to those in the 2nd and 3rd quintiles. No difference was found in the specific MBS procedures used depending on the SES. The obesity level was significantly lower in patients from the 1st and 3rd SES quintiles compared to the patients having a lower SES. CONCLUSION: Our study provides valuable insights into the complex interrelationships between the use of MBS, patients' SES, and obesity levels according to the FDep. These findings underscore the importance of developing targeted interventions to address disparities in the use of bariatric care.

The effect of socio-economic status on children's dental health.

The aim of the present study was to record the oral health status of children from different socioeconomic backgrounds and correlate these findings with parent-associated factors. It comprised a cross-sectional study of healthy children, aged 6-12 years, attending either the Reception and Solidarity Center of the Municipality of Athens or the Postgraduate Paediatric Dentistry Department (NKUA) for dental care. Data regarding the demographics of both parents-guardians, as well as the children, and oral hygiene and dietary habits were collected through a structured questionnaire. This was followed by a thorough clinical examination evaluating oral hygiene status, gingival inflammation and caries experience. Analysis was based on the socioeconomic status (SES) of the parents which was according to the family income. Families with a monthly income of <1400 euros were considered as being of a low SES and families with incomes of >1400 euros as medium. Data were presented in frequency tables and significance of calculated differences was tested using chi-square and Fisher's exact tests. Multivariate regression analysis was used to detect possible risk factors for development of poor dental health. The sample consisted of 216 children (146 from a low and 70 from a medium SES) with a mean chronological age of 9.19 years. Parents from low SES were younger, of lower education, had lived abroad most of their lives and were unemployed or worked in the private sector. Children from low SES backgrounds reported infrequent dental visits, consumed more meals and had more sugary snacks. This was reflected in their worse dental health with significantly higher values for oral hygiene and caries indices. Despite the above differences, none of the parent-associated factors were significantly correlated to worse dental health. In conclusion, SES of parents is reflected in the oral health of children, although it is not a significant predictor of dental health.

Socio-economic status and head and neck cancer incidence in the Nordic countries.

BACKGROUND: The impact of societal factors on the occurrence of head and neck cancers (HNCs) remains understudied, especially in the Nordic countries. METHODS: To quantify the association between socio-economic status (SES) and the occurrence of HNCs, this cohort study uses data from the Nordic Occupational Cancer project that combine occupational and cancer registry data from 1961 to 2005 of 14.9 million individuals aged between 30 and 64 years. Occupational categories were combined into seven socio-economic categories. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates. RESULTS: Altogether, 83 997 HNCs-72% in men and 28% in women-were recorded. Among men, a gradient of risk associated with SES was observed for cancers of the tongue, other oral cavity subsites, pharynx, oropharynx and larynx in groups with lower SES. Managers showed decreased SIRs of 0.50 to -0.90 also for cancers of the lip, tongue, other oral cavity subsites, oropharynx, nasopharynx, nose and larynx. In contrast, excess risks of tongue, other oral cavity subsites, pharyngeal, oropharyngeal and laryngeal cancers were observed among clerical (SIRs 1.05-1.16), skilled workers (1.04-1.14), unskilled workers (1.16-1.26) and economically inactive men (1.38-1.87). Among women, no risk gradient similar to that in men was revealed. CONCLUSIONS: The current study underscores the influence of SES on the incidence of HNCs and highlights the need for targeted interventions, including tobacco and alcohol control policies, and improved access to healthcare services, particularly for socio-economically disadvantaged populations.

Effect of COVID-19 lockdowns on quality-of-life and health services access by socio-economic status in Australia.

This study examined changes in physical and mental health quality-of-life and health services access before and after the onset of the COVID-19 pandemic among individuals of lower and higher socio-economic status (SES) in Australia. Difference-in-differences and logistic regression models were undertaken using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and government data on COVID-19 lockdowns between January 2020 and February 2021. Individuals from higher SES reported larger decreases in mental health quality-of-life scores than those from lower SES after the onset of the pandemic. Those from lower SES reported less disruption with any health services (24.2% vs 30.4%; OR = 0.68; p < 0.001), specifically dental services (8.2% vs 15.4%; OR = 0.51; p < 0.001) and allied health services (5.9% vs 8.5%; OR = 0.60; p < 0.001), compared with those from higher SES. Additional days under lockdown were associated with reduced access to all health services (OR = 1.19). Furthermore, long-term health conditions (higher SES: OR = 1.54) and scores indicative of poorer physical (lower SES: OR = 1.17; higher SES: OR = 1.07) and mental health (lower SES: OR = 1.16; higher SES: OR = 1.12) were associated with increased health services disruption. While individuals from higher SES were more likely than those from lower SES to experience greater relative declines in mental health and increased disruption with health services access, individuals with a greater apparent need for health services, regardless of SES, may have faced inequalities in accessing these services during the COVID-19 pandemic.

Cranial fluctuating asymmetry and its relationship with non-specific physiological stress indicators in a contemporary South African cadaveric skeletal sample.

OBJECTIVES: Biological anthropologists frequently explore skeletal asymmetry, together with population health and disease. Given the conflicting findings in existing literature, this study aimed to clarify whether an association exists in a South African sample. MATERIALS: Dry bone and cranial micro-focus X-ray Computed Tomography (micro-XCT) scans of 115 South African individuals were assessed. METHODS: Fluctuating asymmetry (FA) indices were calculated from interlandmark distances, and the frequency of four types of non-specific signs of physiological stress were documented to explore the relationship between FA and disease. RESULTS: Black South Africans did not exhibit a high FA index; however, they had the highest prevalence of non-specific signs of physiological stress. However, no significant correlations were detected between FA indices and pathological lesions. CONCLUSION: No correlation was observed between FA and populations from different socio-economic backgrounds. However, individuals of lower socio-economic status (SES) demonstrated a greater prevalence of non-specific signs of physiological stress. SIGNIFICANCE: This research suggests that skeletal indicators of stress may be a suitable biological marker for assessing differences in SES among population groups, while indicating that levels of cranial FA is an inadequate biological marker. LIMITATIONS: Possible limitations may include measurement error, and the lack of information on the life history and medical records of individuals in this sample. SUGGESTIONS FOR FURTHER RESEARCH: Future research should include a larger sample with more South African groups, and should evaluate the potential association among age, FA, and expression of skeletal markers of disease.

Lifestyle Clusters of Diet Quality, Sleep, and Screen Time and Associations with Weight Status in Children from Madrid City: ENPIMAD Study.

BACKGROUND: Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors. METHODS: A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status. RESULTS: Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity. CONCLUSION: These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

Parental health risk preferences, socio-economic status and offspring's alcohol behavior in South Africa.

Alcohol consumption represents a widespread behavior with detrimental effects on both individuals and society. Understanding the factors influencing offspring alcohol consumption is crucial for identifying potential risk factors and informing prevention and intervention strategies. Existing empirical literature underscores the intricate interplay of biological, environmental, and social factors in shaping offspring alcohol consumption. Building upon this foundation, this study investigates the determinants of health risk preferences, such as alcohol consumption, among South African offspring, utilizing a dataset comprising the 2008, 2010, 2012, and 2014 waves of the National Income Dynamic Study (NIDS). Logistic regressions are employed to model the determinants of offspring alcohol consumption, while ordered logits are utilized to assess the impact of parental drinking on offspring drinking frequency. The findings indicate that parental drinking significantly influences offspring alcohol intake. Specifically, daughters' alcohol consumption is influenced solely by maternal drinking, whereas sons are affected by both parents' alcohol consumption. Furthermore, while daughters from currently disadvantaged backgrounds may exhibit higher tendencies towards alcohol consumption, those with mothers from such backgrounds and fathers from more affluent backgrounds are less likely to engage in such behavior. Additionally, the results suggest that male offspring from higher-income brackets are less likely to consume alcohol, yet sons of wealthy fathers are more likely to adopt such lifestyles.