Family social environment in childhood and self-rated health in young adulthood.

BACKGROUND: Family social support, as a form of social capital, contributes to social health disparities at different age of life. In a life-course epidemiological perspective, the aims of our study were to examine the association between self-reported family social environment during childhood and self-reported health in young adulthood and to assess the role of family functioning during childhood as a potential mediating factor in explaining the association between family breakup in childhood and self-reported health in young adulthood. METHODS: We analyzed data from the first wave of the Health, Inequalities and Social Ruptures Survey (SIRS), a longitudinal health and socio-epidemiological survey of a random sample of 3000 households initiated in the Paris metropolitan area in 2005. Sample-weighted logistic regression analyses were performed to determine the association between the quality of family social environment in childhood and self-rated health (overall health, physical health and psychological well-being) in young adults (n = 1006). We used structural equation model to explore the mediating role of the quality of family functioning in childhood in the association between family breakup in childhood and self-rated health in young adulthood. RESULTS: The multivariate results support an association between a negative family social environment in childhood and poor self-perceived health in adulthood. The association found between parental separation or divorce in childhood and poor self-perceived health in adulthood was mediated by parent-child relationships and by having witnessed interparental violence during childhood. CONCLUSION: These results argue for interventions that enhance family cohesion, particularly after family disruptions during childhood, to promote health in young adulthood.

Exploring mediating factors in the association between parental psychological distress and psychosocial maladjustment in adolescence.

Parental psychopathology is associated with increased psychosocial maladjustment in adolescents. We examined, from a psychosocial perspective, the association between parental psychological distress and psychosocial maladjustment in adolescents and assessed the mediating role of psychosocial covariates. This is a cross-sectional survey and the setting include representative sample of Quebec adolescents in 1999. The participants of the study include 13- and 16-year-old children (N = 2,346) in the Social and Health Survey of Quebec Children and Adolescents. The main outcome measures are internalizing disorders, externalizing disorders, substance use, and alcohol consumption. For statistical analysis, we used structural equation modeling to test for mediation. Internalizing and externalizing disorders were significantly associated with parental psychological distress, but not substance use or alcohol consumption. The higher the parental distress, the higher the risk of adolescent mental health disorders. The association between parental psychological distress and internalizing disorders was mediated by adolescent self-esteem, parental emotional support and extrafamilial social support. As for externalizing disorders, these variables only had an independent effect. In conclusion, A family's well being is a necessary condition for psychosocial adjustment in adolescence. Beyond the psychiatric approach, psychosocial considerations need to be taken into consideration to prevent negative mental health outcomes in children living in homes with distressed parents.

[Not Available]. / Recherche d'information en santé sur l'internet : une analyse contextuelle des données SIRS, une cohorte parisienne.

From a public healthcare point of view, the Internet rapidly emerged as a potentially useful tool for providing information to patients and for promoting healthcare. While the individual factors involved in the use of online healthcare information are now well known, the effect of the area of residence has been largely ignored. The object of this study is to assess the impact of contextual characteristics associated with the neighbourhood and area of residence on the use of internet for accessing healthcare information. Analyses of multilevel logistical regression were carried out on data drawn from the SIRS cohort, a representative sample of the population in the Paris metropolitan area in 2005. Variations between neighbourhoods were observed both in the general use of internet and, more specifically, in the search for information concerning healthcare. This variability tends to decrease when individual factors are taken into account, which points to an "effect of composition", and disappears altogether when the characteristics of the area of residence are added, indicating a "contextual effect". Individual inequalities of access to internet are even greater in the most underprivileged areas. By contrast, while individual obstacles are also reflected here, the probability of using the internet for issues of healthcare is higher in neighbourhoods that include a large proportion of unqualified people. From the point of view of reducing social inequalities in the realm of healthcare, an active promotion of internet access and training of both individuals and doctors are required both at an individual and at a social level in order that the internet may constitute a medium for publicizing prevention and the promotion of useful and widely used healthcare.

The role of daily mobility in mental health inequalities: the interactive influence of activity space and neighbourhood of residence on depression.

The literature reports an association between neighbourhood deprivation and individual depression after adjustment for individual factors. The present paper investigates whether vulnerability to neighbourhood features is influenced by individual "activity space" (i.e., the space within which people move about or travel in the course of their daily activities). It can be assumed that a deprived residential environment can exert a stronger influence on the mental health of people whose activity space is limited to their neighbourhood of residence, since their exposure to their neighbourhood would be greater. Moreover, we studied the relationship between activity space size and depression. A limited activity space could indeed reflect spatial and social confinement and thus be associated with a higher risk of being depressed, or, conversely, it could be linked to a deep attachment to the neighbourhood of residence and thus be associated with a lower risk of being depressed. Multilevel logistic regression analyses of a representative sample consisting of 3011 inhabitants surveyed in 2005 in the Paris, France metropolitan area and nested within 50 census blocks showed, after adjusting for individual-level variables, that people living in deprived neighbourhoods were significantly more depressed that those living in more advantaged neighbourhoods. We also observed a statistically significant cross-level interaction between activity space and neighbourhood deprivation, as they relate to depression. Living in a deprived neighbourhood had a stronger and statistically significant effect on depression in people whose activity space was limited to their neighbourhood than in those whose daily travels extended beyond it. In addition, a limited activity space appeared to be a protective factor with regard to depression for people living in advantaged neighbourhoods and a risk factor for those living in deprived neighbourhoods. It could therefore be useful to take activity space into consideration more often when studying the social and spatial determinants of depression.

Food insecurity: could school food supplementation help break cycles of intergenerational transmission of social inequalities?

OBJECTIVE: The aim of our study was to investigate the moderating effect of school food programs in schools in disadvantaged neighborhoods on the association between household food insecurity and scholastic difficulties among adolescents. METHODS: We analyzed data from the Social and Health Survey of Children and Adolescents in Quebec, Canada, which was conducted in 1999 and included 2346 adolescent students 13 and 16 years of age (and 1983 of their parents). Sample-weighted regression analyses were performed to determine the association between household food insecurity and school difficulties and to explore the moderating role of food supplementation programs with respect to this association. RESULTS: Household food insecurity, which was linked to the indicators of family socioeconomic status, was strongly associated with the indicators of scholastic difficulties. This association disappeared for adolescents who benefited from food supplementation programs in schools in disadvantaged neighborhoods. The risk of school activity limitation decreased from OR = 2.76 (95% confidence interval [CI]: 1.41-5.41) to OR = 1.57 (95% CI: 1.35-3.40), the risk of below-average grades in the language of instruction decreased from OR = 2.19 (95% CI: 1.28-3.74) to OR = 0.59 (95% CI: 0.21-1.63), the risk of repeating a year decreased from OR = 2.14 (95% CI: 1.35-3.40) to OR = 0.87 (95% CI: 0.42-1.81), and the risk of self-rated poor academic performance decreased from OR = 1.74 (95% CI: 1.08-2.81) to OR = 0.81(95% CI: 0.37-1.78). CONCLUSION: School food supplementation is a moderating factor in the association between household food insecurity and scholastic difficulties for adolescents.

Family breakup and adolescents' psychosocial maladjustment: public health implications of family disruptions.

OBJECTIVES: Recent changes in family structure are associated with an increase in psychosocial maladjustment in adolescents. We examined, from a public health intervention perspective, the association between family breakup and psychosocial maladjustment in adolescents and assessed the mediating role of family-functioning variables. METHODS: We analyzed data from the Social and Health Survey of Children and Adolescents in Quebec, Montreal, Canada, which was conducted in 1999. Sample-weighted logistic regression analyses were performed to determine the risk of internalizing disorders, externalizing disorders, substance abuse, and alcohol consumption in relation to family breakups and family-functioning variables, after adjusting for socioeconomic factors. RESULTS: All 4 of the indicators of psychosocial maladjustment were significantly associated with family breakup. The association between family breakups and internalizing disorders was mediated by parental psychological distress and low paternal emotional support. Independently, the witnessing of interparental violence was also strongly associated with internalizing disorders. For the other 3 outcomes, that is, externalizing disorders, substance abuse, and alcohol consumption, family breakup and family-functioning variables had independent effects. CONCLUSIONS: Family-based interventions and social approaches are complementary support modalities for adolescents experiencing family disruptions.