Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin).

BACKGROUND: Socioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in inequalities is sparse. METHODS: We studied trends in educational inequalities in smoking-attributable mortality (SAM) and assessed their impact on general mortality inequality trends in England and Wales (E&W), Finland, and Italy (Turin) from 1972 to 2017. We used yearly individually linked all-cause and lung cancer mortality data by educational level and sex for individuals aged 30 and older. SAM was indirectly estimated using the Preston-Glei-Wilmoth method. We calculated the slope index of inequality (SII) and performed segmented regression on SIIs for all-cause, smoking and non-SAM to identify phases in inequality trends. The impact of SAM on all-cause mortality inequality trends was estimated by comparing changes in SII for all-cause with non-SAM. RESULTS: Inequalities in SAM generally declined among males and increased among females, except in Italy. Among males in E&W and Finland, SAM contributed 93% and 76% to declining absolute all-cause mortality inequalities, but this contribution varied over time. Among males in Italy, SAM drove the 1976-1992 increase in all-cause mortality inequalities. Among females in Finland, increasing inequalities in SAM hampered larger declines in mortality inequalities. CONCLUSION: Our findings demonstrate that differing education-specific SAM trends by country and sex result in different inequality trends, and consequent contributions of SAM on educational mortality inequalities. The following decades of the smoking epidemic could increase educational mortality inequalities among Finnish and Italian women.

The False Recognition Test, a new tool for the assessment of false memories, with normative data from an Italian sample.

INTRODUCTION: False memory can be defined as remembering something that did not happen. To a certain extent it is a normal phenomenon, but its occurrence seems to increase in healthy and pathological aging, possibly providing relevant clues on some clinical conditions in the spectrum of dementia. We adapted a well-established Deed-Roediger-McDermott paradigm, frequently used in experimental contexts, to devise a new neuropsychological assessment tool, the False Recognition Test (FRT), that can investigate classical facets of episodic memory performance (i.e. free recall and recognition), and assess proneness to produce semantically related and non-semantic false memories. Here we describe the FRT and provide normative data and correction grids to consider the possible effects of age, gender, and education on the FRT scores. METHOD: Two-hundred and thirty-two Italian healthy individuals (99 male) aged 18-91 years, with different educational levels (from primary to university) underwent the FRT, together with validated tests for cognitive screening and episodic memory assessment and one scale for depression. RESULTS: Multiple linear regression analysis revealed that age and education significantly influenced performance on FRT. From the derived linear equations, we provide correction grids for the raw scores of the FRT, and equivalent scores estimated using a nonparametric method. Correlational analysis showed significant associations between FRT subscores and cognitive, executive and memory functions, and depression. CONCLUSION: The FRT may constitute a useful instrument for both clinical and research purposes.

The impact of educational attainment on mental health: A Causal Assessment from the UKB and FinnGen Cohorts.

Observational studies report inverse associations between educational attainment and depression/anxiety risks, but confounding hinders causal inference. This study aimed to assess potential causal relationships using Mendelian randomization (MR). Two-sample MR analysis was conducted using genetic instruments for education, smoking, body mass index, and physical activity from published genome-wide association studies. Depression and anxiety data came from the UK Biobank ([UKB] 117,782 individuals) and FinnGen (215,644 individuals) cohorts. Inverse variance weighted regression determined associations between exposures and mental health outcomes. Increased educational attainment was causally associated with reduced risks of depression (odds ratio [OR] = 0.99 per year, 95% confidence interval [CI]: 0.990-0.996, P < .001) and anxiety (OR = 0.99, CI: 0.98-0.991, P < .001) in both cohorts. Smoking initiation conferred higher risks of depression (UKB OR = 1.05, CI: 1.03-1.06, P < .001; FinnGen OR = 1.20, CI: 1.10-1.32, P < .001) and anxiety (FinnGen only, OR = 1.10, CI: 1.01-1.21, P < .05). Likewise, maternal smoking history associated with greater depression (UKB OR = 1.15, CI: 1.10-1.35, P = .027) and anxiety susceptibility (FinnGen OR = 3.02, CI: 1.67-5.46, P = .011). Higher body mass index elevated depression risk in both cohorts. Physical activity showed no clear associations. This MR study provides evidence that education may causally reduce mental health disorder risk. Smoking, obesity, and low activity appear detrimentally linked to depression and anxiety. Improving access to education could offer effective strategies for lowering population psychiatric burden.

Educational inequalities in multimorbidity at older ages: a multi-generational population-based study.

BACKGROUND: Social inequalities in multimorbidity may occur due to familial and/or individual factors and may differ between men and women. Using population-based multi-generational data, this study aimed to (1) assess the roles of parental and individual education in the risk of multimorbidity and (2) examine the potential effect modification by sex. METHODS: Data were analysed from 62 060 adults aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe, comprising 14 European countries. Intergenerational educational trajectories (exposure) were High-High (reference), Low-High, High-Low and Low-Low, corresponding to parental-individual educational attainments. Multimorbidity (outcome) was ascertained between 2013 and 2020 as self-reported occurrence of ≥2 diagnosed chronic conditions. Inequalities were quantified as multimorbidity-free years lost (MFYL) between the ages of 50 and 90 and estimated via differences in the area under the standardized cumulative risk curves. Effect modification by sex was assessed via stratification. RESULTS: Low individual education was associated with higher multimorbidity risk regardless of parental education. Compared to the High-High trajectory, Low-High was associated with -0.2 MFYL (95% confidence intervals: -0.5 to 0.1), High-Low with 3.0 (2.4-3.5), and Low-Low with 2.6 (2.3-2.9) MFYL. This pattern was observed for both sexes, with a greater magnitude for women. This effect modification was not observed when only diseases diagnosed independently of healthcare-seeking behaviours were examined. CONCLUSIONS: Individual education was the main contributor to intergenerational inequalities in multimorbidity risk among older European adults. These findings support the importance of achieving a high education to mitigate multimorbidity risk.

[Homicides in southern South American cities: educational inequalities and economic fluctuations]. / Homicidios en ciudades del sur de Sudamérica: desigualdades educativas y fluctuaciones económicas.

Information on how economic fluctuations affect educational inequalities in homicides in Latin America is scarce. This study aimed to: (a) analyze the temporal variations of educational inequalities related to homicide mortality and (b) compare these inequalities between years of economic growth and recession in southern South America cities from 2000 to 2019. Data from seven urban areas in three countries in the Southern Cone of South America were used: Mendoza and Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro, and São Paulo (Brazil); and Santiago (Chile). Poisson models were estimated by using age, sex, city of residence, year of economic growth or recession, and schooling level as explanatory variables. Results showed significant differences in the temporal evolution of homicide rates in the seven cities, although populations with a low schooling level always showed the most vulnerability. The four Brazilian cities, analyzed together, showed greater educational inequalities related to homicides in years of economic recession when compared to those of economic growth. On the one hand, the indiscriminate use of force by the State against criminal groups seems to increase social inequality in homicide mortality. On the other hand, criminal fragmentation and economic crisis can exacerbate these inequalities by increasing territorial disputes between criminal groups.

Se sabe poco sobre cómo las fluctuaciones económicas afectan las desigualdades educativas en homicidios en países latinoamericanos. Los objetivos de este estudio fueron (a) analizar las variaciones temporales de las desigualdades relativas educacionales de la mortalidad por homicidio, y (b) comparar estas desigualdades entre años de crecimiento económico y años de recesión en ciudades del sur sudamericano durante el período 2000-2019. Se utilizaron datos de siete áreas urbanas, en tres países del Cono Sur Sudamericano: Mendoza y Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro y São Paulo (Brasil); y Santiago (Chile). Se estimaron modelos de Poisson, utilizando como variables explicativas la edad, sexo, año, ciudad de residencia, año de expansión o recesión económica y nivel educativo. Encontramos diferencias marcadas en la evolución temporal de las tasas de homicidio entre las siete ciudades, aunque siempre las poblaciones de nivel educativo bajo fueron las más vulnerables. Las cuatro ciudades de Brasil, analizadas en conjunto, tuvieron desigualdades educativas relativas de homicidios mayores en años de recesión económica, con respecto a años de crecimiento económico. Por un lado, el uso de la fuerza indiscriminado por parte del Estado enfocado hacia grupos criminales parece haber llevado a una creciente desigualdad social de la mortalidad por homicidio. Por el otro, en un contexto de fragmentación criminal y crisis económica se podrían agravar estas desigualdades a través de mayores disputas territoriales entre grupos criminales.

São escassas as informações sobre como as flutuações econômicas afetam as desigualdades educacionais em homicídios na América Latina. Os objetivos deste estudo foram: (a) analisar as variações temporais das desigualdades educacionais relacionadas à mortalidade por homicídio, e (b) comparar essas desigualdades entre os anos de crescimento econômico e os anos de recessão nas cidades do sul da América do Sul no período de 2000 a 2019. Foram utilizados dados de sete áreas urbanas, em três países do Cone Sul da América do Sul: Mendoza e Rosário (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro e São Paulo (Brasil); e Santiago (Chile). Os modelos de Poisson foram estimados utilizando como variáveis explicativas a idade, sexo, ano, cidade de residência, ano de expansão ou recessão econômica e nível de escolaridade. Os resultados mostraram diferenças significativas na evolução temporal das taxas de homicídio entre as sete cidades, apesar de que as populações com baixo nível de escolaridade sempre foram as mais vulneráveis. As quatro cidades brasileiras, analisadas em conjunto, apresentaram maiores desigualdades educacionais relacionadas a homicídios em anos de recessão econômica em relação aos anos de crescimento econômico. Por um lado, o uso indiscriminado da força pelo Estado contra grupos criminosos parece ter levado ao aumento da desigualdade social na mortalidade por homicídio. Por outro lado, em um contexto de fragmentação criminal e crise econômica, essas desigualdades podem ser exacerbadas pelo aumento das disputas territoriais entre grupos criminosos.

Does School Health Promotion Have Additional Value for Educational Performance? A Repeated Cross-Sectional Multilevel Study.

Little information is available regarding the influence of the interplay between the school context and school health promotion on educational performance. Therefore, we examined whether the variation between primary and secondary schools regarding the educational performance of students could be explained by general school characteristics, school population characteristics, and school health promotion and to what extent these factors interact. We performed multilevel analyses using existing data on 7021 primary schools and 1315 secondary schools in the Netherlands from the school years 2010-2011 till 2018-2019. Our outcomes were the final test score from primary education and the average grade of standardized final exams from secondary education. School health promotion was operationalized as having obtained Healthy School (HS) certification. For the test score, 7.17% of the total variation was accounted for by differences at the school level and 4.02% for the average grade. For both outcomes, the percentage of disadvantaged students in a school explained most variation. HS certification did not explain variation, but moderated some associations. We found small to moderate differences between schools regarding educational performance. Compositional differences of school populations, especially socioeconomic status, seemed more important in explaining variation in educational performance than general school characteristics and HS certification. Some associations were moderated by HS certification, but differences remained small in most cases.

Iron deficiency anemia as a risk factor for pulp disease in children from the central Peruvian jungle: a case‒control study.

AIM: To investigate iron-deficiency anemia as a risk factor for dental pulp disease in children from the central Peruvian jungle. METHODOLOGY: A case-control study was carried out with 270 children, of which 90 referred to cases and 180, to controls. Patients with pulp disease were diagnosed according to the criteria of the Association of Endodontists and the American Board of Endodontics. A specific questionnaire was used to assess ferrous sulfate consumption, maternal education level, maternal age, occupation, and household income. Data were analyzed using Pearson's correlation coefficient and a binary logistic regression. RESULTS: Iron deficiency anemia offers a risk factor for pulp disease in children (OR 7.44, IC 95% 4.0-13.8). According to multivariate analysis using binary logistic regression, ferrous sulfate consumption (OR 13.8, IC 95% 5.6.33.9), maternal education level (OR 2.4, IC 95% 1.1-5.3), maternal age (OR 7.5, IC 95% 2.9-19.4), household income (OR 4.0, IC 95% 1.6-9.6), and caries (OR 10.7, IC 95% 4.5-25.7) configured independent factors that were statistically associated with pulp disease. CONCLUSION: Iron deficiency anemia, ferrous sulfate consumption, maternal education level, maternal age, household income, and dental caries were positively associated with pulp disease in children.

Pathways between a polygenic index for education and years of completed schooling: the presentation of self and assessment of others.

Polygenic scores (PGS) are broadly misconstrued as reflecting direct causal genetic effects on their respective phenotypes. While this assumption might be accurate for some anthropometric traits like height, more complex traits such as educational attainment show very large indirect effects that stem from many sources. One unexplored source of confounding is the possibility of evocative gene-environment correlation (rGE). Using data from the National Longitudinal Study of Adolescent to Adult Health, we examine the relationship between interviewer assessments of respondent appearance as a function of education PGS. We show a bivariate association between educational PGS and 1) perceived grooming, 2) physical attractiveness, and 3) personality. We then regress years of education on the educational PGS and show that very little of the association (~1-2%) is mediated by attractiveness or personality but 7.5% of the baseline association is confounded with how others may perceive grooming. These results highlight the importance of social-behavioral mechanisms that may link specific genotypes to successful transitions through high school and college and continue to bridge research from the social and biological sciences.

Social inequity in health among patients with severe obesity and multimorbidity.

INTRODUCTION: Obesity adversely affects the health of the individual and impacts society through increased healthcare costs and lost workdays. Individuals in lower socioeconomic groups are more severely affected. Here, we examined people living with severe obesity and comorbidities across educational levels. METHODS: Individuals with a BMI ≥ 35 kg/m2 and aged ≥ 16 years from the Danish National Health Survey 2021 were categorised into five educational levels and according to their number of obesity-related comorbidities (0, 1, 2 and ≥ 3). RESULTS: A total of 5.8% had a BMI ≥ 35 kg/m2, ranging from 2.2% to 10.7% in the 98 municipalities, and from 2.6% to 8.8% according to education level. Among individuals with a BMI ≥ 35 kg/m2 and the shortest education, 13.4% had no comorbidities, and 45.6% had ≥ 3 comorbidities. In contrast, among individuals with a BMI ≥ 35 kg/m2 and the longest education, 47.4% had no comorbidities, and 14.6% had ≥ 3 comorbidities. Among those with a BMI ≥ 35 kg/m2 and ≥ 3 comorbidities, 73.6% had elementary or vocational school as their highest education level, and 3.4% had a long higher education. CONCLUSIONS: The prevalence of individuals living with a BMI ≥ 35 kg/m2 differs by 3-5-fold depending on municipality and between the lowest and highest educational level. Additionally, the less educated group living with a BMI ≥ 35 kg/m2 was three times more likely to have ≥ 3 comorbidities than the most educated group. Hence, more research is warranted to understand the underlying causes and reduce social inequity in health. FUNDING: Novo Nordisk Fonden. TRIAL REGISTRATION: Not relevant.

Wealth and education-related inequalities in the utilisation of reproductive, maternal, newborn, and child health interventions within scheduled tribes in India: an analysis of Odisha and Jharkhand.

BACKGROUND: The utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than among the rest of the country's population. The tribal population's poorest and least-educated households are further denied access to RMNCH care due to the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand. METHODOLOGY: We have constructed two summary measures, namely, the Co-coverage indicator and a modified Composite Coverage Index (CC), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21) whereas in Jharkhand, the wealth- and education-related absolute and relative inequalities present a reduction between 2016 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation should be improved. INTERPRETATION: The study results underscore the urgent need of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce inequalities in access to healthcare.

Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study.

OBJECTIVES: To estimate the prevalence of good self-reported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18-49 years in Yangon Region, Myanmar. DESIGN: Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex. SETTING: Urban and rural areas of Yangon Region, Myanmar. PARTICIPANTS: The sample included 2,506 participants (91.8% response rate) aged 18-49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate. RESULTS: The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95% CI 69.3 to 74.5), younger individuals (69.2%, 95% CI 66.2 to 72.1), urban residents (63.6%, 95% CI 60.8 to 66.3), extended family dwellers (66.6%, 95% CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95% CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women. CONCLUSIONS: Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.

Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018.

BACKGROUND: Inequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. METHODS: This study employed the World Health Organisation's Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF). RESULTS: The study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20-49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018. CONCLUSION: The inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.

Education disrupts the intergenerational transmission of health disadvantage across three generations in China.

This article utilizes survey data from the China Family Panel Studies (CFPS) to examine whether grandparents' health disadvantage have both direct and indirect effects on the health disadvantage of their grandchildren, and whether the completion of compulsory education by parents disrupts these intergenerational transmissions in China. The findings suggest that grandparents' health disadvantage significantly increases the probability of grandchildren's health disadvantage with and without controlling parental health disadvantage and other characteristics. Moreover, the study identifies a disruptive influence of parental education on this transmission process. Rigorous robustness tests, including the use of the Compulsory Education Law as an instrumental variable to control for unobserved factors, validate these results. Mechanism analysis shows that parents completing compulsory education contribute to improving their nutritional balance and adopting healthy behaviors, attaining higher social status, earning higher income, which ultimately reduce the probability of health disadvantage for both themselves and their children. These findings highlight the persistent intergenerational transmission of health disparities within families and emphasize the importance of enhancing individuals' education levels to disrupt this transmission. By doing so, it may be possible to mitigate health inequalities and disparities across the population.

Trends in socioeconomic inequalities in self-rated health and mental distress during four decades in a Norwegian population: a HUNT Study.

BACKGROUND: Socioeconomic inequalities constitute an important focus area for public health, and it has long been established that higher educational level and longer lifespan are correlated. Little is known about decennial time trends in poor self-rated health and mental distress. METHODS: This study linked decennial cross-sectional survey data on self-rated health and mental distress from the Trøndelag Health Study (HUNT) from 1984 to 2019 with educational registry data using personal identification numbers. Survey participation ranged from 50 807 to 77 212. Slope index of inequality (SII) and relative index of inequality (RII) were calculated using generalized linear models in Stata. Analyses were stratified by sex and age, using the age categories of 30-59 years and 60-80 years. RESULTS: Absolute inequalities in self-rated health and mental distress between educational groups have stayed relatively stable throughout all rounds of HUNT. Relative inequalities in self-rated health and mental distress have generally increased, and both men and women with the lowest education level were more likely to experience poor self-rated health and mental distress relative to those with the highest education level. RII in self-rated health increased over time for both sexes and both age groups. RII for mental distress increased in both sexes and both age groups, except for men and women aged 60-80. DISCUSSION: This study shows that relative inequalities in self-rated and mental health in the Norwegian population are still persistent and have increased. Further knowledge about groups with a disadvantageous health situation should have implications for health care resource allocation.

Social Determinants of Health and Incident Apparent Treatment-Resistant Hypertension Among White and Black US Adults: The REGARDS Study.

BACKGROUND: We examined the association of multilevel social determinants of health with incident apparent treatment-resistant hypertension (aTRH). METHODS AND RESULTS: We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow-up visit. Over a median 9.5 years of follow-up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%). CONCLUSIONS: Part of the association between race and incident aTRH risk was mediated by social determinants of health.

Do you like school? Social class, gender, ethnicity and pupils' educational enjoyment.

This study investigates structural inequalities in educational enjoyment in a contemporary cohort of United Kingdom (UK) primary school children. Foundational studies in the sociology of education consistently indicate that the enjoyment of education is stratified by social class, gender, and ethnicity. Analysing data from the UK Millennium Cohort Study, which is a major cohort study that tracks children born at the start of the 21st century, we examine children's enjoyment of both school and individual academic subject areas. The overarching message is that at age 11 most children enjoy their education. The detailed empirical analyses indicate that educational enjoyment is stratified by gender, and there are small differences between ethnic groups. However, there is no convincing evidence of a social class gradient. These results challenge orthodox sociological views on the relationship between structural inequalities and educational enjoyment, and therefore question the existing theoretical understanding of the wider role of enjoyment in education.

Social Mobility Across the Pacific: An Analysis of Japanese Americans in the Continental United States.

The impact of immigrant parents' premigration family background on their second-generation children residing in destination countries remains underexplored in the literature on historical social mobility. Using multigenerational historical survey records from the Japanese American Research Project, this study investigates the influence of premigration socioeconomic and cultural background of Japan-born grandparents and parents on the social mobility of second-generation Japanese Americans born in the continental United States in the early twentieth century. The analysis reveals the enduring effects of family premigration socioeconomic status, as indicated by occupation and education, and culture conducive to upward mobility, proxied by samurai ancestry, on second-generation Japanese Americans' educational and income levels. These effects may extend back to their nonmigrant grandparents and possibly contrast with their European second-generation immigrant counterparts, who typically experienced upward mobility regardless of their family background. The results point to the critical role of origin-country socioeconomic status and culture in immigrant social mobility research, particularly for populations whose negative reception has hindered their resource access in their new countries.

Educational inequalities in cervical cancer screening participation in 24 European countries.

OBJECTIVES: Cervical cancer screening (CCS) is an important public health measure for early detection of cervical cancer and prevents a large proportion of cervical cancer deaths. However, participation in CCS is relatively low and varies substantially by country and socio-economic position. This study aimed to provide up-to-date participation rates and estimates on educational inequalities in CCS participation in 24 European countries with population-based CCS programmes. STUDY DESIGN: This was a cross-sectional study. METHODS: Using data from the European Health Interview Survey (EHIS) conducted in 2019, 80,479 women aged 25-64 years were included in the analyses. First, standardized participation rates and standardized participation rates by educational attainment were calculated for all 24 countries based on each country-specific screening programme organization. Second, a series of generalized logistic models was applied to assess the effect of education on CCS participation. RESULTS: Screening participation rates ranged from 34.1% among low-educated women in Romania to 97.1% among high-educated women in Finland. We observed that lower-educated women were less likely to attend CCS than their higher-educated counterparts. Largest educational gaps were found in Sweden (odds ratio [OR] = 6.36, 95% confidence interval [CI] = 3.89-10.35) and Poland (odds ratio = 5.80, 95% CI = 4.34-7.75). CONCLUSION: Population-based screening initiatives have successfully reduced participation differences between women with medium and high educational attainment in some countries; however, persistent disparities still exist between women with low and high levels of education. There is an urgent need to increase participation rates of CCS, especially among lower-educated women.

Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States.

OBJECTIVES: To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States (US). We also assess MMLE inequalities by sex and education. METHODS: Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of 2 or more chronic diseases. Disability is defined using limitations in activities of daily living. RESULTS: Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated. DISCUSSION: Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts.

Relationship between Maternal Socioeconomic Factors and Preterm Birth in Latvia.

Background and Objectives: Worldwide, preterm birth (PTB) stands as the primary cause of mortality among children under 5 years old. Socioeconomic factors significantly impact pregnancy outcomes, influencing both maternal well-being and newborn health. Understanding and addressing these socioeconomic factors is essential for developing effective public health interventions and policies aimed at improving pregnancy outcomes. This study aims to analyse the relationship between socioeconomic factors (education level, marital status, place of residence and nationality) and PTB in Latvia, considering mother's health habits, health status, and pregnancy process. Materials and Methods: A cross-sectional study was conducted using data from the Medical Birth Register (MBR) of Latvia about women with singleton pregnancies in 2022 (n = 15,431). Data analysis, involving crosstabs, chi-square tests, and multivariable binary logistic regression, was performed. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Results: Lower maternal education was statistically significantly associated with increased odds of PTB. Mothers with education levels below secondary education had over two times higher odds of PTB (aOR = 2.07, p < 0.001, CI 1.58-2.70) and those with secondary or vocational secondary education had one and a half times higher odds (aOR = 1.58, p < 0.001, CI 1.33-1.87) after adjusting for other risk factors. Study results also showed the cumulative effect of socioeconomic risk factors on PTB. Additionally, mothers facing two or three socioeconomic risk factors in Latvia exhibited one and a half times higher odds of PTB (aOR = 1.59, p = 0.021). Conclusions: The study highlights the cumulative impact of socioeconomic risk factors on PTB, with higher maternal education demonstrating the highest protective effect against it. This underscores the importance of education in promoting optimal foetal development. Since the influence of socioeconomic factors on PTB is not a widely studied issue in Latvia, further research is needed to improve understanding of this complex topic.