Search

BACKGROUND: Income inequality is theorized to impact health. However, evidence among adolescents is limited. This study examined the association between income inequality and health‐related school absenteeism (HRSA) in adolescents. METHODS: Participants were adolescents (n = 74,501) attending secondary schools (n = 136) that participated in the 2018‐2019 wave of the COMPASS study. Chronic (missing ≥3 days of school in the previous 4 weeks) and problematic (missing ≥11 days of school in the previous 4 weeks) HRSA was self‐reported. Income inequality was assessed via the Gini coefficient at the census division (CD) level. Multilevel modeling was used. RESULTS: Greater income inequality was associated with a higher likelihood of chronic and problematic HRSA (chronic: OR = 1.17, 95% CI: 1.06, 1.30; problematic: OR = 1.29, 95% CI 1.11 to 1.50). Increased predicted probabilities for Problematic HRSA were observed at greater degrees of income inequality among students who identified as either white, black, Latinx, or mixed, while protective associations were observed among students who identified as Asian or other. No associations were modified by gender. CONCLUSION: Income inequality demonstrated unfavorable associations with HRSA, which was modified by racial identity. [ABSTRACT FROM AUTHOR]

Our study examines the association between perceived discrimination due to race and unmet medical needs among a nationally representative sample of children in the United States. We used data from the 2016-2017 National Survey of Children's Health, a population-based cross-sectional survey of randomly selected parents or guardians in the United States. We compared results from the coarsened exact matching (CEM) method and survey-weighted logistic regression to assess the robustness of the results. Using self-reported measures from caregivers, we find that ∼2.7% of US children have experienced racial discrimination with prevalence varying significantly by race. While <1% of non-Hispanic whites have experienced some measure of racism, this increases to 8.8% among non-Hispanic blacks. Perceived discrimination was associated with significantly greater odds of unmet medical needs in the adjusted, survey-weighted multivariate-adjusted model (adjusted odds ratio [OR] = 2.4 and 95% confidence interval [CI] = 1.2, 4.9) as well as in the CEM-model estimate (OR = 2.8 and 95% CI = 1.8, 4.0). Children who have experienced perceived discrimination had higher odds of unmet medical needs. Awareness of discrimination among children may help inform future intervention development that addresses unmet medical needs during childhood. [ABSTRACT FROM AUTHOR]

Background Previous work has identified a relationship between income inequality and risk for obesity and heart attack. We investigated the relationship between state-level income inequality and physical activity among US adults. Methods We used Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional data from a population based and representative sample of n = 428 828 US adults. Multilevel models were used to determine the association between state-level income inequality and participation in physical activity and strengthening exercises in the previous month. Results In comparison to males, females were significantly more likely to report being physically inactive (OR = 1.07, 95% CI = 1.04, 1.11), and less likely to meet aerobic activity requirements (OR = 0.90, 95% CI = 0.88, 0.93), meet strengthening activities (OR = 0.71, 95% CI = 0.69, 0.74), and meet overall physical activity recommendations (OR = 0.91, 95% CI = 0.88, 0.94). Cross-level Gini × sex interactions indicated that income inequality was associated with increased odds for participating in no physical activity (OR = 1.08, 95% CI = 1.05, 1.12), decreased odds in participating in strengthening physical activity (OR = 0.92, 95% CI = 0.89, 0.96), aerobic activity (OR = 0.96, 95% CI = 0.93, 0.99), and in meeting overall physical activity recommendations (OR = 0.93, 95% CI = 0.91, 0.95) among women only. Conclusions Future studies are needed to identify mechanisms in which income inequality leads to physical activity behavior among US women. [ABSTRACT FROM AUTHOR]

Background Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses. Methods Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death. Results In this analysis of 32 830 participants and a total follow-up time of 498 845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants' underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals. Conclusions Political party affiliation and political ideology appear to be different predictors of mortality. [ABSTRACT FROM AUTHOR]

Background Sufficient sleep is needed for the healthy development of youth. However, only a small minority of adolescents obtain adequate amounts of sleep. Although individual-level correlates of sleep have been identified, studies investigating the influence of the environment on sleep are warranted. Methods By using cross-sectional data collected from 1878 urban adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey (BYS), we determined the association between neighborhood social fragmentation and sleep. Social fragmentation of each participant's residential neighborhood was composed using 2010 US Census data. Multilevel regression models were used to determine the association between social fragmentation and meeting the recommended hours of sleep (>8.5 h) and sleep duration while controlling for individual-level sex, race, age and nativity. Results Moderate (OR = 0.51, 95% CI = 0.27, 0.97) and high (OR = 0.33, 95% CI = 0.18, 0.61) social fragmentation within the residential neighborhood was associated with a decreased likelihood of obtaining adequate sleep. Those in moderate (β = −23.9, 95% CI = −43.1, −4.8) and high (β = −22.1, 95% CI = −43.3, −0.9) socially fragmented neighborhoods obtained fewer minutes of sleep per night. Conclusions Social fragmentation may be an important determinant of sleep among youth living in urban settings. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether the socioeconomic environment was associated with no participation in physical activity among adolescents in Boston, Massachusetts. Methods. We used cross-sectional data from 1878 urban adolescents living in 38 neighborhoods who participated in the 2008 Boston Youth Survey, a biennial survey of high school students (aged 14–19 years). We used multilevel multiple regression models to determine the association between neighborhood-level exposures of economic deprivation, social fragmentation, social cohesion, danger and disorder, and students’ reports of no participation in physical activity in the previous week. Results. High social fragmentation within the residential neighborhood was associated with an increased likelihood of being inactive (odds ratio = 1.53; 95% confidence interval = 1.14, 2.05). No other neighborhood exposures were associated with physical inactivity. Conclusions. Social fragmentation might be an important correlate of physical inactivity among youths living in urban settings. Interventions might be needed to assist youths living in unstable neighborhoods to be physically active. [ABSTRACT FROM AUTHOR]

Background Although cross-sectional and ecological studies have shown that higher area-level income inequality is related to increased risk for depression, few longitudinal studies have been conducted. This investigation examines the relationship between state-level income inequality and major depression among adults participating in a population-based, representative longitudinal study. Methods We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=34 653). Respondents completed structured diagnostic interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modelling was used to determine if US state-level income inequality (measured by the Gini coefficient) was a significant predictor of depression at baseline and at follow-up, while controlling for individual-level and state-level covariates. We also repeated the longitudinal analyses, excluding those who had a history of depression or at baseline, in order to test whether income inequality was related to incident depression. Results State-level inequality was associated with increased incidence of depression among women but not men. In comparison to women residing in states belonging to the lowest quintile of income inequality, women were at increased risk for depression in the second (OR=1.18, 95% CI 0.86 to 1.62), third (OR=1.22, 95% CI 0.91 to 1.62), fourth (OR=1.37, 95% CI 1.03 to 1.82) and fifth (OR=1.50, 95% CI 1.14 to 1.96) quintiles at follow-up (p<0.05 for the linear trend). Conclusions Living in a state with higher income inequality increases the risk for the development of depression among women. [ABSTRACT FROM AUTHOR]

Objectives. We determined whether community-level income inequality was associated with mortality among a cohort of older adults in São Paulo, Brazil. Methods. We analyzed the Health, Well-Being, and Aging (SABE) survey, a sample of community-dwelling older adults in São Paulo (2000-2007).We used survival analysis to examine the relationship between income inequality and risk for mortality among older individuals living in 49 districts of São Paulo. Results. Compared with individuals living in the most equal districts (lowest Gini quintile), rates of mortality were higher for those living in the second (adjusted hazard ratio [AHR] = 1.44, 95% confidence interval [CI] = 0.87, 2.41), third (AHR = 1.96, 95% CI = 1.20, 3.20), fourth (AHR = 1.34, 95% CI = 0.81, 2.20), and fifth quintile (AHR = 1.74, 95% CI = 1.10, 2.74). When we imputed missing data and used post-stratification weights, the adjusted hazard ratios for quintiles 2 through 5 were 1.72 (95% CI = 1.13, 2.63), 1.41 (95% CI = 0.99, 2.05), 1.13 (95% = 0.75, 1.70) and 1.30 (95% CI = 0.90, 1.89), respectively. Conclusions. We did not find a dose-response relationship between area-level income inequality and mortality. Our findings could be consistent with either a threshold association of income inequality and mortality or little overall association. [ABSTRACT FROM AUTHOR]

Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services). We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion , and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death. Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HR adj. = 1.28; 95 CI = 1.05, 1.55), suicide (HR adj. = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HR adj. = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HR adj. = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes. Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada. • Our study explored income inequality and deaths of despair among Canadians. • Greater income inequality predicted an increased hazard of deaths of despair. • Stress, social cohesion, and service access influenced mortality outcomes. [ABSTRACT FROM AUTHOR]

• Investigated income inequality and daily substance use among adolescents. • Increased Gini coefficient was associated with daily cannabis use. • We found no significant relationship between income inequality and daily smoking. • Increased Gini coefficient was associated with daily e-cigarette use only in girls. Cannabis, cigarette, and e-cigarette use among Canadian adolescents is a major public health concern. Income inequality has been associated with adverse mental health among youth and may contribute to the risk of frequent cannabis, cigarette, and e-cigarette use. We tested the association between income inequality and the risk of daily cannabis, cigarette, and e-cigarette use among Canadian secondary school students. We used individual-level survey data from Year 6 (2018/19) of Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary Behavior (COMPASS) and area-level data from the 2016 Canadian Census. Three-level logistic models were used to assess the relationship between income inequality and adolescent daily and current cannabis use, cigarette smoking, and e-cigarette use. The analytic sample included 74,501 students aged 12–19. Students were most likely to report being male (50.4%), white (69.1%), and having weekly spending money over $100 (23.5%). We found that a standard deviation unit increase in Gini coefficient was significantly associated with increased likelihood of daily cannabis use (OR=1.25, 95% CI = 1.01–1.54) when adjusting for relevant covariates. We found no significant relationship between income inequality and daily smoking. While Gini was not significantly associated with daily e-cigarette use, we observed a significant interaction between Gini and gender (OR=0.87, 95% CI= 0.80–0.94), indicating that increased income inequality was associated with higher risk of reporting daily e-cigarette use among females only. An association between income inequality and the likelihood of reporting daily cannabis use across all students and daily e-cigarette use in females were observed. Schools in higher income inequality areas may benefit from targeted prevention and harm reduction programs. Results emphasize the need for upstream discussion on policies that can mitigate the potential effects income inequality. [ABSTRACT FROM AUTHOR]