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Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality. [ABSTRACT FROM AUTHOR]

Background: Despite the large body of research on the adverse effects of income inequality, to date, few studies have examined its impact on sleep. The objective of this investigation is to examine the association between US state income inequality and the odds for regularly obtaining inadequate (< 7 h) and very inadequate (< 5 h) of sleep in the last 24 h.Methods: We analysed data from 350,929 adults participating in the US 2018 Behavioral Risk Factor Surveillance System (BRFSS). Multilevel modeling was used to determine the association between state-level income inequality, as measured by the Gini coefficient, and the odds for obtaining inadequate and very inadequate sleep. We also determined if associations were heterogeneous across gender.Results: A standard deviation increase in the Gini coefficient was associated with increased odds for inadequate (OR = 1.06, 95% CI: 1.00, 1.13) and very inadequate sleep (OR = 1.11, 95% CI: 1.03,1.20). Also, a cross-level Gini Coefficient X Gender interaction term was significant (OR = 1.07, 95% CI:1.01,1.13), indicating that increasing income inequality was more detrimental to women's sleep behavior.Conclusion: Future work should be conducted to determine whether decreasing the wide gap between incomes can alleviate the burden of income inequality on inadequate sleep in the United States. [ABSTRACT FROM AUTHOR]

Background: Since the 2010 election, the number of laws in the U.S. that create barriers to voting has increased dramatically. These laws may have spillover effects on population health by creating a disconnect between voter preferences and political representation, thereby limiting protective public health policies and funding. We examine whether voting restrictions are associated with county-level COVID-19 case and mortality rates. Methods: To obtain information on restricted access to voting, we used the Cost of Voting Index (COVI), a state-level measure of barriers to voting during a U.S. election from 1996 to 2016. COVID-19 case and mortality rates were obtained from the New York Times' GitHub database (a compilation from multiple academic sources). Multilevel modeling was used to determine whether restrictive voting laws were associated with county-level COVID-19 case and mortality rates after controlling for county-level characteristics from the County Health Rankings. We tested whether associations were heterogeneous across racial and socioeconomic groups. Results: A significant association was observed between increasing voting restrictions and COVID-19 case (ß = 580.5, 95% CI = 3.9, 1157.2) and mortality rates (ß = 16.5, 95% CI = 0.33,32.6) when confounders were included. Conclusions: Restrictive voting laws were associated with higher COVID-19 case and mortality rates. [ABSTRACT FROM AUTHOR]

Purpose: Vulnerability to post-traumatic disorder (PTSD) following a traumatic event can be influenced by individual-level as well as contextual factors. Characteristics of the social and economic environment might increase the odds for PTSD after traumatic events occur. One example that has been identified as a potential environmental determinant is income inequality. The purpose of this study is to investigate the association between State-level income inequality and PTSD among adults who have been exposed to trauma.Methods: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653). Structured diagnostic interviews were administered at baseline (2001-2002) and follow-up (2004-2005). Weighted multi-level logistic regression was used to determine if US State-level income inequality, as measured by the Gini coefficient, was associated with incident episodes of PTSD during the study's 3-year follow-up period adjusting for individual and state-level covariates.Results: The mean Gini coefficient across states in the NESARC was 0.44 (SD = 0.02) and ranged from 0.39 to 0.53. Of the respondents, 27,638 reported exposure to a traumatic event. Of this sample, 6.9 and 2.3% experienced persistent or recurrent and incident PTSD, respectively. State-level inequality was not associated with increased odds for persistent or recurrent PTSD (OR = 1.02; 95% CI 0.85, 1.22), but was associated with incident PTSD (OR = 1.30, 95% CI 1.04, 1.63).Conclusion: The degree of income inequality in one's state of residence is associated with vulnerability to PTSD among individuals exposed to traumatic events. Additional work is needed to determine if this association is causal (or alternatively, is explained by other socio-contextual factors associated with income inequality), and if so, what anxiogenic mechanisms explain it. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the relationship between sweetened beverage consumption and depressive symptoms among adolescents.DesignIn a cross-sectional study, adolescents were asked how often they drank soda and fruit drinks in the past 7 d. Depressive symptoms were measured using a brief adapted version of the Modified Depression Scale. Summation scores were standardized using the Z-transformation. We used multilevel multiple linear regression models to estimate the association between soda and fruit drink consumption and depressive symptoms.SettingThe 2008 Boston Youth Survey.SubjectsAdolescents (n 1878), high-school students in grades 9–12 of Boston public schools, Massachusetts, USA.ResultsCompared with those who never drank soda in the past 7 d, those who consumed soda 2–6 times/week (β=0·18; 95 % CI 0·04, 0·32) or ≥1 times/d (β=0·29; 95 % CI 0·13, 0·45) had higher depressive symptoms. Similarly, those who consumed fruit drinks 2–6 times/week (β=0·14; 95 % CI 0·00, 0·28) and those who consumed ≥1 times/d (β=0·22; 95 % CI 0·04, 0·40) had higher depressive symptoms.ConclusionsFrequent consumption of both soda and fruit drinks is associated with greater depressive symptoms among adolescents. [ABSTRACT FROM PUBLISHER]

We explored how investments in housing for vulnerable populations (including those experiencing homelessness) are described as leading to cost containment for the health, justice, and social service systems; the nature of any costs and benefits; and variations by housing type and over time. A structured search of peer-reviewed academic research focused on the core concepts of economic benefit, public housing programs, and vulnerable populations. Findings from 42 articles reporting on cost containment specific to health, justice, and social service systems at the municipal, regional, and/or state/provincial level were synthesized. Most of the studies focused on supportive housing interventions, targeted adults (mainly men) experiencing chronic homelessness in the USA, and reported results over 1–5 years. Approximately half of the articles reported on the costs required to house vulnerable populations. About half reported on funding sources, which is critical information for leadership decisions in cost containment for supportive housing. Most of the studies assessing program cost or cost-effectiveness reported a reduction in service costs and/or greater cost-effectiveness. Studies mostly reported impacts on health services, with hospital/inpatient care and emergency service use typically decreasing across the intervention types. All the studies that assessed cost impacts on the justice system reported a decrease in expenditures. Housing vulnerable populations was also found to decrease shelter service use and engagement with the foster care/welfare systems. Housing interventions may offer cost-savings in the short- and medium-term, with a limited evidence base also demonstrating long term benefit. [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]

Objective To examine associations between utilitarian walking, utilitarian cycling, leisure time physical activity and body mass index (BMI). Methods Participants from the National Population Health Survey (NPHS) of Statistics Canada were interviewed by telephone every two years from 1994 to 2010. Analysis includes data from 6894 living participants aged 18-64 years. Fixed effects and random intercepts models examined the association between BMI, utilitarian walking, and utilitarian cycling, controlling for behavioral and sociodemographic factors. Results The final adjusted fixed effects models showed no significant relationship between utilitarian walking and BMI. In the unbalanced sample utilitarian cycling for 1 to 5 h per week (b = - 0.15, 95% CI: - 0.28 to - 0.02), and more than 5 h per week (b = - 0.22, 95% CI: - 0.44 to 0.00) was significantly associated with BMI over time. In the fully balanced sample utilitarian cycling for 1 to 5 h per week (b = - 0.12, 95% CI: - 0.27 to 0.03), more than 5 h per week (b = - 0.16, 95% CI: - 0.45 to 0.13) was not significantly associated with BMI over time. Conclusion The results suggest that utilitarian walking is not related to BMI. The relationship between utilitarian cycling and BMI is less clear. [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]

Objectives: To examine the independent influence of school economic deprivation, social fragmentation, and social cohesion on the likelihood of participating in no physical activity among students. Methods: Data are from a large-scale longitudinal study of schools based in disadvantaged communities in Quebec, Canada. Questionnaires were administered every year between 2002 and 2008 among n = 14,924 students aged 12 to 18 from a sample of 70 schools. Cross-sectional and longitudinal analyses were conducted. Multilevel modeling was utilized to account for the clustering of students within schools. Schools were categorized as being low, moderate or high economic deprivation, social fragmentation and social cohesion. Those who indicated that they do no participate in any physical activity during the week were identified as being physically inactive. Results: In baseline multilevel cross-sectional analyses, adolescents attending schools in the highest (compared to the lowest) levels of socioeconomic deprivation and social fragmentation were more likely to be physically inactive (OR = 1.33, 95% CI = 1.03, 1.72; and OR = 1.24, 95% CI = 0.98, 1.56, respectively). Conversely, students attending schools with the highest cohesion were less likely to be physically inactive (OR = 0.78, 95% CI = 0.61, 0.99). In longitudinal analysis, physically active students who attended schools with the highest social fragmentation were more likely to become physically inactive over two years (OR = 1.65, 95% CI = 1.09, 2.51). Conclusion: The school socioeconomic environment appears to be an important contextual influence on participation in no physical activity among adolescents. Following adolescents beyond two years is necessary to determine if these environments have a lasting effect on physical activity behavior. [ABSTRACT FROM AUTHOR]

Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95 % confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95 % CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95 % CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95 % CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95 % CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95 % CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors. [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]

Abstract: Objectives: Non-fatal overdose remains a significant source of morbidity among people who inject drugs (IDU). Although depression and social support are important in shaping the health of IDU, little is known about the relationship between these factors and overdose. Therefore, we sought to determine whether depressive symptoms and social support predicted non-fatal overdose among IDU in a Canadian setting. Methods: Data were derived from three prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS), the ACCESS Cohort, and the At-Risk Youth Study (ARYS). Multilevel modeling was used to determine if depression and social support were significant predictors of non-fatal overdose across time. Analyses were stratified by sex. Results: There were 1931 participants included in this analysis, including 653 (33.8%) females and 69 (3.6%) youth 20 years old or younger. Depressed men (adjusted odds ratio [AOR]=1.53, 95% confidence intervals [CI]=1.25, 1.87) and women (adjusted odds ratio [AOR]=2.23, 95% confidence intervals [CI]=1.65, 3.00) were more likely to experience a non-fatal overdose. Further, among women, those who reported having 3 or more persons they could rely upon for social support were less likely to experience a non-fatal overdose (AOR=0.54, 95% CI 0.31, 0.93). Conclusion: Although depression was a significant predictor of non-fatal drug overdose, social support was a significant predictor among women only. Possible strategies to prevent non-fatal overdose may include identifying IDU experiencing severe depressive symptoms and providing targeted mental health treatments and mobilizing interpersonal social support among IDU, especially among women. [Copyright &y& Elsevier]

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]

Introduction: In addition to individual-level characteristics, the social and physical environment may influence the initiation of cigarette smoking in adolescents. The objective of this paper is to describe the association between smoking intolerance in schools, and in restaurants and corner stores located near schools, and initiation of cigarette smoking among adolescents. Methods: Data on cigarette smoking were collected in self-report questionnaires every 3 months from 1999 to 2005 in a sample of 1,293 Grade 7 students in 10 secondary schools in Montreal, Canada. Baseline never-smokers (n = 868) were retained for analysis. School administrators completed questionnaires on tobacco control policies and activities within schools. Data on access to tobacco products and smoking restrictions in restaurants and corner stores located in school neighborhoods were collected through direct observation. Schools, restaurants, and corner stores were classified as smoking tolerant or intolerant. Time to initiation of cigarette smoking was modeled as a function of smoking intolerance in schools, restaurants, and corner stores in survival analyses (Cox proportional hazards modeling). Results: Students in smoking-intolerant schools were less likely to initiate smoking than students in smoking-tolerant schools (hazard ratio [HR; 95% CI] = 0.83 [0.68, 1.01]). Students attending schools located in neighborhoods with smoking-intolerant restaurants were less likely to initiate smoking (HR [95% CI] = 0.85 [0.68, 1.07]). There was no association between corner store smoking intolerance and initiation. Conclusions: Smoking intolerance in schools and restaurants may protect against initiation of cigarette smoking and could be useful targets for more intense tobacco control efforts. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate if students who use of Active Transportation (AT) to and from school among urban and rural Canadian children are more likely to meet physical activity recommendations. Methods: The Raising healthy Eating and Active Living in Alberta (REAL Kids Alberta) study is a population-based health survey among Grade 5 students. In 2009, physical activity levels were measured using time-stamped pedometers (number of steps/hour) among 688 children. Parents reported mode of transportation to and from school (AT/non-AT). Multilevel multiple linear regression analyses with corresponding β coefficients were conducted to quantify the relationship between mode of transportation to and from school with (1) overall step count, and (2) the likelihood of achieving at least 13,500 steps per day recommended for optimal growth and development. Results: Among urban children, those who used AT to and from school accumulated more steps [β=1124(95% CI=170,2077)] and although not significant, were more likely to achieve the recommended 13,500 steps/day compared to those not using AT to and from school [OR=1.61(95% CI=0.93,2.81)]. Conclusion: Using AT to and from school appears to be beneficial to children by supplementing their physical activity, particularly those living in urban regions. Strategies to promote physical activity are needed, particular for children residing in rural regions and smaller towns. [Copyright &y& Elsevier]

ObjectiveTo identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.DesignChildren's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.SettingEdmonton region, Canada.SubjectsChildren aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.ResultsChildren from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.ConclusionsSocio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the combined influence of poverty and dangerousness of the neighborhood on active transportation (AT) to school among a cohort of children followed throughout the early school years. Methods: Growth curve modeling was used to identify determinants of AT to school among 710 children participating in the Quebec Longitudinal Study of Child Development from 2003 through 2006. Parent-reported dangerousness and pedestrian–vehicle collision data were merged with travel mode and health data. Results: At age 6 years, insufficient household income, having an older sibling, and living in a neighborhood that is not excellent for raising children, or characterized with high decay were predictive of greater likelihood of using AT and remained unchanged as children progressed from kindergarten through grade 2. Conclusion: A public health concern is children experiencing environmental injustice. Since AT is most likely to be adopted by those living in poverty and because it is also associated with unsafe environments, some children are experiencing environmental injustice in relation to AT. Interventions may be implemented to reduce environmental injustice through improvements in road safety. [Copyright &y& Elsevier]

Abstract: In light of geographical and epidemiological research suggesting that the socioeconomic environment beyond the family may influence children’s physical activity, this study investigated the extent to which neighbourhood socioeconomic conditions predict change in physical activity from ages 10 through 15 years, controlling for the attributes of the individual child and family. Data came from 889 children participating in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development cohort study. Accelerometers measured Moderate-to-Vigorous Physical Activity (MVPA) during the week and weekend, when the children were aged 10, 11, and 15 years. Selected US census block variables were used to create ‘independent’ area measures of economic deprivation and social fragmentation scores for child’s area of residence at age 10 years. Also, parents’ perception of neighbourhood social cohesion was measured in terms of relationships with neighbours. All analyses controlled for participant characteristics: gender, ethnicity, household income-to-needs ratio, maternal education, and for United States region of residence. Growth curve analyses indicated that whereas social fragmentation did not predict MVPA over time, greater area deprivation at age 10 years was associated with lower weekday MVPA for boys at 10 years (β=−0.5, p =0.03) and these differences persisted to age 11 and 15 years. This relationship was reversed for girls. Weekend MVPA was not significantly associated with the level of deprivation in the place of residence at age 10 years. Although the census measure of social fragmentation in the area of residence showed no significant association with MVPA, parent-reported neighbourhood social cohesion was positively associated with weekday (β=2.0, p <0.01) and weekend (β=3.1, p <0.01) MVPA minutes across time. This association was most pronounced for boys. Area level factors may be determinants of physical activity among children and youth in complex ways and parental perception of area social environment may be as important for children’s activity levels as ‘independently assessed’ socioeconomic conditions. [Copyright &y& Elsevier]

Abstract: Objective. : The purposes of this study were to describe the prevalence of modes of transportation to school and to identify socioeconomic correlates. Methods. : Proportions of students using different modes of transportation were estimated among a population-based sample of 3613 youth aged 9, 13, and 16 years who participated in the 1999 Quebec Child and Adolescent Health and Social Survey. Results. : Weighted analyses showed significant differences in the use of different modes of transportation to and from school across socioeconomic groups. For example, 40.3%, 15.2%, and 13.0% of 9, 13, and 16 year olds walked to school. In addition, 1.2%, 11.3%, and 13.8% of 9, 13, and 16 year olds used public transportation whereas 33.1%, 51.2%, and 55.6% of 9, 13, and 16 year olds took the school bus to school; 14.3%, 7.3%, and 5.0% of 9, 13, and 16 year olds were transported by car; finally, 10.7%, 14.1%, and 11.7% of 9, 13, and 16 year olds indicated they used multiple modes of transportation. Girls, higher income of children, children of immigrants, and rural-dwelling children were less likely to walk to school. Conclusion. : Findings indicate that there are differing modes of transportation to and from school across socioeconomic groups. [Copyright &y& Elsevier]

Background: United States state-level income inequality is positively associated with infant mortality in ecological studies. We exploit spatiotemporal variations in a large dataset containing individual-level data to conduct a cohort study and to investigate whether current income inequality and increases in income inequality are associated with infant and neonatal mortality risk over the period of the 2007-2010 Great Recession in the United States.Methods: We used data on 16,145,716 infants and their mothers from the 2007-2010 United States Statistics Linked Infant Birth and Death Records. Multilevel logistic regression was used to determine whether 1) US state-level income inequality, as measured by Z-transformed Gini coefficients in the year of birth and 2) change in Gini coefficient between 1990 and year of birth (2007-2010), predicted infant or neonatal mortality. Our analyses adjusted for both individual and state-level covariates.Results: From 2007 to 2010 there were 98,002 infant deaths: an infant mortality rate of 6.07 infant deaths per 1000 live births. When controlling for state and individual level characteristics, there was no significant relationship between Gini Z-score and infant mortality risk. However, the observed increase in the Gini Z-score was associated with a small but significant increase likelihood of infant mortality (AOR = 1.03 to 1.06 from 2007 to 2010). Similar findings were observed when the neonatal mortality was the outcome (AOR = 1.05 to 1.13 from 2007 to 2010).Conclusions: Infants born in states with greater changes in income inequality between 1990 and 2007 to 2010 experienced a greater likelihood of infant and neonatal mortality. [ABSTRACT FROM AUTHOR]

Introduction: Existing literature shows that increased community engagement is associated with decreased depressive symptoms. To our knowledge, no existing studies have investigated the relationship between community engagement and adverse mental health among mothers in a Canadian context, nor has this relationship been studied over time. The current study aims to address these gaps by modelling the association between community engagement and anxiety and depression longitudinally using a cohort of prenatal and postnatal mothers living in Calgary, Alberta. Methods: We used data from the All our Families (AOF) study, a prospective cohort study of expectant and new mothers in Calgary, Alberta from 2008 to 2017 across seven timepoints. We used three-level latent growth curves to model the relationship between individual-level community engagement and maternal depression and anxiety scores, while adjusting for both individual and neighborhood-level characteristics. Results: The study sample consisted of 2129 mothers across 174 neighborhoods in Calgary. Adjusted latent growth curve models demonstrated that community engagement was associated with lower depression (b = − 0.28, 95% CI − 0.33, − 0.23) and anxiety (b = − 0.07, 95% CI − 0.12, − 0.02) scores among mothers over time. Discussion: Adjusted results show that community engagement has a protective effect against depression and anxiety amongst mothers. The results of this study are in line with existing evidence suggesting that social cohesion, civic participation, and community engagement are protective against adverse mental health outcomes. [ABSTRACT FROM AUTHOR]

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]

Introduction: Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19. Material and methods: Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19. Results: The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (β = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19. Discussion: The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health. [ABSTRACT FROM AUTHOR]

Objective: To investigate the possible effects of middle and high school racial composition on later reporting of lifetime non-medical use of prescription painkillers (NMUPP) in young adulthood, and to explore whether there is evidence of variability by individual race/ethnicity in such effects.Methods: Using data from Wave 1 (1994/5) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we categorized the sample's 52 middle schools and 80 high schools as majority (>50%) non-Hispanic white, majority non-Hispanic black, or neither. We used two-level hierarchical modeling to explore associations between individual- and school-level race at Wave 1 and lifetime prescription painkiller misuse reported at Wave 4. We included a cross-level interaction between individual race and school racial composition to assess variability in school-level associations by race.Results: Overall crude prevalence of lifetime NMUPP in majority white schools (17.9%) was over three times that of prevalence in majority black schools (4.8%), and also higher than prevalence in schools neither predominantly black nor predominantly white (12.4%). Lifetime misuse among blacks in majority white schools was more prevalent (5.2%) than among blacks in black schools (2.8%), as was misuse among whites in white schools (19.3%) compared to their white peers in black schools (15.7%). Two-level random intercept Poisson regression results suggest that attendance in a majority black secondary school lowered a participant's risk of lifetime NMUPP (compared to attending a majority white school: RR=0.66, p = 0.03). Compared to blacks in black schools, blacks in white schools had twice the risk of prescription painkiller misuse (p = 0.004) over a decade later, and whites in white schools had 5.5 times the risk (p = 0.01). The risk ratio comparing whites in black schools to whites in white schools was not significant (RR: 1.30; p = 0.37).Conclusions: We found evidence of an effect of school racial composition on the risk of misusing prescription painkillers over a decade later, over and above individual race, with higher risk of misuse reported among participants who had attended white schools. Black participants who had attended predominantly white schools were, on average, twice as likely to report lifetime misuse of prescription painkillers compared to blacks who had attended black schools. [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]

Background: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. Methods: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. Results: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. Conclusions: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives. [ABSTRACT FROM AUTHOR]

Background: Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. Methods: We conduct ecological analyses (ZIP code, N = 166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count #200 cell/mL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. Results: Overall, low to high political participation and social cohesion corresponded with significant (P, 0.0001) decreasing trends in late HIV diagnosis rates. Among men [relative risk (RR) = 0.66, 95% CI: (0.47 to 0.98)] and women [RR = 0.43, 95% CI: (0.28 to 0.67)], highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control [RR = 0.67, 95% CI: (0.48 to 0.93)] among men only and moderate social cohesion [RR = 0.71, 95% CI: (0.55 to 0.92)] among women only were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. Discussion: The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the extent to which active transportation (AT) to and from school is associated with changes in body mass index (BMI) from kindergarten (6-year-olds) through grade 2 (8-year-olds). Methods: The sample included 1170 children (50.4% of baseline participants) who were part of the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort established in 1998 in Quebec, Canada. Data were collected by trained interviewers using structured interviews and measuring height and weight in the home with the person most knowledgeable about the child''s health. Relative weight was operationalized as age- and sex-adjusted BMI Z-scores. Results: Growth curve analyses showed that using AT to and from school both when in kindergarten and in grade 1 was predictive of a lower BMI Z-score (coeff=-0.18, SE=0.09, p=0.05) in grade 1. Using AT to and from school in kindergarten, grade 1, and grade 2 was predictive of a lower BMI Z-score (coeff=-0.30, SE=0.098, p=0.003) in grade 2. No other covariates were predictive of relative weight across time, although having an overweight or obese mother was associated with a BMI Z-score of 0.39 (SE=0.07, p<0.001) across all time points. Conclusion: Sustained AT is associated with more healthful trajectories of BMI across the early school years. [Copyright &y& Elsevier]

Background: Several studies have linked neighbourhood environment to preschool-aged children's behavioural problems. Income inequality is an identified risk factor for mental health among adolescents, however, little is known as to whether this relationship extends to younger children. Objective: To explore the association between neighbourhood-level income inequality and general psychopathology problems among preschool-aged children. Methods: We analyzed data from the All Our Families (AOF) longitudinal cohort located in Calgary, Canada at 3-years postpartum. The analytical sample consisted of 1615 mother-preschooler dyads nested within 184 neighbourhoods. Mothers completed the National Longitudinal Survey of Children and Youth Child Behaviour Checklist (NLSCY-CBCL), which assessed internalizing and externalizing symptoms. Income inequality was assessed via the Gini coefficient, which quantifies the unequal distribution of income in society. Mixed effects linear regression assessed the relationship between neighbourhood income inequality and preschooler's general psychopathology. Results: The mean Gini coefficient across the 184 neighbourhoods was 0.33 (SD = 0.05; min, max: 0.20-0.56). In the fully adjusted model income inequality was not associated with general psychopathology in children β = 0.07 (95%CI: -0.29, 0.45). Neighbourhood environment accounted for 0.5% of the variance in psychopathology in children. Conclusion: The lack of significant findings may be due to a lack of statistical power in the study. Future studies should investigate this relationship with appropriately powered studies, and over time, to assess if income inequality is a determinant of preschooler psychopathology in Canada. [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]

Background: Previous research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults. Methods: Cross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates. Results: In comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87–0.99), fruits only (OR = 0.95; 95% CI, 0.92–0.99) and vegetables only (OR = 0.92; 95% CI, 0.89–0.96). Conclusions: This study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women's health is more likely to be detrimentally affected when living in a state with higher income inequality. [ABSTRACT FROM AUTHOR]

An editorial is presented in which the authors discuss access to abortion, legislation and potential U.S. Supreme Court hearings concerning abortion in U.S. states, and public and population health.

Social fragmentation has been theorized and empirically associated with suicide in prior research. However, less is known about whether social fragmentation is associated with deaths attributed to alcohol use or drug use. This research examined the association between social fragmentation and risk for deaths attributable to alcohol use, drug use, and suicide (collectively known as deaths of despair) among Canadian adults. A weighted sample representing 15,324,645 Canadians within 288 census divisions between 2006 and 2019 was used. Mortality data from the Canadian Vital Statistics Database (alcoholic liver disease, drug use, and suicide) was linked with census division socioeconomic data from the 2006 Canadian census using the Canadian Census Health and Environment Cohorts. Social fragmentation at the census division was created based on the Congdon Index. Cox-proportional hazard regression with survey weights and the sandwich estimator were used to account for clustering of individuals (level-1) nested within census divisions (level-2). After adjusting for individual and census division confounders, social fragmentation was positively associated with all-cause mortality (HR = 1.04; 95% CI: 1.02, 1.07), suicide (HR = 1.09; 95%CI: 1.01, 1.18), drug overdose related mortality (HR = 1.13; 95%CI: 1.03, 1.24), and deaths of despair (HR = 1.10; 95% CI: 1.04, 1.16), and not significantly associated with alcohol related liver disease (HR = 1.06; 95% CI: 0.91, 1.23). Social fragmentation is associated with an increased hazard of deaths of despair among Canadian adults. Efforts to improve social cohesion in areas that are highly socially fragmented need to be evaluated. • Social fragmentation was associated with a greater hazard for deaths of despair. • More social fragmentation was also associated with greater all-cause mortality. • Social fragmentation was not associated with alcohol related liver disease. • Survey weighted cox-proportional hazard regression was used. [ABSTRACT FROM AUTHOR]

The infant mortality rate (IMR) is the rate of death of children younger than one year of age. In the United States, the IMR has been declining over time. However, it has been declining much more slowly than in other nations. As a result, the US global ranking in IMRs is also declining. This analytic essay explores some of the reasons why it might be undergoing this relative decline by critically dissecting secondary sources of data. We found that slow progress in reducing IMR over the past decade is partly due to lower birth rates among immigrants, who tend to have healthier babies than native-born mothers. However, this does not explain longer-term trends, which reveal a relative decline in the well-being of women of reproductive age. We speculate that longer-term declines are partially due to a deemphasis on government health and antipoverty programs. This deemphasis results not only in weaker socioeconomic support but also in rising medical costs, which are consuming an increasingly larger share of Americans' declining disposable income. [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]