Aims
This study investigates the link between personal income and smoking among adolescents, and aims to answer the following questions: (i) to what extent is personal income related to smoking, ...independent of family socio‐economic status (SES) and (ii) does the association between personal income and smoking apply to different subpopulations?
Design
Cross‐sectional study.
Setting
Six cities from European countries (Amersfoort, the Netherlands; Coimbra, Portugal; Hannover, Germany; Latina, Italy; Namur, Belgium; Tampere, Finland) in 2013.
Participants
A school‐based sample of 10 794 adolescents aged 14–17 years.
Measurements
We modelled smoking experimentation, weekly smoking, daily smoking and (among daily smokers) smoking intensity as function of personal income, adjusting for age, sex, family SES, parental smoking and country. We tested interactions between personal income and covariates. Stratification analyses were performed for the variables for which interactions were significant.
Findings
Adolescents in the highest income quintile were more likely to be smoking experimenters odds ratio (OR) = 1.87; P < 0.01, weekly smokers (OR = 3.51; P < 0.01) and daily smokers (OR = 4.55; P < 0.01) than those in the lowest quintile. They also consumed more cigarettes per month (β = 0.79; P < 0.01). Adjusting for family SES did not modify the significance of relationships, and increased the magnitude of the association for daily smoking. None of the interactions between covariates and personal income was significant for smoking measures. For the intensity of smoking, the interaction was significant for SES. The stratified analysis showed a non‐significant association between smoking intensity and personal income among the oldest adolescents and those with the lowest SES background, while significant among younger and higher SES backgrounds.
Conclusion
In the Netherlands, Portugal, Germany, Italy, Belgium and Finland, adolescents' personal income is related positively to smoking behaviours independent of family socio‐economic status (SES). However, among low socio‐economic status adolescent daily smokers, the association between the intensity of smoking and personal income is weaker.
In this article, we contribute to understanding of the mechanisms through which students’ socio‐economic family background can translate into academic performance by focusing on the concept of ...student engagement. Drawing on theoretical perspectives from disciplines across the social sciences, and a major nationally representative dataset from Australia, which links survey responses with administrative records on school performance, we conduct a series of multiple regression models to investigate the mediating role of student engagement on the relationship between students’ socio‐economic status (SES) and academic achievement. We find that, first, low‐SES students show lower levels of engagement than other students, particularly in terms of behavioural and cognitive aspects; they also have lower achievement levels as measured by standardised test scores. We further find that lower engagement is associated with lower achievement levels, and that the effects of SES on achievement are partially mediated through student engagement. Although there are clearly other mechanisms in place that operate at the same time, it is important to focus on student engagement since it can be directly influenced by teachers and school leaders, as well as curriculum choices and school resources. This makes it a ripe target for government policies aimed at improving educational outcomes for students from low‐SES families, compared with approaches targeting the influences of family environment or peer groups.
Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are ...concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.
•Evidence of socioeconomic inequalities in the number of prostate surgeries.•Inequalities did not amplify following COVID-19.•No evidence of inequalities in other dimensions of access, such as waiting times.
Background: Lower socioeconomic status (SES) is a risk factor for obesity and may predict suboptimal weight loss following bariatric surgery (BS). The identification of specific challenges associated ...with lower SES is critical to developing interventions to address them. All patients who qualify for BS must complete a pre-operative nutritional education program (NEP) at the time of surgical consultation. We aimed to determine if there were changes in associations between SES and ethnicity with nutritional knowledge (NK) among a cohort of patients at initial visit to BSC and a cohort at surgical consultation. Methods: Patients at initial visit to BSC (n = 32) and at surgical consultation following pre-operative NEP (n = 16) completed an online survey comprised of the General Nutritional Knowledge Questionnaire (GNKQ), Adult Eating Behavior Questionnaire (AEBQ), and questions related to SES and ethnicity including highest level of education and yearly income. All patients were English speaking. Study was conducted at an academic, tertiary care institution in a diverse metropolitan setting. Significance among groups was determined using ANOVA test. Results: Lower income (p = 0.045), lower education level (p = 0.036), and Hispanic ethnicity (p = 0.034) were significantly associated with lower mean GNKQ scores among patients at initial presentation to BSC. At time of surgical consult, after preparation, lower Income (p = 0.08), lower education level (p = 0.18), and Hispanic ethnicity (p = 0.52) were not significantly associated with lower mean GNKQ scores. Conclusions: Our study demonstrates that although lower SES and Hispanic ethnicity are associated with lower general NK, this association does not persist in patients following a pre-operative NEP. This finding suggests that we may have addressed existing SES-associated deficits in NK with our comprehensive pre-surgical NEP. We are currently studying whether general NK predicts outcomes after BS.
The adverse impact of a low family socioeconomic status (SES) on rural-to-urban migrant children’s academic achievement has been widely demonstrated. However, knowledge regarding the mechanisms ...underlying this relationship is limited. The current study aimed to examine the potential mediating effects of educational expectations and the moderating effects of subjective SES on the relationship between family SES and academic achievement among Chinese rural-to-urban migrant adolescents. A sample of 321 rural-to-urban migrant adolescents (48.2% girls; mean age = 11.73 years, SD = 1.16 years) was recruited in China. The results indicated that migrant adolescents’ educational expectations mediated the relationship between family SES and academic achievement. In addition, the link between family SES and educational expectations was weak among adolescents with higher levels of subjective SES. These findings suggest that subjective SES serves as a protective factor buffering the negative effects of a low family SES on migrant adolescents’ academic achievement through educational expectations.
Preoperative opioid users (POU) experience worse outcomes and higher complication rates compared to opioid naïve patients (ONP) following shoulder arthroplasty. This study evaluates the effects of ...socioeconomic status (SES), as measured by the distressed communities index (DCI), on pre- and postoperative opioid use and its influence on clinical outcomes such as readmission and revision surgery.
A retrospective review of patients who underwent primary shoulder arthroplasty (CPT code 23472) from 2014-2022 at a single academic institution was performed. Exclusion criteria included arthroplasty for fracture, active malignancy, and revision arthroplasty. Demographics, Charlson Comorbidity Index (CCI), DCI, and clinical outcomes including 90-day readmission and revision surgery were collected. Patients were classified according to the DCI score of their zip code. Using the Prescription Drug Monitoring Program database, patient pre- and postoperative opioid use in morphine milligram equivalents (MME) was gathered.
Individuals from distressed communities utilized more opioids within 90 days preoperatively compared to patients from prosperous, comfortable, mid-tier, and at-risk populations respectively. Patients from distressed communities also used significantly more opioids within 90 days postoperatively compared to prosperous, comfortable, and mid-tier respectively. Of patients from distressed communities, 35.1% developed prolonged opioid use (filling prescriptions >30 days after surgery), significantly more than all other cohorts. Among all patients, 3.5% were readmitted within 90 days and were more likely to be prolonged opioid users (38.9 vs 21.3%, p<0.001). Similarly, 1.5% of patients underwent revision surgery. Those who underwent revision were significantly more likely to be prolonged opioid users (38.2 vs 21.7%, p=0.002).
Shoulder arthroplasty patients from distressed communities use more opioids within 90 days before and after their surgery and are more likely to become prolonged opioid users placing them at risk for readmission and revision surgery. Identifying patients at an increased risk for excess opioid use is essential to employ appropriate strategies that minimize the detrimental effects of prolonged use following surgery.
Research has demonstrated a protective effect of social support on health. Social support is most often treated as an independent variable. However, as with disease risk factors, which are not ...randomly distributed, health-promoting resources such as social support are also systematically patterned. For example, in the USA, family support is thought to be high among Latinos, Mexican Americans in particular. Using data from the Project on Human Development in Chicago Neighborhoods, we explored the relationships between ethnicity/nativity status, socioeconomic status (SES) and perceived social support from family and friends. We also assessed the role of retention of culture—measured as primary language spoken at home—on social support. Finally, we tested whether SES moderated the relationship between ethnicity/nativity status and social support. Foreign and US-born Latinos, most notably, foreign-born Mexicans, reported higher family support compared to non-Latino whites. Primary language spoken at home seems to account for the relationship between ethnicity/nativity and familial social support. Mexican-born and US-born Latino immigrants reported lower social support from family at higher levels of SES. Each ethnic minority group reported lower perception of friend support compared to non-Latino whites. There was a strong SES gradient in subjective support from friends with higher support reported among those with higher SES. This study provides evidence for the notion that Latinos in the USA, specifically foreign-born Mexicans, may rely on family ties for support more than do non-Latino whites. Findings also help identify ethnicity/nativity status, primary language spoken and SES as determinants of social support. Specifically, the higher familial social support found among Latino immigrants may be due to retention of culture. Effect modification by SES suggests that Latinos of lower and higher SES may differ with regard to the traditionally-held value of
familism.
Objectives
Class‐based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio‐economic status (SES) being typically ...dehumanized. This study specifically examined how nurses’ perceptions of pain patients’ SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations.
Design
Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story‐Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis.
Results
The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle‐SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self‐manage pain. The low‐SES woman was associated with Human Nature traits (hard‐working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation.
Conclusion
Findings reveal the role of class‐based cultural belief systems in pain care, showing how nurses’ recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn.
Statement of contribution
What is already known on the subject?
•
Psychosocial research on health and pain care disparities has paid more attention to the role of race/racism and gender/sexism than the role of social class/classism;
Belief systems about social class are shared across cultures; people from lower SES are often dehumanized by being denied competence, civility, and self‐determination;
Class‐based dehumanization may influence the relational and technical aspects of clinical encounters but little is still known about these processes.
What does this study add?
Drawing upon a mixed‐methods approach, this study provides novel findings on class‐based dehumanization inferences made by female nurses on female chronic pain patients;
Nurses perceived the lower SES patient with fewer Uniquely Human traits, that is, less competent, with more pain‐related disability, and recommended her more psychoeducation.
Class‐based dehumanization processes may contribute to reproducing pain care disparities and may prove to be important targets for intervention development.
Frailty is a phenotype associated with adverse health outcomes in older persons. It has been evaluated mainly in middle-aged persons with HIV (PWH). The French multicenter prospective ANRS EP66 ...SEPTAVIH study aimed to assess frailty prevalence and risk factors in PWH aged 70 years or older on antiretroviral treatment (ART) for at least 12 months.
At baseline, Fried frailty phenotype criteria, sociodemographic data, medical/HIV history, functional status, comorbidities, including impaired cognitive function, depression, history of falls, and co-medications were collected. We measured the prevalence of frailty and compared the characteristics of frail versus prefrail and robust participants using univariate (Kruskal-Wallis tests for continuous variables and Chi 2 tests for categorical variables) and multivariate analyses.
Five hundred and ten PWH, mostly male (81.4%), were included with a median age of 73 years. The median HIV and ART durations were 22.7 years and 15.7 years, respectively. The prevalence of frailty was 13.5%, and of prefrailty 63.3%. In the multivariate analysis, increasing age odds ratio (OR) 1.79 for each 5-year increment; 95% confidence interval (CI) 1.32-2.41, deprived socioeconomic status (OR 3.17; 95% CI 1.76-5.70), and multimorbidities (three or more) (OR 2.03; 95% CI 1.06-3.90) were associated with frailty.
A low prevalence of frailty was reported (13.5%) in PWH aged 70 years or older, whereas two-thirds of them were prefrail. Age, low socioeconomic status, and multimorbidities, but no HIV-related factors, were associated with frailty, suggesting the need to target these factors to help promoting successful aging in this population.
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