Inequalities In Caries Among Pre-School Italian Children With Different Background

Background: The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient. Methods: The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.76% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) and behavioral habits of children/parents/caregivers were estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated as the weighted sum of the worst circumstances deriving from social explanatory variables. Children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic regression in children with European background and a logistic regression in children with non-European background) were used to elucidate the associations between all explanatory variables and health outcome (namely the caries prevalence). Mantel Haenszel trend of odds adjusted by immigrant background and area of living were calculated to study the existence, dimensions and direction of a social gradient in oral health. Results: Overall, 54.37% (95%CI 46.71–58.28%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.59% vs 41.62% p<0.01). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z=5.24, p<0.01). Conclusions: Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background. The proposed gradient was clearly able to identify children with the worst dental conditions.

The role of social cognitions in the social gradient in adolescent mental health: A longitudinal mediation model

Purpose. The social gradient in adolescent mental health is well established: adolescents’ socioeconomic status (SES) is negatively associated with their mental health. However, de-spite changes in social cognition during adolescence, and theory and evidence that SES, so-cial cognitions, and adolescent mental health are associated, little is known about whether social cognitions mediate this gradient.Methods. This study used three data waves, each six months apart, from a socioeconomi-cally diverse sample of 1,429 adolescents (Mage = 17.9) in the Netherlands. With a longitu-dinal mediation model, we examined whether three social cognitions (self-esteem, sense of control, and optimism) mediated the associations between perceived family wealth and four indicators of adolescent mental health problems (emotional symptoms, conduct prob-lems, hyperactivity, and peer problems).Results. Adolescents with lower perceived family wealth reported more emotional symp-toms and peer problems concurrently and an increase in peer problems six months later. Adolescents with lower perceived family wealth reported a decrease in sense of control six months later, and lower sense of control predicted increases in emotional symptoms and hyperactivity six months later (though not in the multivariate model with all three social cognitions). Perceived family wealth predicted neither later self-esteem nor optimism, though we found concurrent positive associations between perceived family wealth and all three social cognitions, and concurrent negative associations between social cognitions and mental health problems.Conclusion. Our findings indicate that social cognitions may be an overlooked mediator of the social gradient in adolescent mental health. Future research on this social gradient may benefit from incorporating a focus on social cognition.

Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys

Aims: This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. Methods: We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT’s European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma ( n=11,401), Roma neighbours ( n=5857) and the general population ( n=101,579) stratified by gender, and adjusted by age, country and educational level. Results: There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. Conclusions: These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population’s social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

The social gradient in adolescent mental health: mediated or moderated by belief in a just world?

Purpose A social gradient in adolescent mental health exists: adolescents with higher socioeconomic status (SES) have fewer mental health problems than their peers with lower SES. Little is known about whether adolescents’ societal beliefs play a role in this social gradient. Belief in a just world (BJW) may be a mediator or moderator of the social gradient in adolescent mental health. Methods Using data from 848 adolescents (Mage = 17) in the Netherlands, path analyses examined whether two indicators of BJW (general and personal) mediated or moderated the associations between two indicators of SES (family affluence and perceived family wealth), and four indicators of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity, and peer problems). Results Adolescents with lower family affluence and lower perceived family wealth reported more emotional symptoms, and the association between perceived family wealth and emotional symptoms was mediated by lower personal and general BJW. Furthermore, higher personal BJW amplified the negative association between SES and peer problems. Conclusion This study suggests BJW may both mediate and amplify the social gradient in adolescent mental health. Adolescents’ beliefs about society may be important to include in research aimed at understanding this social gradient.

A Social Gradient of Cortical Thickness Relative to Age in Adolescence: Relations Among Neighborhood Socioeconomic Disadvantage, Advanced Cortical Thinning, and Depressive Symptoms

Background: Mental and physical health are affected by family and neighborhood socioeconomic status (SES). Accelerated biological aging in the context of lower SES is one mechanism that might contribute to underlying health disparities; few studies, however, have considered neighborhood SES in relation to neural markers of biological aging in adolescents. Methods: In 120 adolescents 13-18 years of age, we examined family and neighborhood SES in relation to biological aging in the brain, indexed by cortical thickness relative to chronological age. We also examined whether advanced cortical thinning relative to age was related to depressive symptoms and explored regions of interest.Results: Neighborhood socioeconomic disadvantage was uniquely associated with advanced cortical thinning in the left hemisphere (=-.20), which was related to more severe depressive symptoms (=-.33). In contrast, family income-to-needs was not significantly associated with cortical thickness age after controlling for relevant covariates. In exploratory, covariate-adjusted analyses of cortical thickness relative to age at the regional level, neighborhood socioeconomic disadvantage was associated with advanced cortical thinning in the left superior frontal gyrus (=-.27), fusiform gyrus (=-.20), and insula (=-.21). Of these regions, only advanced cortical thinning in the left superior frontal gyrus was associated with more severe depressive symptoms (=-.18). Conclusion: Our findings provide evidence for a social gradient of accelerated biological aging at the neural level during adolescence. Adolescents living in less advantaged communities have a thinner left hemisphere cortex than expected given their chronological age. Advanced cortical thinning may increase risk for depression in adolescence.

Is there a social gradient in how youth with mental disorder perform academically? Findings from a Swedish longitudinal register-based study

Background It is well established that academic achievement and other school-related outcomes are associated with mental health status in children and youths. However, few studies have examined the influence of socioeconomic background on the relationship between poor childhood/adolescent mental health and school performance. From an equity perspective, it is important to explore how school-related outcomes are affected for young people with mental disorder and if these outcomes differ depending on gender and socioeconomic background. This study aimed to investigate social gradients in the prospective association between childhood/adolescent mental disorder and academic achievement. Methods This register based study used data from the Umeå SIMSAM Lab of linked Swedish registers on all children born between 1990 and 1994 and their parents (N = 642 558). The outcome was school grades achieved upon compulsory school graduation (age 15/16). Mental disorder was indicated by number of hospitalisations due to ICD classified mental disorders and prescription of psychoanaleptic drugs. Indicators of socioeconomic position were parental level of education and family income in four categories respectively. Parental history of mental disorder was controlled for. Linear regressions, including interaction analyses, were performed. Results Mental disorder in childhood/adolescence was related to lower grades, particularly in boys. The drop in academic achievement among youth with mental disorder was more pronounced among girls in mid SEP categories than among their less and more advantaged peers. A less clear interaction pattern was identified in boys. Conclusions Based on theory and existing research we expected a typical social gradient in the strength of the association between mental disorder and academic achievement. However, we identified a U-shaped social gradient among girls. Analyses of the links between mental health and academic outcomes need to take both gender and social position into account. More research is needed to investigate these patterns further.

112Neighbourhood environment and health-related quality of life, Limassol, Cyprus

Background The extent and magnitude of socio-geographical inequalities in health in Cyprus is not clear as neither “place” nor “health inequalities” feature on the public health agenda. Methods In the context of a wider Neighbourhood Environment and Health programme, the magnitude of inequality in health-related quality of life (HRQoL) among Limassol citizens was explored in a door-to-door SF-36 survey of residents aged 45-64 (N = 450, 50:50 gender quota) across 45 randomly selected neighbourhoods stratified by socio-economic disadvantage and profiled using a culturally-adapted Systematic Social Observation neighbourhood audit tool. Results The social gradient was steeper for physical than mental component scores of HRQoL irrespective of the indicator of social position. Education and income captured the gradient better in women, and occupational-based social class in men, with large effect (0.7-1 SD) on the SF-36 scale at opposite ends of the continuum. Lower HRQoL and more adverse health behaviours observed in disadvantaged neighborhoods according to census area-level measures and neighbourhood audit profiles, with generally larger differences in women. Conclusions This study profiled the variability in the urban neighbourhood environment,and documented the magnitude of social gradient in health and health-related quality of life in a representative sample of late working-life population in Cyprus. Key messages Social gradient in health behaviours and quality of life in late working-life Cypriot population. Gradient apparent in both men and women across individual and neighborhood measures of social position.