A test of the predictive validity of relative versus absolute income for self-reported health and well-being in the United States.

BACKGROUND: A classic debate concerns whether absolute or relative income is more salient. Absolute values resources as constant across time and place while relative contextualizes one's hierarchical location in the distribution of a time and place. OBJECTIVE: This study investigates specifically whether absolute income or relative income matters more for health and well-being. METHODS: We exploit within-person, within-age, and within-time variation with higher-quality income measures and multiple health and well-being outcomes in the United States. Using the Panel Study of Income Dynamics and the Cross-National Equivalent File, we estimate three-way fixed effects models of self-rated health, poor health, psychological distress, and life satisfaction. RESULTS: For all four outcomes, relative income has much larger standardized coefficients than absolute income. Robustly, the confidence intervals for relative income do not overlap with zero. By contrast, absolute income mostly has confidence intervals that overlap with zero, and its coefficient is occasionally signed in the wrong direction. A variety of robustness checks support these results. CONCLUSIONS: Relative income has far greater predictive validity than absolute income for self-reported health and well-being. CONTRIBUTION: Compared to earlier studies, this study provides a more rigorous comparison and test of the predictive validity of absolute and relative income that is uniquely conducted with data on the United States. This informs debates on income measurement, the sources of health and well-being, and inequalities generally. Plausibly, these results can guide any analysis that includes income in models.

Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles.

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

Go-along interview assessment of community health priorities for neighborhood renewal.

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.

Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool.

OBJECTIVES: To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health. METHODS: Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less. RESULTS: Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2. CONCLUSIONS: The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test-retest reliability and construct validity.

Parental psychosocial factors, unmet dental needs and preventive dental care in children and adolescents with special health care needs: A stress process model.

BACKGROUND: Children and adolescents with special health care needs (SHCN) have higher unmet dental needs, but the potential mechanisms by which parental factors can influence dental care use have not been determined. Parenting a child with SHCN can present special demands that affect parents' well-being and, in turn, their caregiving. Hence, the study's overall aim was to apply the stress process model to examine the role of parental psychosocial factors in the association between child SHCN and dental care. Specifically, the study tested hypotheses regarding how (a) children's SHCN status is associated with child dental care (unmet dental needs and lack of preventive dental visits), both directly and indirectly via parental psychosocial factors (parenting stress, instrumental, and emotional social support) and (b) parental social support buffers the association between parenting stress and child dental care. METHODS: A secondary data analysis of the 2011-2012 US National Survey of Children's Health was performed for 6- to 11-year-old children (n = 27,874) and 12- to 17-year-old adolescents (n = 31,328). Our age-stratified models estimated associations between child SHCN status and parental psychosocial factors with two child dental care outcomes: parent-reported unmet child dental needs and lack of preventive dental care. RESULTS: Parents of children with (vs without) SHCN reported higher unmet child dental needs, higher parenting stress, and lower social support (instrumental and emotional). Instrumental, but not emotional, parental support was associated with lower odds of their child unmet dental needs in both age groups. The association between parenting stress and child dental care outcomes was modified by parental social support. CONCLUSION: Differences existed in child unmet dental needs based on SHCN status, even after adjusting for parental psychosocial factors. SHCN status was indirectly associated with unmet dental needs via parental instrumental support among adolescents, and parental instrumental support buffered the negative association between parenting stress and both child dental care outcomes. Hence, parental social support was an important determinant of child dental care and partially explained the dental care disparities in adolescents with SHCN.

Support for a vaccination documentation mandate in British Columbia, Canada.

BACKGROUND: In recent years, Canadian provinces have been discussing, implementing, and tightening vaccination "mandate" policies for school enrolment. British Columbia (BC), Canada's westernmost province, implemented a Vaccination Status Reporting Regulation (VSRR) in September 2019, which requires the vaccination status of children in public, private, and home schooling be reported to a provincial vaccination registry and education for parents who refuse to vaccinate. Legal vaccination mandates can carry the risk of backlash, thereby making it important to monitor public attitudes across policy implementation windows. The present study aimed to evaluate public support for this new provincial mandate following implementation. METHODS: An online panel of BC adults (n = 1301) was surveyed about 15 vaccine-promotion policy options in April 2020 following mandate implementation. Respondents were representative of the provincial population by gender, age, geographic residence, and percentage of households with children younger than 19 years of age. Poisson regression was used to estimate predictors of policy endorsement, and support for the VSRR. RESULTS: Strong support existed for the VSRR with 88.2% of respondents agreeing or strongly agreeing that parents should be required to provide their children's immunization records at school entry, and 74.6% supporting required education sessions for parents who refuse to vaccinate their children. Overall, the sample was supportive of vaccination, and pro-vaccine attitudes were associated with strong agreement for nearly all vaccine policy options. Policies to impose rewards (e.g., tax credits) and penalties (e.g., fines) were the least likely to receive strong agreement from respondents. CONCLUSIONS: Near the end of the first school year in British Columbia subject to the Vaccination Status Reporting Regulation, support for both the mandated documentation and mandated education elements of the policy are high, and associated with pro-vaccine attitudes. There are not marked differences in strong support based on gender, age, parenting, education level, or income.

Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA.

Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.

Socioeconomic status, social support, and oral health-risk behaviors in Canadian adolescents.

OBJECTIVES: We tested hypotheses regarding how adolescent oral health-related behaviors are associated with socioeconomic status (SES) and family and peer social support, including the extent to which such associations differ for boys and girls. METHODS: We analyzed data from the 2013/2014 Canadian Health Behavior in School-aged Children Study for 20,357 adolescents ages 12-18 years. Family Affluence Scale was used to assess SES. Family and peer social support were assessed using the Multidimensional Scale of Perceived Social Support. We estimated average marginal effects from multivariable binary logistic regression models for three oral health-risk behaviors outcomes: infrequent toothbrushing, high sugar-sweetened beverage (SSB) intake, and high sweets consumption across both genders. RESULTS: Adolescents from low SES households had lower probability of parental and peer support, and were significantly more likely to report infrequent toothbrushing and high SSB consumption, both before and after controlling for both types of support. Lower family support was associated with higher probability of engaging in infrequent toothbrushing and high SSB intake, while lower peer support was associated with higher probability of engaging in infrequent toothbrushing and lower likelihood of engaging in high SSB consumption. The associations of family support with oral health-related behaviors were somewhat stronger for boys than girls. CONCLUSIONS: Low SES and low family support were associated with a higher likelihood of oral health-risk behaviors (infrequent toothbrushing and SSB consumption). Regardless of adolescents' gender, parental support exerted a protective role, but peer support had countervailing risk and protective roles on oral health-related behaviors.

Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China.

BACKGROUND: In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China. METHOD: In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15). RESULTS: Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75). CONCLUSION: Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.

Parenting stress as a mediator in the oral health of children and adolescents: A stress process model.

OBJECTIVES: We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress. METHODS: We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11 years (n = 21 596) and 12-17 years (n = 23 584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits. RESULTS: For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed. CONCLUSION: Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

Measures of personal social capital over time: A path analysis assessing longitudinal associations among cognitive, structural, and network elements of social capital in women and men separately.

Studies on personal social capital and health have relied on several key measures of social capital - trust, participation, network capital - all with the aim of capturing the resources to which individuals or groups might have access through their social networks. As this work has evolved, researchers have sought to differentiate among key measures, often arguing that each represents a different type of social capital. Despite the importance of this work, few studies have examined (a) whether these measures are in fact distinct constructs, particularly over time, (b) if these relationships are causal, and (c) whether gender patterns the ways these measures are related. Using a probability-based sample of adults with 1-3 observations per respondent, we apply generalized structural equation modeling to assess in women and men separately whether generalized trust, trust in neighbors, network diversity, social isolation, and social participation are associated with each other, hypertension, and self-reported health over a five-year period. The initial response rate was 38.7%, with cooperation rates of 60.4% and 56.3% at waves two and three. Findings highlight stability in the longitudinal relationship of the same measure across waves. They also suggest that social capital measures operate differently for men and women, with key measures of one type of social capital more often associated with another type in women than men. Nevertheless, the strengths of the associations remain weak in women and men, particularly over time, suggesting that these measures (especially generalized trust) may be inadequate proxies for each other. Lastly, social capital seemed more salient for women's than men's health. Future research on social capital might consider more deeply the role and meaning of gender in interpreting the results of studies linking social capital to health. Further consideration of trust, participation, and network capital as distinct constructs is also warranted.