Mapping intersectional sociodemographic inequalities in measurement and prevalence of depressive symptoms: A Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) using data from a population based nationwide survey in Germany.

OBJECTIVE: Understanding how social categories like gender, migration background, LGBT status (lesbian/gay/bisexual/transgender), education and their intersections affect health outcomes is crucial. Challenges include avoiding stereotypes and fairly assessing health outcomes. This paper aims to demonstrate how to analyse these aspects. STUDY DESIGN AND SETTING: The study used data from N=19,994 respondents from the German Socio-Economic Panel (SOEP) 2021 data collection. Variations between and within intersectional social categories regarding depressive symptoms and self-reported depression diagnosis were analyzed. We employed Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) to assess the impact of gender, LGBT status, migration, education and their interconnectedness. A Configuration-Frequency Analysis (CFA) assessed typicality of intersections. Differential Item Functioning (DIF) analysis was conducted to check for biases in questionnaire items. RESULTS: I-MAIHDA analysis revealed significant interactions between these categories for depressive symptoms and depression diagnosis. The CFA showed that certain combinations of social categories occurred less frequently compared to their expected distribution. The DIF analysis showed no significant bias in a depression short scale across social categories. CONCLUSION: Results reveal interconnectedness between the social categories, affecting depressive symptoms and depression probabilities. More privileged groups had significant protective effects while those with less societal privileges showed significant hazardous effects. Although statistical significance was found in interactions between categories, the variance within categories outweighs that between them, cautioning against individual-level conclusions.

Explicit discrimination among Brazilian dental students: A multicenter study.

OBJECTIVE: To test the association between socioeconomic and sociodemographic status of Brazilian dental students with discriminatory experiences suffered by them. METHODS: This multicenter cross-sectional study was conducted with 531 undergraduate dental students from four different Brazilian states. The Explicit Discrimination Scale (EDS) was used to measure the experience of discrimination in several daily situations. A questionnaire about sociodemographic and socioeconomic characteristics, form of admission, and permanence in dental schools was developed and validated by experts and six dental students through cognitive interviews. The EDS and questionnaire were sent to students by an online platform using snowball sampling. Descriptive analysis, bivariate tests, and multiple Poisson regression were performed. RESULTS: Among the participants, most were female, white, heterosexual, and cisgender. The mean EDS total score was higher among those students who used Brazilian Affirmative Actions for higher education access and permanence (p < 0.005). The multiple analysis indicated that students who were black (prevalence ratio [PR] = 1.484; 95% confidence interval [95%CI]: 1.291-1.705), women (PR = 1.227; 95%CI: 1.030-1.462), had lower monthly income (PR = 1.212; 95%CI: 1.043-1.409) and were lesbian, gay, bisexual, transgender, intersex, queer, pansexual, and plus (LGBTQIAP+) (PR = 1.466; 95%CI: 1.238-1.735) showed a higher probability of discriminatory experiences when compared to white, male and heterosexual students with higher monthly income. CONCLUSION: There is a racial and social class pattern among dental students. The exclusionary factors such as black race, female gender, lower monthly income and being LGBTQIAP+ make students more vulnerable to discriminatory experiences.

Effect of non-optimal ambient temperature on preterm birth stratified by social positioning in Nepal: a space-time-stratified case-crossover study.

BACKGROUND: The ongoing increase in the global mean temperature will increase around the globe, indicating that women and infants will have higher exposure to heat events leading to adverse outcomes. The study investigates the effect of non-optimal ambient temperature on the risk of preterm birth stratified by social position in Nepal. METHOD: This is a space-time-stratified case-crossover design, based on hospital-registered perinatal data between 2017 and 2021 (n=47,807). A daily count of pregnant women residing in seven heat-prone districts was extracted together with their social status (ethnicity), obstetric complication and gestation of birth. The daily count of events was matched with the daily ambient temperature of their residence using the NASA spatial temperature recording. Ambient temperature exposure was analysed using conditional Poisson regression and distributed lag non-linear models. FINDINGS: In the general population, with exposure to ambient temperature at the 75th centile (28 °C) the cumulative risk of preterm birth over 28 days was 1·29 times higher (RR, 1·29; 95% CI; 1·09, 1·54) than at median temperature (24.1 °C), and even higher among the socially disadvantaged population. Cumulative risk of preterm birth to cold ambient temperature at the 1st centile is high but not significant. Exposure to ambient temperature at the 90th centile (32·5 °C) has the highest cumulative risk of preterm birth for pregnant women from socially disadvantaged populations (RR 1·81; 95% CI; 1·28, 2·55). The delayed effect after exposure to temperatures above the 75th percentile seems to be more prolonged in the disadvantaged than the advantaged social group. CONCLUSION: Although exposure to cold with certain effect on preterm births, heat (increase in ambient temperature) carries a risk of preterm birth in Nepal, and is more profound among socially disadvantaged populations.

Beyond the focus on individuals: Adding environment into the redefined successful aging paradigm.

Since the origin of the Successful Aging (SA) model by Rowe and Kahn, scholars have been working on enriching the content of SA and taking actions to promote this concept worldwide. While most studies primarily focus on older individuals, only a few scholars have considered the environmental aspect of SA. However, the environment, directly and indirectly, enhances older adults' abilities to achieve SA. To measure SA comprehensively and address inequalities among older adults, this theoretical article aims to challenge current SA models by incorporating both individual and environmental aspects and proposing four measurement dimensions: inclusivity of disadvantaged groups, culture-specific adaptation, balance between physical and social environments, and dynamics of the whole lifecycle. Moreover, this article provides examples to illustrate how environment can support older adults especially those who would be defined as "unsuccessful" under the original SA model. Our proposed model would provide theoretical guidance for future research and spark new ideas for policies and programs that support every older adult in achieving SA.

Social Inequities in Access to Dental Care in Australian Adults over Time.

INTRODUCTION: Social inequities in dental caries are reflected by both inequities in the social structures that contribute to disease severity and inequities in the provision of dental care. This study aimed to describe social differentials in the dental caries experience among Australian adults across a 13-y period and to examine if the highest magnitude of oral health inequities persisted across dental caries prevalence (decayed teeth [DT]) or its management (missing teeth [MT], filled teeth [FT]). METHODS: Data were from 2 population-based cross-sectional surveys of Australian adult oral health conducted in 2004-2006 (National Survey of Adult Oral Health-1 [NSAOH-1], n = 5,505) and 2017-2018 (NSAOH-2, n = 5,022). In each survey, representative samples of adults were obtained through a 3-stage, stratified sample design within metropolitan and regional areas in each state/territory. Clinical outcomes included the prevalence and mean of DT, MT, FT, and DMFT. Equivalized household income was grouped into approximately quartiles from low to high. RESULTS: Across all income quartiles, the mean DT and % DT >0 was higher in NSAOH-2 than in NSAOH-1. The increase in prevalence was highest in the third highest income group (prevalence difference [PD] = 8.4, from 24.1 to 32.5). Similarly, % MT >0 was lower in NSAOH-2 than in NSAOH-1 across all income groups, with the decrease most marked for the lowest income group (PD = -6.5, from 74.1 to 67.8). Across all income quartiles, % FT >0 was lower in NSAOH-2 than in NSAOH-1. The decrease was the most marked for the lowest income group (PD = -8.9, from 81.1 to 72.2). CONCLUSION: The findings confirm that although oral health inequities decreased for the most extreme management outcome of dental caries (MT), inequities increased for experience of that disease (DT) and the more conservative management of dental caries (FT). For all D, M, and F components (DMFT), inequities between the lowest and highest household income groups increased from 2004-2006 to 2017-2018. KNOWLEDGE TRANSFER STATEMENT: This study found that social inequities in oral health (experience of untreated dental caries and missing teeth) increased between the most socially advantaged and disadvantaged groups between 2004-2006 and 2017-2018. This suggests that models of dental service provision in Australia are increasingly benefitting those who can afford and access the care and who arguably need the services less than their less socially advantaged counterparts do.

Who is Anaemic in India? Intersections of class, caste, and gender.

Anaemia severely impacts physical and mental abilities, raises health risks, and diminishes the quality of life and work capacity. It is a leading cause of adverse pregnancy outcomes and maternal mortality, especially in developing nations like India, where recent data on anaemia from National Family and Health Survey (NFHS-4) (2015-16) and NFHS-5 (2019-21) indicate a tremendous rise. Anaemia is a marker of poor nutrition and health, and socio-economic factors such as gender norms, race, income, and living conditions influence its impact. As a result, there are disparities in how anaemia affects different segments of society. However, existing research on health inequity and anaemia often employs a single-axis analytical framework of social power. These studies operate under the assumption that gender, economic class, ethnicity, and caste are inherently distinct and mutually exclusive categories and fail to provide a comprehensive understanding of anaemia prevalence. Therefore, the study has adopted the theoretical framework of intersectionality and analysed the NFHS-5 (2019-21) data using bivariate cross-tabulations and binary logistic regression models to understand how gender, class, caste, and place of residence are associated with the prevalence of anaemia. The results suggest that the women of Scheduled Tribes (ST) and Scheduled Castes (SC) share a disproportionate burden of anaemia. This study confirms that economic class and gender, geographical location, level of education, and body mass index significantly determine the prevalence of anaemia. The ST and SC women who are economically marginalised and reside in rural areas with high levels of poverty, exclusion, and poor nutritional status have a higher prevalence of anaemia than other population groups. Thus, the study suggests that intersections of multiple factors such as caste, class, gender, and place of residence significantly determine 'who is anaemic in India'.

Association between trajectories of the neighborhood social exposome and mental health in late adolescence: A FinnTwin12 cohort study.

BACKGROUND: Adolescent mental health problems impose a significant burden. Exploring evolving social environments could enhance comprehension of their impact on mental health. We aimed to depict the trajectories of the neighborhood social exposome from middle to late adolescence and assess the intricate relationship between them and late adolescent mental health. METHODS: Participants (n = 3965) from the FinnTwin12 cohort with completed questionnaires at age 17 were used. Nine mental health measures were assessed. The social exposome comprised 28 neighborhood social indicators. Trajectories of these indicators from ages 12 to 17 were summarized via latent growth curve modeling into growth factors, including baseline intercept. Mixture effects of all growth factors were assessed through quantile-based g-computation. Repeated generalized linear regressions identified significant growth factors. Sex stratification was performed. RESULTS: The linear-quadratic model was the most optimal trajectory model. No mixture effect was detected. Regression models showed some growth factors saliently linked to the p-factor, internalizing problems, anxiety, hyperactivity, and aggression. The majority of them were baseline intercepts. Quadratic growth factors about mother tongues correlated with anxiety among sex-combined participants and males. The linear growth factor in the proportion of households of couples without children was associated with internalizing problems in females. LIMITATIONS: We were limited to including only neighborhood-level social exposures, and the multilevel contextual exposome situation interfered with our assessment. CONCLUSIONS: Trajectories of the social neighborhood exposome modestly influenced late adolescent mental health. Tackling root causes of social inequalities through targeted programs for living conditions could improve adolescent mental health.

How traditional Norwegian outdoor activities are changing; a 10-year follow up in relation to sociodemographic factors.

Introduction: The study aims to evaluate the relationship between sociodemographic factors and changes in Norwegian outdoor activities between 2008 and 2018. Traditional outdoor activities, such as family trips in nature, the gathering of mushrooms and wild berries, and growing one's own plants to eat, are believed to have a positive impact on physical activity levels and health in general. Method: This study includes repeated cross-sectional surveys conducted in 38 randomly selected schools across two Norwegian counties. In 2008, 1,012 parents of 6th and 7th grade students from 27 schools completed a questionnaire. In 2018, 609 new parents from 25 schools participated. Variables were dichotomized. Descriptive analyses between groups were conducted using chi-square statistics. Binary logistic regression analyses were performed with the three outdoor activities as dependent variables, including year only (model 1), and then also gender, age (continuous), education (own and partners), and household income as independent variables (model 2). Results: Participation in weekly family trips in nature increased from 22% to 28% (p = 0.002), the OR for year 2018 vs. year 2008 was 1.51. Adjusted for sociodemographic factors, the OR remained stable and significant. Education was the only significant sociodemographic factor (OR = 1.60), indicating the odds of those with a higher education to be 60% higher to engage in weekly family trips in nature. Gathering of wild mushrooms and plants remained stable with time. Being female (OR = 1.44), age (OR = 1.049) and education (OR = 1.49) was related to gathering. An increase in growing plants to eat was observed with an increase from 42% to 51% (p < 0.001), OR = 1.33. However, it did not remain significant in model 2. Education was, in general, positively related to growing food (OR = 1.35). Conclusion: We observed a positive increase in family trips in nature over the period from 2008 to 2018. Furthermore, elder parents seem to be more involved in the long-rooted traditional Norwegian grow- and gather culture, and a social gradient is apparent as those with higher education do participate more often in traditional outdoor activities.

The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study.

BACKGROUND AND HYPOTHESIS: Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. STUDY DESIGN: We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. STUDY RESULTS: Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. CONCLUSIONS: Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.

Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective.

OBJECTIVE: To study educational gradients in births after medical assisted reproduction across five countries with different institutional arrangements. DESIGN: We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in five countries. SUBJECTS: This study includes survey or register data containing information on births in five countries: N=61, 564 for Denmark, N= 37,533 for France, N=12,889 for Spain, N= 17,097 for the United Kingdom, and N=3,700,442 for the United States. INTERVENTION (FOR RCT) OR EXPOSURE (FOR OBSERVATIONAL STUDIES): None. MAIN OUTCOME MEASURES: Probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree. RESULTS: University educated mothers are more likely to give birth after assisted reproduction compared to mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whilst they attenuate but persist in the other countries. The United States seems to show a larger educational gradient. CONCLUSION: The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States - the context with the lowest subsidization - seems to show larger educational gradients than other contexts. In a context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realise their fertility intentions in countries with a less generous subsidization of treatments.

Residential mobility and persistently depressed voting among disadvantaged adults in a large housing experiment.

This study examines the impact of residential mobility on electoral participation among the poor by matching data from Moving to Opportunity, a US-based multicity housing-mobility experiment, with nationwide individual voter data. Nearly all participants in the experiment were Black and Hispanic families who originally lived in high-poverty public housing developments. Notably, the study finds that receiving a housing voucher to move to a low-poverty neighborhood decreased adult participants' voter participation for nearly two decades-a negative impact equal to or outpacing that of the most effective get-out-the-vote campaigns in absolute magnitude. This finding has important implications for understanding residential mobility as a long-run depressant of voter turnout among extremely low-income adults.

Child undernutrition in Brazil: the wound that never healed

Abstract Objective To describe the scenario of child undernutrition in Brazil and its determinants. Data source Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). Conclusion Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.

The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries.

This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.

Effects of chronic social equality and inequality conditions on passive avoidance memory and PTSD-like behaviors in rats under chronic empathic stress.

INTRODUCTION: Social inequality conditions induce aversion and affect brain functions and mood. This study investigated the effects of chronic social equality and inequality (CSE and CSI, respectively) conditions on passive avoidance memory and post-traumatic stress disorder (PTSD)-like behaviors in rats under chronic empathic stress. METHODS: Rats were divided into different groups, including control, sham-observer, sham-demonstrator, observer, demonstrator, and co-demonstrator groups. Chronic stress (2 h/day) was administered to all stressed groups for 21 days. Fear learning, fear memory, memory consolidation, locomotor activity, and PTSD-like behaviors were evaluated using the passive avoidance test. Apart from the hippocampal weight, the correlations of memory and right hippocampal weight with serum corticosterone (CORT) levels were separately assessed for all experimental groups. RESULTS: Latency was significantly higher in the demonstrator and sham-demonstrator groups compared to the control group. It was decreased significantly in other groups compared to the control group. Latency was also decreased in the observer and co-demonstrator groups compared to the demonstrator group. Moreover, the right hippocampal weight was significantly decreased in the demonstrator and sham-demonstrator groups compared to the control group. Pearson's correlation of memory and hippocampal weight with serum CORT levels supported the present findings. CONCLUSION: Maladaptive fear responses occurred in demonstrators and sham-demonstrators. Also, extremely high levels of psychological stress, especially under CSI conditions (causing abnormal fear learning) led to heightened fear memory and PTSD-like behaviors. Right hippocampal atrophy confirmed the potential role of CSI conditions in promoting PTSD-like behaviors. Compared to inequality conditions, the abnormal fear memory was reduced under equality conditions.

Relationship between social inequality perception patterns and depressive symptoms among Chinese adults: A national representative longitudinal study.

BACKGROUND: The rising prevalence of depressive symptoms presents a pressing global public health concern, exacerbated by prevailing social inequality. AIM: This study seeks to identify latent profiles of social inequality perception and explore their associations with depressive symptoms. METHODS: Data were obtained from the China Family Panel Studies (CFPS) involving 10,529 residents aged 18 years and above. Latent profile analysis (LPA) was used to identify different patterns of social inequality perception. Multiple linear regression analysis examined the links between these patterns and depressive symptoms. RESULTS: Three distinct patterns of social inequality perception were identified: the disappointed pattern (TDP), the neutral pattern (TNP), and the positive pattern (TPP). Perceived social inequality was significantly associated with short-term and long-term depressive symptoms (ß = .51, 95% CI [0.29, 0.72] vs. ß = .51, 95% CI [0.27, 0.74]). Increases in social inequality perception patterns were also related to more severe depressive symptoms (ß = .55, 95% CI [0.36, 0.74]). CONCLUSIONS: Increasing perceived social inequality is closely linked to elevated depressive symptoms in Chinese adults. This underscores the need for tailored strategies aimed at addressing heightened perceptions of social inequality to reduce the risk of depressive symptoms.

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review.

Background and objective: Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality. Methods: A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis. Results: Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care. Conclusion: The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

Trends in social inequality in breastfeeding duration in Denmark 2002-2019.

AIMS: The aim of the present study was to analyse trends in full breastfeeding for at least 4 months across socioeconomic position in Denmark over a 17-year-long period from 2002 to 2019 using parental education as the indicator of socioeconomic position. METHODS: The study used data on full breastfeeding collected between 2002 and 2019 by community health nurses in the collaboration Child Health Database, n=143,075. Data were linked with five categories of parental education from population registers. Social inequality was calculated as both the relative (odds ratio) and absolute social inequality (slope index of inequality). A trend test was conducted to assess changes in social inequality over time. RESULTS: A social gradient in full breastfeeding was found for the entire study period. The odds ratio for not being fully breastfed for at least 4 months ranged from 3.30 (95% confidence interval 2.83-3.84) to 5.09 (95% confidence interval 4.28-6.06) during the study period for infants of parents with the lowest level of education (primary school) compared with infants of parents with the highest level of education (5+ years of university education). The slope index of inequality was between -38.86 and -48.81 during the entire study period, P=0.80. This indicated that both the relative and absolute social inequality in full breastfeeding to at least 4 months of age was unchanged in the study period from 2002 to 2019. CONCLUSIONS: This study showed a persistent relative and absolute social inequality in full breastfeeding for at least 4 months from 2002 to 2019 in Denmark.

Increasing health inequality among Inuit in Greenland from 1993 to 2018: Different patterns for household assets, urbanization and a sociocultural index as indicators of social position.

Income inequality affects population health and wellbeing negatively. In Greenland, health inequality has been shown to exist among social groups, regionally and according to urbanization, and between Inuit and migrants from Denmark. The purpose of the study was to compare the changes in health inequality from 1993 to 2018 according to three measures of social position, i.e. a socioeconomic measure (household assets), a measure of urbanization and a composite sociocultural index. We hypothesized that social inequality in health increased parallel to the increasing economic inequality in Greenland. The sample was based on four population health surveys conducted among the Inuit in Greenland in 1993, 2005-2010, 2014 and 2018. The total number of interviews was 9024 and the total number of individuals interviewed was 5829, as participants were invited to several surveys as part of a cohort. As statistical measure of social disparity we used the slope index of inequality (SII) adjusted for age and sex. Analyses were performed with daily smoking, suicidal thoughts and obesity as health outcomes. Daily smoking was most prevalent among participants with low social position whereas obesity was most prevalent among participants with high social position. With household assets as indicator of social position, the results showed high and increasing social inequality for both daily smoking and obesity. Social inequality for daily smoking increased over time also for urbanization and the sociocultural index. The hypothesis that social inequality increased over time was thus confirmed for daily smoking and obesity but not for suicidal thoughts. With the results from the present study there is solid evidence to guide prevention and health care towards social equality in health.

"Well, that Was Pretty Clever!"-Ethnic Minority Women's Views on HPV Self-Sampling Devices for Cervical Cancer Screening: Attitudes to Brushes, First-Void Urine, and Menstrual Blood Devices.

BACKGROUND: Ethnic minority women are less likely to participate in cervical cancer uteri (CCU) screening compared to native women. Human Papillomavirus (HPV) self-sampling kits for CCU screening may be a potential strategy to increase participation. This study aimed to explore views and attitudes on four different types of self-sampling kits (two brushes, a first-void urine device, and a menstrual blood device) among non-Western ethnic minority women living in Denmark. METHODS: The study was a social science single case study based on focus group interviews with 30 women aged 32-54 with non-Western background from a deprived area. A phenomenological approach was applied to describe the phenomenon "self-sampling" as seen from the women's lifeworlds. The interviews were transcribed verbatim and analysed using systematic text condensation. RESULTS: The women expressed significant interest in the possibility of using HPV self-sampling kits as an alternative to being screened by their general practitioner. They were particularly motivated to use the non-invasive self-sampling kits for CCU screening as they were deemed suitable for addressing cultural beliefs related to their bodies and virginity. The women expressed interest in the use of the invasive self-sampling kits but were cautious, primarily due to lack of confidence in correctly performing self-sampling with a brush and due to cultural beliefs. CONCLUSION: The use of non-invasive self-sampling kits, such as a first-void urine collection device and menstrual blood pad, represents a promising solution to overcome cultural barriers and promote greater equality in CCU screening participation among non-Western ethnic minority women.

Urban-rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden.

BACKGROUND: Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban-rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban-rural disparities in the economic burden attributed to NO2 and the explanation for the disparities. METHODS: Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden. RESULTS: For every 10-µg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban-rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 µg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services. CONCLUSIONS: Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban-rural differences in socioeconomic status and medical resources contributed to the urban-rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.