Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early-life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early-life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross-sectional sample of 6-year-olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early-life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural-urban differences in demographic, socioeconomic, early-life, and anthropometric variables, then created linear mixed models to evaluate associations between early-life variables and child anthropometric outcomes. Two-way interactions were tested between early-life variables and child sex, and between early-life variables and rural-urban residence. Results showed that rural children were shorter-statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6-year-old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early-life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.     

Estimation of secular trends in adult height, and childhood socioeconomic circumstances in three Eastern European populations

The objective of these analyses was to estimate the strength and direction of secular trends in adult height and childhood socioeconomic circumstances in eight towns in three Eastern European countries in the mid-20th century, and to assess the extent to which childhood conditions might explain the height differences. We used cross-sectional data from the baseline survey of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study, conducted in 2002-2005. The study examined 24,012 men and women born between 1933 and 1957, randomly selected from the general populations of Novosibirsk (Russia), Krakow (Poland) and six towns of the Czech Republic. To allow for age-related height loss we estimated maximum attained height. Parental education and household item ownership at age 10 were used as markers of childhood socioeconomic conditions. In all 5-year birth cohorts, Novosibirsk men and women were shortest. There were positive and statistically significant secular trends in childhood conditions and in maximum adult height. Adjustment for childhood conditions explained about one third of the trend in height. There appeared to be a small reduction in height of persons born during the Second World War which was, however, only significant in Novosibirsk. These results suggest that secular trends in height mirror, but are not wholly explained by, trends in socioeconomic circumstances in early life.     

Multivariate analysis of infant and child mortality in Java and Bali

The data used in this analysis come from the 1976 Indonesian Fertility Survey, part of the World Fertility Survey. The data are examined 3 times, fitting them to models which include different combinations of independent variables. The dependent variables are: 1) the proportion of children born between 5 and 15 years before the survey who died before their 1st birthday, for infant mortality; and 2) among those alive on their 1st birthday, the proportions who died before reaching their 5th birthday, for child mortality. The figures indicate that the chance of dying for children who were 1st born, born shortly after a previous child, whose previous sibling had died, who lived in rural areas, or had parents who were young and with little education, was greater than for children without these characteristics. In all 3 models used, the greatest net effects are attributed to the survival of a preceding sibling or the length of the preceding interval. Birth order does not have a significant gross effect on infant mortality, but the net effects are significant because of the control on maternal age. Education of both parents has significant effects, but these are overshadowed in magnitude by the demographic variables. Maternal education has a greater influence in determining differences in child mortality than was found for infant mortality. Father's education also has a significant independent effect, but mainly for 1st births. It is uncertain whether these variables are measuring the effect of schooling as such, or other characteristics such as economic status or various social roles adopted by people with different levels of education. The variables distinguishing urban from rural status shows significant gross effects which are greatly reduced when controls for other variables are introduced in the model which includes all births. That is to say, the difference in the survival chances of a child in the city is more a function of the education of its parents, and the associated demographic variables than city residence as such. Access to medical services is quite probably the main element in these differences. The findings are weakened to some extent by the lack of satisfactory data on household economic status which might have provided a better base for indirectly discerning the effects of nutrition and sanitation on mortality at young ages.     

Blood pressure and hypertension in an American colony (Puerto Rico) and on the USA mainland compared, 1886–1930

We compare blood pressure and hypertension between adult men on the USA mainland and in Puerto Rico born during 1886-1930 to test hypotheses about the link between cardiovascular health and large socioeconomic and political changes in society: (a) 8853 men surveyed in Puerto Rico in 1965 and (b) 1449 non-Hispanic White men surveyed on the mainland during 1971-1975. Systolic and diastolic blood pressure and hypertension were regressed separately on demographic and socioeconomic variables and cardiovascular risk factors. Mainland men not taking anti-hypertensive medication showed statistically significant improvements in systolic blood pressure and hypertension at the beginning of the century and men in Puerto Rico showed improvements in diastolic blood pressure but only during the last two quinquenniums. An average man born on the mainland during the last birth quinquennium (1926-1930) had 7.4-8.7 mmHg lower systolic blood pressure and was 61% less likely to have systolic hypertension than one born before 1901. On average Puerto Rican men born during 1921-1925 had approximately 1.7 mmHg lower diastolic blood pressure than men born before 1901. Analyses of secular trends in cardiovascular health complements analyses of secular trends in anthropometric indicators and together provide a fuller view of the changing health status of a population.     

The association of adolescent socioeconomic position and adult height: Variation across racial/ethnic groups

Numerous studies have demonstrated the association of childhood socioeconomic position and adult height. Many have suggested the use of adult height as a marker of overall childhood well-being. However, few studies have examined the relationship between child/adolescent socioeconomic position and adult height in a racially/ethnically diverse cohort. Using the National Longitudinal Study of Adolescent Health, we examined the association of child/adolescent SEP (maternal education and maternal report of household income) and measured adult height in a diverse cohort of US adolescents/young adults. We found a positive gradient effect of maternal education on height in the overall population and in White and Mixed race males and females; no such gradient existed in Hispanic, Asian, or Black males or females. Only in Mixed race females was household income positively associated with height. These findings emphasize the need to recognize differential effects of socioeconomic status on height in different racial/ethnic and gender subpopulations.     

Biosocial correlates of stature in a British national cohort

Analyses of height variation using the 1970 UK national cohort study (12,508 children at age 10 and 5470 at age 16) found clear evidence that children of higher socioeconomic status (as measured by social class, crowding, tenure, type of accommodation, income and receipt of government financial assistance) were on average taller than children of lower socioeconomic status but there was little or no difference in average stature between children living in urban or rural areas. Significant differences in height remained for most of the variables after removing the effects of father's social class suggesting that reliance on social class per se to explain height variation is inadvisable.     

Differential fertility in Bangladesh: A path analysis

Abstract

This study attempts to show both theoretically and empirically the causal links between selected background, socioeconomic, and demographic variables, on the one hand, and between these variables and cumulative fertility, on the other. Two distinct models, urban and rural, emerge as a result of a statistical test. In both models, neither wife's nor husband's childhood background is found to have any significant direct effects on fertility. Wife's age, religion, and age at marriage are the common variables which directly affect the number of children ever born. While age and religion bear positive direct effects, age at marriage exerts a negative direct effect. The indirect effect of religion is positive both in the rural and urban area. Both the direct and indirect effects of wife's education on fertility in urban Bangladesh are negative. Husband's education, in contrast, has a positive direct effect in the urban area and no effect at all in the rural area.     

Socioeconomic variation in the growth status of children in a subsistence agricultural community

Socioeconomic variation in the growth status of 293 children, 6 through 13 years of age, from a rural subsistence agricultural community in southern Mexico was considered. Socioeconomic status was based on an index developed from landholdings, household goods, and occupation, and households were classified as high and low status. Growth measurements included weight, stature, sitting height, estimated leg length, arm and estimated arm muscle circumferences, triceps skinfold, and right gripping strength. The growth status of boys showed a clear socioeconomic differential, while that of girls did not. The results are consistent with the generalization that males are more influenced by environmental stresses than females, including, of course, the favorable stress of improved socioeconomic circumstances, even within seemingly single-class rural communities.     

The effect of divorce on infant mortality in a remote area of Bangladesh

The process of divorce is usually lengthy and hazardous, and can start quarrels that can lead to the abuse of women and their children. This study examines the effects of divorce on neonatal and postneonatal mortality of babies born before and after divorce in Teknaf, a remote area of Bangladesh. The longitudinal demographic surveillance system (DSS) followed 1,762 Muslim marriages in 1982-83 for 5 years to record divorce, deaths of spouse, emigration and births. It recorded 2,696 live births during the follow-up period, and their survival status during infancy. Logistic regression models were used to estimate the effect of divorce on neonatal and postneonatal mortality, controlling for maternal age at birth, parity, sex of the child and household economic status. The odds of neonatal and postneonatal deaths among babies born after divorce or less than 12 months before mothers were divorced were more than double the odds of those born to mothers of intact marriages. The odds of postneonatal deaths were two times higher among babies born more than 12 months before divorce happens than their peers. The high mortality of infants born before and after mothers were divorced may reflect how abusive marriage and divorce increase the vulnerability of women and children in rural Bangladesh. Divorce and abuse of women are difficult and intractable social and health problems that must be addressed.     

Adult male height in an American colony: Puerto Rico and the USA mainland compared, 1886–1955

The links between adult height and socioeconomic-political marginality are controversial. We test hypotheses by comparing secular trends between two groups of USA adult male citizens born during 1886-1930: (a) 9805 men surveyed in Puerto Rico during 1965 and (b) 3064 non-Hispanic Whites surveyed on the mainland during 1971-1975. Puerto Rico provides an apt case study because it is the oldest colony in the world and was the poorest region of the USA during the 20th century. During the period considered the average adult man in Puerto Rico was 164.8 cm tall, 8.3 cm shorter than the average adult man on the mainland (173.1cm). Both groups experienced secular improvements in height, with men on the mainland having higher rates than men in Puerto Rico. In neither case were results statistically significant. The modest changes in Puerto Rico likely reflect the offsetting role of improved health and a stagnant rural economy during the first half of the 20th century.     

Healthcare infrastructure, contraceptive use and infant mortality in Uttar Pradesh, India

This paper analyzes data on approximately 30,000 women from a survey in Uttar Pradesh in 1995 together with the data from surveys of public and private providers of healthcare and family planning services. A framework was developed for analyzing the effects of quality of services on utilization, and for understanding the gradual evolution of the healthcare infrastructure. The empirical results from logistic regressions for use of female sterilization and IUD showed significant effects of quality of services in government and private hospitals, and of socioeconomic variables such as education, caste, and an index of household possessions. Secondly, models for infant mortality of children born in the preceding 3-year period showed significant effects of socioeconomic variables, quality of healthcare services and birth spacing. Lastly, analysis of data at a more aggregated (Primary Sampling Unit) level indicated differential effects of economic development on the quality of services available in the public and private facilities.     

Changing determinants of infant and child mortality: on the basis of the Korean experience, 1955-73

Data from the 1974 Korean National Fertility Survey were analyzed to learn more about the main determinants of infant and child mortality in the course of mortality decline and how they change. In the Korean survey, about 5000 eligible women were selected for the individual survey and the sample design aimed at a self-weighting nationally representative and probability sample. Preliminary analysis showed clear mortality differentials between different socioeconomic levels and between demographic subgroups in infant and child mortality during the period 1955-73 in Korea. To examine the net effect of each variable on mortality, the logit-linear model was used. A table shows the probability level of 4 variables -- maternal age, birth order, mother's education, and number of rooms used by household -- in Korea, when the effects of others were controlled. In the urban areas, only the socioeconomic factors were the main determinants of infant mortality on all the birth cohorts. Mother's education and number of rooms used strongly affected infant mortality in the 1955-59 and 1960-64 birth cohorts, but the effects became weaker in the 1965-69 and 1970-73 birth cohorts, and their statistical significance was reduced. In the rural areas, the effects of 3 variables -- the exception being number of rooms used -- on infant mortality were statistically significant. It is concluded that the main determinants of infant mortality in urban areas were socioeconomic factors. The main determinants of infant mortality in the rural areas were demographic in the earlier birth cohorts, but in the recent birth cohorts mother's education, a socioeconomic factor, became the main determinant while the effects of demographic variables became weaker and finally disappeared. The change in the determinants of child mortality appears to be the reverse of that for infant mortality. Prior to the introduction of the national development program, in the rural areas mother's education was the main determinant of child mortality (rural 1955-59 cohort), but with the socioeconomic development the determinants changed to give dominance to demographic factors (urban 1955-59) cohort and, in the recent period, even the effects of demographic factors on child mortality became weaker (urban 1960-69 cohort). When the differences in living status by maternal age were weaker and the competition among siblings less because of small family size, only the socioeconomic variables remained as main determinants affecting child mortality.     

Age at first marriage in Nepal: differentials and determinants

The aim of this paper is to investigate the differentials and determinants of female age at first marriage in rural Nepal. The life table technique was employed to calculate median age at marriage. The proportional hazard model was used to study the effect of various socioeconomic variables, and to identify the magnitude and significance of their effects on the timing of first marriage. The data were taken from a sample survey of Palpa and Rupandehi districts in rural Nepal. Both married and unmarried females of marriageable age were included in the survey. Median age at marriage was about 17 years for data from only married females, whereas it was about 18 years for data from married as well as unmarried females of marriageable age. Median age at marriage was about 16 years for uneducated females and 19 years for females educated up to intermediate or higher level. The analysis underestimates the median age at marriage for married females, probably due to right censoring. The risk of getting married early decreased gradually with increasing year-of-birth cohort. The risk of early marriage was higher among females of high socioeconomic status compared with those of low socioeconomic status. Females engaged in service married earlier than those engaged in household work. High socioeconomic status families are motivated, for religious and prestige reasons, to get their daughters married at an early age, preferably before menarche. Thus, education, occupation and age at menarche are the most powerful factors in deciding the timing of first marriage in Nepal.     

Cigarette smoking by socioeconomic group,sex, and age: effects of price,income, and health publicity.

OBJECTIVE--To assess effects of price, income, and health publicity on cigarette smoking by age, sex, and socioeconomic group. DESIGN--Econometric multiple regression analysis of data on cigarette smoking from the British general household survey. SUBJECTS--Random sample of adult population in Britain interviewed for biennial general household surveys 1972-90. MAIN OUTCOME MEASURES--Changes in cigarette consumption and prevalence of smoking. RESULTS--Price elasticities of demand for cigarettes (percentage change in cigarette consumption for a 1% change in price) were significant at -0.5 (95% confidence interval -0.8 to -0.1) for men and -0.6 (-0.9 to -0.3) for women, were highest in socioeconomic group V (-1.0 for men and -0.9 for women), and lowest (not significantly different from zero) in socioeconomic groups I and II. The gradient in price elasticities by socioeconomic group was significant for men (F = 5.6, P = 0.02) and for women (F = 6.1, P = 0.02). Price was a significant factor in cigarette consumption by age for women in every age group and for men aged 25-34. Cigarette consumption by young men aged 16-34 increased with income. There was a significant decrease in smoking over time by women in socioeconomic groups I and II and by men in all age and social groups except socioeconomic group V attributable to health publicity. Price significantly affected smoking prevalence in socioeconomic group V (-0.6 for men and -0.5 for women) and for all women (-0.2). CONCLUSIONS--Men and women in lower socioeconomic groups are more responsive than are those in higher socioeconomic groups to changes in the price of cigarettes and less to health publicity. Women of all ages, including teenagers, appear to have been less responsive to health publicity than have men but more responsive to price. Response to health publicity decreased linearly with age. Real price increases in cigarettes could narrow differences between socioeconomic groups in smoking and the related inequalities in health, but specific measures would be necessary to ameliorate effects on the most deprived families that may include members who continue to smoke. The use of a policy to steadily increase cigarette tax is likely to help achieve the government''s targets for smoking and smoking related diseases.     

Determinants of infant and early childhood mortality in Cameroon: The role of socioeconomic factors,housing characteristics,and immunization status

Abstract

This study examines factors impinging on the survival of children in Cameroon using longitudinal data collected by the United Nations Demographic Training and Research Institute of Yaounde, Cameroon. It deals especially with the role of socioeconomic factors (mother's education, employment, marital status, ethnicity, and household income), housing characteristics (construction materials, power source, source of water supply, extent of crowding), and immunization status on infant and child mortality. Two‐state parametric and nonparametric hazards models for the risk of death at any time within the course of the study are used, with and without accounting for unmeasured heterogeneity. Overall, overcrowding has robust deleterious effects on infant and child survival. As regards the effects of socioeconomic variables, the robustness of the effects of household income and ethnic differentials are unchanged, even after controlling for unmeasured heterogeneity; the deleterious effects of marital status are also apparent, but these effects are largely explained by unmeasured covariates. The data also suggest that the protective effects of full immunization status are robust and not contaminated by confounding factors, at least in the first 16 months of life. These findings provide solid ground to support immunization programs and efforts as a means to reduce significantly infant and child mortality.     

Assessment of the Magnitude of Contextual and Individual Demographic Effects on Diabetes Mellitus and Glucose Intolerance in Rural Southwest China: A Multilevel Analysis

Objective

This study aimed to determine the contribution of individual and contextual socioeconomic status (SES) to the prevalence of diabetes mellitus and glucose intolerance in the adult population in rural southwest China.

Methods

A population-based cross-sectional study of diabetes was performed in 4801(2152 men) Chinese adults (≥25 years old). Multilevel logistic regression model was used to examine the association between individuals’ and townships’ variables and the prevalence of diabetes mellitus and glucose intolerance.

Results

The age-and gender-standardized prevalence of diabetes mellitus and glucose intolerance were 7.1% (3.6% for undiagnosed) and 8.8% in adults aged ≥25 years, respectively, and increasing with age. Females were more likely to develop diabetes than males. The probability of developing diabetes increased with BMI. Both contextual and individual educational level and yearly household income were found to be negatively associated with the prevalence of diabetes. Residence in communities with a higher percentage of ethnic minorities was associated with higher prevalence of diabetes. Smoking had a protective effect for diabetes, drinking had a positive association with diabetes mellitus and glucose intolerance.

Conclusions

Diabetes mellitus and glucose intolerance are common in rural adults of southwest China by international standards. These results indicate that diabetes mellitus has become a major public health problem in rural areas in southwest China, and strategies aimed at the prevention and treatment of diabetes mellitus and glucose intolerance are needed.     

Reproductive and socioeconomic determinants of child survival: confounded, interactive, and age-dependent effects.

Studies of infant and child mortality have evolved to distinguish between two sets of explanatory variables-factors related to reproductive or maternal characteristics and socioeconomic factors, generally described as characteristics of the family or household. Almost all multivariate analyses include variables from each of these two sets, but there has been little consideration of the relationship between them. We examine how these two sets of variables jointly affect mortality. We test first for confounded effects by examining socioeconomic effects while excluding and then including reproductive variables in nested multivariate models. Next, we look for age-dependent effects among the explanatory variables and find that reproductive and socioeconomic factors affect mortality at differing ages of children. Finally, we examine interactive effects of the two sets of variables. We conclude that the higher mortality observed among the low status groups is not a result of greater concentration of poor reproductive patterns in those groups. Instead, higher status groups probably have more resources available for combating the negative effects of the same high-risk reproductive patterns.     

Genetic and environmental effects on growth of children from a subsistence agricultural community in southern Mexico

Sibling correlations for size attained in height, weight, sitting height, estimated leg length, the triceps skinfold, arm circumference, and estimated midarm muscle circumference were compared in 6- through 13-year-old schoolchildren grouped by household socioeconomic status. The children were residents of a Zapotec-speaking, subsistence agricultural community in the Valley of Oaxaca in southern Mexico. Sibling pairs were classified as being from high and low socioeconomic status (SES) households, and sibling correlations were computed within each SES group controlling for environmental effects derived from a factor analysis of information on household demography and land and livestock holdings. Like-sex siblings from lower SES households have significantly different correlations in four instances. Correlations are higher for leg length in lower SES brothers and higher for sitting height and weight in lower SES sisters, while the correlation for sitting height is higher in upper SES brothers. The sibling correlation results are not entirely consistent with observations on growth status by SES, particularly if the power and similarity of a common environment is the only cause of higher sibling correlations. Reduced body size under poorer socioeconomic and presumably nutritional circumstances is apparent, but it is not possible in this analysis to distinguish whether genotypic (developmental) plasticity or genetic adaptation, or both, are involved.     

A comparison of the body height of the Israeli-born and immigrants to Israel

This paper reports a study of body height in the adult Jewish population of Israel, comparing native-born with immigrant groups. The sample tested included 1,411 men and 961 women, all clinically healthy according to the results of multiphasic screening. The phenomenon observed in other immigration-absorbing countries also holds for Israel: native Israelis are significantly taller than their immigrant counterparts. The findings were verified over different age and working activity strata, and thus may be taken to reflect the influence of better socioeconomic and environmental conditions on the bodily development of those born in Israel.     

Month of birth, socioeconomic background and development in Swedish men

Season of birth has been shown to correlate with many aspects of somatic and mental disorders, development and social adaptation (so-called 'birth-date effects'). In a sample of young Swedish men, corresponding roughly to a one-year birth cohort, the results of intelligence tests, psychologists' ratings of psychological function, school achievement, body height, weight and self-reported health during childhood, were found to be correlated with month of birth, and--more strongly--father's socioeconomic status. The results were more favourable for men who were born during March-May (the period of highest birth rate), and whose fathers were of higher socioeconomic status, than for those born in November and December (the period of lowest birth rate), and whose fathers were in the lower socioeconomic group. It seems reasonable to conclude, from this study and previously reported findings, that these so-called 'birth-date effects' are determined by varying and often interacting biological and psychosocial factors. Among these factors, the light-induced entrainment of circadian and annual rhythms in the fetus and/or infant seems to be of pivotal importance. The organization of children into one-year age classes therefore produces an unfair lack of equality of possibilities.