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Special Issue "Health Inequalities in Children"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 March 2019).

Special Issue Editors

Guest Editor
Prof. Sharon Goldfeld

Centre for Community Child Health, Royal Children's Hospital, Murdoch Children’s Research Insitute, University of Melbourne, Melbourne, Australia
Website | E-Mail
Interests: child health and developmental inequities; system/service inequities; child health indicators; equity randomized controlled trials
Guest Editor
Prof. Dr. Lise Gauvin

Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
École de santé publique, Université de Montréal, Montreal, QC, Canada
Website | E-Mail
Interests: public health interventions and equity; physical activity and healthy eating; child and adolescent health; natural experiments, pragmatic trials, and methodological developments
Guest Editor
Assoc. Prof. Hannah Badland

Healthy Liveable Cities Group, Centre for Urban Research, RMIT University, Melbourne, Australia
Website | E-Mail
Interests: built environment indicators; health inequities; social determinants of health; vulnerable populations

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue investigating relationships between the built and social environments, and child health in the International Journal of Environmental Research and Public Health. This is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences (broadly defined) and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph. 

Improving the health of populations is an important objective for urban planners, service planners, policy makers, and public health officials alike. Public health means preventing disease, prolonging life, and promoting physical, mental, and social well-being. This is especially so for children where there is robust evidence to support the importance of a healthy early childhood in determining optimal and more equitable adult health and social outcomes. Inequities in outcomes are inequalities that are considered preventable. The environments that children grow up in can have a significant impact on the development and the health of their families; including the built and social environments.

The built environment, including neighborhoods, public spaces, parks, housing, services and transport systems may affect public health, through individual transport choices (e.g., using active modes instead of a car), activity patterns (e.g., promoting social participation), destinations (e.g. the places families can access for services) and environmental exposures. Complementing the built environment is the social environment. The social environment includes social ties/interaction and networks, as well as social capital, neighbourhood attachment, crime, trust, and safety. Not surprisingly there is overlap between the influence of social and physical/built environments, and both have the potential to influence children’s health and development. Research, both in cities and rural areas, and across low, middle and high-income countries, can offer actionable evidence and interventions for policy efforts and planning for public health; especially when considering how these might be targets for reducing child health inequities.

This Special Issue is open to any subject area related to relationships between the built and social environments and child health and development. The listed keywords suggest just a few of the many possibilities.

Prof. Sharon Goldfeld
Prof. Dr. Lise Gauvin
Assoc. Prof. Hannah Badland
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Built environment
  • Child health
  • Child development
  • Child mental
  • Emissions
  • Environmental exposures
  • Health geography
  • Health inequities
  • Healthy cities
  • Healthy eating
  • Independent mobility
  • Leisure
  • Neighbourhood effects
  • Neighbourhood indicators
  • Physical activity
  • Public health
  • Quality of life
  • Recreation
  • Sense of community
  • Social cohesion
  • Social determinants of health
  • Social epidemiology
  • Social participation
  • Urban development
  • Urban planning
  • Walkability

Published Papers (12 papers)

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Research

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Open AccessArticle
Does Place Matter? An International Comparison of Early Childhood Development Outcomes between the Metropolitan Areas of Melbourne, Australia and Montreal, Canada
Int. J. Environ. Res. Public Health 2019, 16(16), 2915; https://doi.org/10.3390/ijerph16162915
Received: 5 May 2019 / Revised: 24 July 2019 / Accepted: 28 July 2019 / Published: 14 August 2019
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Abstract
There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better [...] Read more.
There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better understand the impact of these ecological determinants on ECD. This study compared ECD outcomes between metropolitan Melbourne (Australia) and Montreal (Canada), and contrasted disparities across demographic and socioeconomic characteristics. Methods: Population wide surveys using the Early Development Instrument (EDI) were conducted among 4–6 years-old children in both Montreal and Melbourne in 2012, measuring five domains of ECD: 1-Physical Health/Well-Being (PHYS); 2-Social Competence (SOC); 3-Emotional Maturity (EMOT); 4-Language/Cognitive Development (COGN); and 5-Communication Skills/General Knowledge (COMM). Descriptive analyses of summary EDI indicators and domain indicators (including median scores and interquartile ranges) were compared between metropolitan areas, using their respective 95% confident intervals (CIs). Analyses were performed using Stata software (v14). Results: The proportion of children developmentally vulnerable in at least one domain of ECD was 26.8% (95% CIs: 26.2, 27.3) in Montreal vs. 19.2% (95% CIs: 18.8, 19.5) in Melbourne. The Melbourne advantage was greatest for EMOT and COGN (11.5% vs. 6.9%; 13.0% vs. 5.8%). In both Montreal and Melbourne, boys, immigrants, children not speaking the language of the majority at home, and those living in the most deprived areas were at greater risk of being developmentally vulnerable. Relative risks as a function of home language and area-level deprivation subgroups were smaller in Montreal than in Melbourne. Conclusion: This study shows that Melbourne’s children globally experience better ECD outcomes than Montreal’s children, but that inequity gaps are greater in Melbourne for language and area-level deprivation subgroups. Further research is warranted to identify the environmental factors, policies, and programs that account for these observed differences. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
Open AccessFeature PaperArticle
The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia
Int. J. Environ. Res. Public Health 2019, 16(11), 1970; https://doi.org/10.3390/ijerph16111970
Received: 28 March 2019 / Revised: 14 May 2019 / Accepted: 21 May 2019 / Published: 3 June 2019
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Abstract
Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally [...] Read more.
Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Predictors of In-Hospital Mortality in Aboriginal Children Admitted to a Tertiary Paediatric Hospital
Int. J. Environ. Res. Public Health 2019, 16(11), 1893; https://doi.org/10.3390/ijerph16111893
Received: 23 March 2019 / Revised: 25 May 2019 / Accepted: 26 May 2019 / Published: 29 May 2019
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Abstract
Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify [...] Read more.
Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children’s Hospitals Network (SCHN) over five years (2011–2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, p < 0.001), neoplasm/blood/immune disorders (OR 2.77, p < 0.001), emergency admissions (OR 1.94, p < 0.001), aboriginality (OR 1.73, p = 0.005) and longer length of stay (OR 1.012; p < 0.001). Conclusions: Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
Open AccessArticle
Local Housing Characteristics Associated with Early Childhood Development Outcomes in Australian Disadvantaged Communities
Int. J. Environ. Res. Public Health 2019, 16(10), 1719; https://doi.org/10.3390/ijerph16101719
Received: 29 March 2019 / Revised: 7 May 2019 / Accepted: 8 May 2019 / Published: 16 May 2019
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Abstract
Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The [...] Read more.
Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015–2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing ‘better than expected’ and ‘as expected’ on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Aboriginal Status and Neighborhood Income Inequality Moderate the Relationship between School Absenteeism and Early Childhood Development
Int. J. Environ. Res. Public Health 2019, 16(8), 1347; https://doi.org/10.3390/ijerph16081347
Received: 21 March 2019 / Revised: 7 April 2019 / Accepted: 12 April 2019 / Published: 15 April 2019
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Abstract
The negative impact of school absenteeism on children’s academic performance has been documented in the educational literature, yet few studies have used validated development indicators, or investigated individual and neighborhood characteristics to illuminate potential moderating factors. Using cross-sectional Early Development Instrument (EDI) panel [...] Read more.
The negative impact of school absenteeism on children’s academic performance has been documented in the educational literature, yet few studies have used validated development indicators, or investigated individual and neighborhood characteristics to illuminate potential moderating factors. Using cross-sectional Early Development Instrument (EDI) panel data (2001–2005) we constructed multilevel linear and logistic regression models to examine the association between school absenteeism and early childhood development, moderated by Aboriginal status, length of school absence, neighborhood-level income inequality, and children’s sex assigned at birth. Our study included 3572 children aged four to eight in 56 residential neighborhoods in Saskatoon, Canada. Results indicated that Aboriginal children missing an average number of school days (3.63 days) had significantly lower EDI scores compared to non-Aboriginal children, controlling for individual and neighborhood factors. As school absenteeism lengthened, the gap in EDI scores between Aboriginal and non-Aboriginal children narrowed, becoming non-significant for absences greater than two weeks. Children with long-term school absence (>4 weeks of school), living in neighborhoods of low income inequality, had significantly better physical and social development scores compared to children from medium or high income inequality neighborhoods. Across all EDI domains, girls living in neighborhoods with low income inequality had significantly better EDI scores than boys in similar neighborhoods; however, sex-differences in EDI scores were not apparent for children residing in high income inequality neighborhoods. Results add to the literature by demonstrating differences in the relationship between school absenteeism and early developmental outcomes moderated by Aboriginal status, length of school absence, neighborhood income inequality, and sex assigned at birth. These moderating factors show that differential approaches are necessary when implementing policies and programs aimed at improving school attendance. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital
Int. J. Environ. Res. Public Health 2019, 16(8), 1326; https://doi.org/10.3390/ijerph16081326
Received: 4 March 2019 / Revised: 1 April 2019 / Accepted: 8 April 2019 / Published: 12 April 2019
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Abstract
Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data [...] Read more.
Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
Open AccessArticle
Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth
Int. J. Environ. Res. Public Health 2019, 16(8), 1313; https://doi.org/10.3390/ijerph16081313
Received: 22 February 2019 / Revised: 1 April 2019 / Accepted: 9 April 2019 / Published: 12 April 2019
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Abstract
The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that [...] Read more.
The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that converge on the AT experiences of low-income youth and youth of color (YOC) that have yet to be fully uncovered. This study uses an intersectional framework, largely focusing on the race-gender-class trinity, to examine youth AT within a context of transportation inequity. Theoretically guided by the Ecological Model of Active Transportation, focus groups were completed with two groups of girls (15 participants) and two groups of boys (nine participants) ranging between the ages of 12–15 years who lived within the Washington D.C. area. This research found race, gender, and class to be inhibitors of AT for both boys and girls, but with more pronounced negative influences on girls. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
The Effect of Rotavirus Vaccine on Socioeconomic Differentials of Paediatric Care Due to Gastroenteritis in Swedish Infants
Int. J. Environ. Res. Public Health 2019, 16(7), 1095; https://doi.org/10.3390/ijerph16071095
Received: 30 January 2019 / Revised: 14 March 2019 / Accepted: 22 March 2019 / Published: 27 March 2019
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Abstract
Background: Previous Swedish studies have shown a social gradient on paediatric care for viral gastroenteritis. Aim: To study the effect of a free rotavirus vaccine programme on hospital care for viral gastroenteritis. Method: A register-based national cohort study of paediatric [...] Read more.
Background: Previous Swedish studies have shown a social gradient on paediatric care for viral gastroenteritis. Aim: To study the effect of a free rotavirus vaccine programme on hospital care for viral gastroenteritis. Method: A register-based national cohort study of paediatric in- and outpatient care for viral gastroenteritis in children <2 years old in two Swedish counties in 2014–2017, with the rest of the country as comparison. Adjusted hazard ratios were estimated by the differences-in-differences (DiD) estimator in Cox regression in the entire cohort and by social indicators. Results: Reductions of 37% and 24% for inpatient care, and 11 % and 21% for outpatient care for viral gastroenteritis were found in the Stockholm and Jönköping counties, respectively, after adjusting for time trends and social indicators. For inpatient care, the change was similar over social groups in both counties. In the larger county of Stockholm, smaller reductions in outpatient care were detected for children in socially disadvantaged families. Conclusions: A free rotavirus vaccination programme moderately reduced paediatric care for viral gastroenteritis. There were indications of an increase in socioeconomic differences in paediatric outpatient care for viral gastroenteritis, but further studies are needed to confirm this result in a broader health care perspective. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Visualising Combined Time Use Patterns of Children’s Activities and Their Association with Weight Status and Neighbourhood Context
Int. J. Environ. Res. Public Health 2019, 16(5), 897; https://doi.org/10.3390/ijerph16050897
Received: 21 January 2019 / Revised: 23 February 2019 / Accepted: 6 March 2019 / Published: 12 March 2019
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Abstract
Compositional data techniques are an emerging method in physical activity research. These techniques account for the complexities of, and interrelationships between, behaviours that occur throughout a day (e.g., physical activity, sitting, and sleep). The field of health geography research is also developing rapidly. [...] Read more.
Compositional data techniques are an emerging method in physical activity research. These techniques account for the complexities of, and interrelationships between, behaviours that occur throughout a day (e.g., physical activity, sitting, and sleep). The field of health geography research is also developing rapidly. Novel spatial techniques and data visualisation approaches are increasingly being recognised for their utility in understanding health from a socio-ecological perspective. Linking compositional data approaches with geospatial datasets can yield insights into the role of environments in promoting or hindering the health implications of the daily time-use composition of behaviours. The 7-day behaviour data used in this study were derived from accelerometer data for 882 Auckland school children and linked to weight status and neighbourhood deprivation. We developed novel geospatial visualisation techniques to explore activity composition over a day and generated new insights into links between environments and child health behaviours and outcomes. Visualisation strategies that integrate compositional activities, time of day, weight status, and neighbourhood deprivation information were devised. They include a ringmap overview, small-multiple ringmaps, and individual and aggregated time–activity diagrams. Simultaneous visualisation of geospatial and compositional behaviour data can be useful for triangulating data from diverse disciplines, making sense of complex issues, and for effective knowledge translation. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Prevalence of Childhood Overweight and Obesity in Liverpool between 2006 and 2012: Evidence of Widening Socioeconomic Inequalities
Int. J. Environ. Res. Public Health 2018, 15(12), 2612; https://doi.org/10.3390/ijerph15122612
Received: 13 October 2018 / Revised: 12 November 2018 / Accepted: 19 November 2018 / Published: 22 November 2018
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Abstract
The primary aim of this study was to describe the prevalence of childhood overweight and obesity in Liverpool between 2006 and 2012. A secondary aim was to examine the extent to which socioeconomic inequalities relating to childhood overweight and obesity in Liverpool changed [...] Read more.
The primary aim of this study was to describe the prevalence of childhood overweight and obesity in Liverpool between 2006 and 2012. A secondary aim was to examine the extent to which socioeconomic inequalities relating to childhood overweight and obesity in Liverpool changed during this six-year period. A sample of 50,125 children was created using data from the National Child Measurement Program (NCMP) in Liverpool. The prevalence of overweight and obesity was calculated for Reception and Year 6 aged children in Liverpool for each time period by gender and compared against published averages for England. Logistic regression analyses examined the likelihood of children in Liverpool being classified as overweight and obese based on deprivation level for each time period. Analyses were conducted separately for Reception and Year 6 aged children and were adjusted for gender. The prevalence of overweight and obesity among Reception and Year 6 aged children in Liverpool increased between 2006 and 2012. During the same period, socioeconomic disparities in overweight and obesity prevalence between children living in the most deprived communities in Liverpool and those living in less deprived communities in Liverpool, widened. This study evidences rising rates of overweight and obesity among Liverpool children and widening socioeconomic health inequalities within Liverpool, England’s most deprived city between 2006 and 2012. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Open AccessArticle
Cystic Fibrosis Mortality in Childhood. Data from European Cystic Fibrosis Society Patient Registry
Int. J. Environ. Res. Public Health 2018, 15(9), 2020; https://doi.org/10.3390/ijerph15092020
Received: 31 July 2018 / Revised: 29 August 2018 / Accepted: 7 September 2018 / Published: 15 September 2018
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Abstract
Data collected in the European Cystic Fibrosis Society Patient Registry (ECFSPR) database were used to investigate whether risk factors for death in childhood and adolescents CF patients have different impact in countries of different income. In this way, it is possible to recognize [...] Read more.
Data collected in the European Cystic Fibrosis Society Patient Registry (ECFSPR) database were used to investigate whether risk factors for death in childhood and adolescents CF patients have different impact in countries of different income. In this way, it is possible to recognize where interventions could improve the quality of care and survival in these patients. We matched deceased and alive patients by age, country, year of follow-up. Multivariable logistic models were developed. In the years of this study, the ECFSPR collected information on 24,416 patients younger than 18 years: 7830 patients were from countries with low/middle income and 16,586 from countries with high income; among these the dead are 102 and 107 (p < 0.001), respectively. The use of oxygen, forced expiratory volume in one second (FEV1) below 40% and BMI standard deviation score (SDS) below −2 represent risk factors for death. However, some patients from countries with high income remain alive even if their values of FEV1% and BMI-SDS were low, and some deceased patients from countries with high income had high values of FEV1% (>60%). Evaluation of mortality in pediatric age may reflect the availability of resources for CF diagnosis and treatment in some countries. Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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Review

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Open AccessReview
Reducing Inequities in Early Childhood Mental Health: How Might the Neighborhood Built Environment Help Close the Gap? A Systematic Search and Critical Review
Int. J. Environ. Res. Public Health 2019, 16(9), 1516; https://doi.org/10.3390/ijerph16091516
Received: 29 March 2019 / Revised: 18 April 2019 / Accepted: 27 April 2019 / Published: 29 April 2019
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Abstract
Background: Optimal mental health in early childhood is key to later mental health, physical health, education, and social outcomes; yet, children facing disadvantage tend to have worse mental health and fewer opportunities to develop this foundation. An emerging body of research shows that [...] Read more.
Background: Optimal mental health in early childhood is key to later mental health, physical health, education, and social outcomes; yet, children facing disadvantage tend to have worse mental health and fewer opportunities to develop this foundation. An emerging body of research shows that neighborhoods provide important opportunities for the development of children’s mental health. Synthesizing this evidence can advance understandings of the features of the neighborhood built environment (e.g., housing, parks) that (1) promote optimal mental health in childhood and (2) reduce mental health inequities. Methods: We systematically searched and critically reviewed the international quantitative literature investigating associations between the neighborhood built environment and young children’s mental health. Results: 14 articles met inclusion criteria; most examined nature or public open space. Studies tended to find greater access to or quantity of neighborhood nature or public open space were associated with better mental health. Significant gaps included a lack of studies investigating social infrastructure, and few studies examined how the built environment related to positive mental health (i.e., functioning, rather than problems). Conclusions: Current evidence suggests there is some relationship, but additional research is needed that addresses these gaps and examines differences in associations between child subgroups (e.g., diverse socioeconomic backgrounds). Full article
(This article belongs to the Special Issue Health Inequalities in Children)
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