Background By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children’s health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries. Methods This review followed the methodology of “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews”. To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator “AND”: (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus. Results The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent–child conflicts) are identified to have mediating or moderating effects. While families’ living conditions (i.e., TVs in children’s bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities. Conclusion Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children’s health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.
Zusammenfassung Hintergrund Multiple Sklerose (MS) ist eine chronisch progredient verlaufende Erkrankung, welche mit einer Vielzahl von MS-spezifischen Symptomen einhergeht. Viele dieser Symptome wirken sich negativ auf die gesundheitsbezogene Lebensqualität (Health Related Quality of Life, HRQoL) der Betroffenen aus. Bisher ungeklärt ist, welche MS-spezifischen Symptome einen besonders großen Einfluss auf die HRQoL haben. Methodik Die durchgeführte Untersuchung basiert auf den Daten einer Mitgliederbefragung der Deutschen MS Gesellschaft (DMSG) im Jahr 2015 (n = 424). Unter Berücksichtigung von soziodemographischen Variablen und allgemeinen medizinischen Variablen wurde der Einfluss der MS-spezifischen Symptome auf die HRQoL untersucht. Die HRQoL wurde mit dem Multiple Sclerosis Quality of Life-54-Instrument (MSQOL-54-Instrument) erhoben. In einem Vortest wurden alle Einflussfaktoren auf einen signifikanten Mittelwertunterschied (p = 0,05) bzw. eine mittlere Korrelation (Pearson’s r ≥ 0,3) getestet. Anschließend wurde der Einfluss der im Vortest identifizierten Variablen auf die HRQoL mithilfe der multiplen linearen Regressionsanalyse untersucht. Ergebnisse Für die Befragten konnte ein durchschnittlicher Physical Health Composite Score (PHCS) von 48,3 (sd = 17,7) und ein durchschnittlicher Mental Health Composite Score von 56,0 (sd = 20,1) errechnet werden. Als wichtigste Einflussfaktoren auf die HRQoL ergeben sich die MS-spezifischen Symptome Depression, Schmerz und kognitive Einschränkungen. MS-bedingte Symptome mit einem Mobilitätskontext zeigen negativen Zusammenhang mit dem PHCS. Sprechstörung und Schwindel sind mit einem abnehmenden MHCS verbunden. Der Beschäftigungsstatus ist der einzige sozioökonomische Faktor, der sich in der multiplen Regression signifikant auf die HRQoL auswirkt. Die allgemeinen medizinischen Faktoren zeigen keinen signifikanten Einfluss auf die HRQoL. Schlussfolgerung MS-spezifische Symptome haben einen großen Einfluss auf die HRQoL von Menschen mit MS. In der Untersuchung konnte gezeigt werden, dass besonders die sogenannten „versteckten Symptome“ einen wesentlichen Einfluss auf die HRQoL haben. Hier sind beispielsweise die Symptome Depression, Schmerz und kognitive Einschränkungen zu nennen. Diese sollten stärker in der Versorgung von Menschen mit MS berücksichtigt werden.
This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6–18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.
Objective Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family’s socioeconomic position and adolescents’ self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. Methods Using data from wave 2 of the”German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents’ subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. Conclusion The analysis revealed how a family’s position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).
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