Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

Blume, Miriam; Rattay, Petra; Hoffmann, Stephanie; Spallek, Jacob; Sander, Lydia; Herr, Raphael M.; Richter, Michael; Dragano, Nico; Pischke, Claudia R.; Iashchenko, Iryna; Hövener, Claudia; Wachtler, Benjamin

doi:10.3390/ijerph18157739

Cited by 12 publications

(9 citation statements)

References 90 publications

(372 reference statements)

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“…To date, few studies have investigated whether health inequalities in adolescents are mediated by familial determinants [ 47 ]. A scoping review by Blume et al [ 47 ] revealed that parenting practices, parental mental health, as well as family conflict and distress, were relevant mediators for health inequalities in childhood and adolescence. Regarding mediation by familial determinants, a relatively large number of studies have examined mental health of young people.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, for other health outcomes (e.g., SRH), this issue has received relatively little investigation. Blume et al’s review [ 47 ] identified only three studies that explored whether the association between SEP and young people’s SRH was mediated by familial determinants [ 22 , 48 , 49 ]. Of the two studies that analyzed mediation through the parent-child relationship, one revealed a significant result [ 49 ] whereas the other found no mediating effect [ 48 ].…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

et al. 2022

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

et al. 2022

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“…One limitation is that despite a large number of children attending day care facilities, this review focuses exclusively on the mediating and moderating effects of the family as the most important social environment in early childhood. The findings presented here should, therefore, be supplemented by reviews of cooperating research groups [ 68 ] on the effects of further relevant social environments, such as kindergartens [ 69 ] and schools [ 70 ], and by reviews examining late childhood and adolescence [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The dimensions of parental investment may be as manifold as follows: behaviour (e.g., parent–child time spent, promotion of extracurricular activities), nutrition (e.g., sufficiently nutritious diets), education (e.g., learning materials available at home), health behaviour and health (e.g., utilization of medical care, parental health behaviour, rules restricting of media use), and living conditions (e.g., residence) [ 25 – 28 ]. The FIM and FSM reflect theoretical assumptions of family’s mechanisms underlying health inequalities, which only have been studied with regard to few health conditions among children [ 29 ]. However, in line with the assumptions of social causation (e.g., FSM, FIM), family characteristics could depend on the SEP which, in turn, affects children’s health (defining mediating effects).…”

Section: Introductionmentioning

confidence: 99%

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries – a scoping review

et al. 2022

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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.

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“…Empirical research suggests upstream factors of health literacy may interact with each other and play different roles in child health literacy [ 89 , 90 ]. For example, family socioeconomic status has been found as a moderator in the relationship between health literacy and health outcomes such as health behaviours and health service use in the Irish population [ 90 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

Guo

Davis

et al. 2022

Children

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Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children’s developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7–9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0–37), the six-item Newest Vital Sign (NVS, score range 0–6), and the 16-item Health Literacy Survey (HLS, score range 0–16). Based on Manganello’s health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child’s health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.

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Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

Cited by 12 publications

References 90 publications

Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries – a scoping review

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

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