Jessica M. Perkins

Weight of nations: a socioeconomic analysis of women in low- to middle-income countries

BACKGROUND The increasing trend in body mass index (BMI) and overweight in rapidly developing economies is well recognized. OBJECTIVE We assessed the association between socioeconomic status and BMI and overweight in low- to middle-income countries. DESIGN We conducted a cross-sectional analysis of nationally representative samples of 538,140 women aged 15-49 y drawn from 54 Demographic and Health Surveys conducted between 1994 and 2008. BMI, calculated as weight in kilograms divided by height squared in meters, was specified as the outcome, and a BMI (in kg/m(2)) of ≥25 was additionally specified to model the likelihood of being overweight. Household wealth and education were included as markers of individual socioeconomic status, and per capita Gross Domestic Product (pcGDP) was included as a marker of country-level economic development. RESULTS Globally, a one-quartile increase in wealth was associated with a 0.54 increase in BMI (95% CI: 0.50, 0.64) and a 33% increase in overweight (95% CI: 26%, 41%) in adjusted models. Although the strength of this association varied across countries, the association between wealth and BMI and overweight was positive in 96% (52 of 54) of the countries. Similar patterns were observed in urban and rural areas, although SES gradients tended to be greater in urban areas. There was a positive association between pcGDP and BMI or overweight, with only weak evidence of an interaction between pcGDP and wealth. CONCLUSION Higher BMI and overweight remain concentrated in higher socioeconomic groups, even though increasing BMI and overweight prevalence are important global public concerns.

Do burdens of underweight and overweight coexist among lower socioeconomic groups in India

BACKGROUND The coexistence of underweight and overweight in rapidly developing economies is well recognized. However, less is known about the socioeconomic patterning of underweight and overweight as economies move through the epidemiologic transition. OBJECTIVE The objective was to assess whether burdens of underweight and overweight coexist among lower socioeconomic groups in India. DESIGN Repeated cross-sectional analyses were conducted in nationally representative samples of 76,514 and 80,054 women aged 15-49 y drawn from the 1998-1999 and 2005-2006 Indian National Family Health Survey, respectively. Body mass index (in kg/m(2)) was used to measure weight status. We also calculated a ratio of the number of underweight women (<18.5) divided by the number of overweight women (>24.9). Indicators of socioeconomic status (SES) included wealth and education. RESULTS Although the ratio of underweight to overweight women decreased from 3.3 in 1998-1999 to 2.2 in 2005-2006, there were still considerably more underweight women than overweight women. It was only in the top wealth quintile and in groups with higher education that there was a slight excess of overweight women as compared with underweight women. There was a strong positive relation between SES and body mass index at both time points and across urban and rural areas. A positive relation between SES and body mass index was also observed for men in 2005-2006. CONCLUSIONS The distribution of underweight and overweight in India remains socially segregated. Despite rapid economic growth, India has yet to experience a situation in which underweight and overweight coexist in the low-SES groups.

Using social norms to reduce bullying: A research intervention among adolescents in five middle schools

Bullying attitudes and behaviors and perceptions of peers were assessed in a case study experiment employing a social norms intervention in five diverse public middle schools in the State of New Jersey (Grades 6 to 8). Data were collected using an anonymous online survey (baseline n = 2,589; postintervention n = 3,024). In the baseline survey, students substantially misperceived peer norms regarding bullying perpetration and support for probullying attitudes. As predicted by social norms theory, they thought bullying perpetration, victimization, and probullying attitudes were far more frequent than was the case. Also as predicted, variation in perceptions of the peer norm for bullying was significantly associated with personal bullying perpetration and attitudes. Using print media posters as the primary communication strategy, an intervention displaying accurate norms from survey results was conducted at each of the five school sites. A pre-/postintervention comparison of results revealed significant reductions overall in perceptions of peer bullying and probullying attitudes while personal bullying of others and victimization were also reduced and support for reporting bullying to adults at school and in one’s family increased. The extent of reductions across school sites was associated with the prevalence and extent of recall of seeing poster messages reporting actual peer norms drawn from the initial survey data. Rates of change in bullying measures were highest (from around 17% to 35%) for the school with the highest message recall by students after a one-and-a-half-year intervention. Results suggest that a social norms intervention may be a promising strategy to help reduce bullying in secondary school populations.

Social networks and health: a systematic review of sociocentric network studies in low- and middle-income countries.

In low- and middle-income countries (LMICs), naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various resources. Understanding how social network structure, and influential individuals within the network, may amplify the effects of interventions in LMICs, by creating, for example, cascade effects to non-targeted participants, presents an opportunity to improve the efficiency and effectiveness of public health interventions in such settings. We conducted a systematic review of PubMed, Econlit, Sociological Abstracts, and PsycINFO to identify a sample of 17 sociocentric network papers (arising from 10 studies) that specifically examined health issues in LMICs. We also separately selected to review 19 sociocentric network papers (arising from 10 other studies) on development topics related to wellbeing in LMICs. First, to provide a methodological resource, we discuss the sociocentric network study designs employed in the selected papers, and then provide a catalog of 105 name generator questions used to measure social ties across all the LMIC network papers (including both ego- and sociocentric network papers) cited in this review. Second, we show that network composition, individual network centrality, and network structure are associated with important health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, we highlight the opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. In summary, human health and wellbeing are connected through complex webs of dynamic social relationships. Harnessing such information may be especially important in contexts where resources are limited and people depend on their direct and indirect connections for support.

Adult height, nutrition, and population health

In this review, the potential causes and consequences of adult height, a measure of cumulative net nutrition, in modern populations are summarized. The mechanisms linking adult height and health are examined, with a focus on the role of potential confounders. Evidence across studies indicates that short adult height (reflecting growth retardation) in low- and middle-income countries is driven by environmental conditions, especially net nutrition during early years. Some of the associations of height with health and social outcomes potentially reflect the association between these environmental factors and such outcomes. These conditions are manifested in the substantial differences in adult height that exist between and within countries and over time. This review suggests that adult height is a useful marker of variation in cumulative net nutrition, biological deprivation, and standard of living between and within populations and should be routinely measured. Linkages between adult height and health, within and across generations, suggest that adult height may be a potential tool for monitoring health conditions and that programs focused on offspring outcomes may consider maternal height as a potentially important influence.

Patterns and trends of adult height in India in 2005-2006

Differences in height by wealth, education, caste, geography, and birth years are examined for men and women born between 1961 and 1981 in India using data from the 2005-2006 Indian National Family Health Survey. There is a positive association between socioeconomic position (SEP) and height with lower SEP individuals being shorter. Height varies across the 29 Indian states even after accounting for individual differences in SEP, with substantial variation in height remaining at the neighborhood and state levels. Among men, height appears to have modestly increased for all birth cohorts as compared to the 1961-1965 cohort, with smaller increases for the most recent cohorts. For women, height across birth cohorts has shown little increase. These results suggest that inequalities in several health outcomes for low SEP adults may be reflected in inequalities in height, which can be used to represent long-term health at the population level. Shorter stature and slower growth among some groups may indicate that they did not experience the improvements that were assumed to have occurred across the population. This study presents a comprehensive, empirical description of mean height differences and the underlying variation among adults in India across diverse socioeconomic, demographic, and geographically oriented groups as well as birth cohorts.

Peer weight norm misperception as a risk factor for being over and underweight among UK secondary school students

Background:Erroneous perceptions of peer weight norms may be important risk factors for being underweight and overweight. This study assessed misperceptions of peer weight norms and their association with being overweight or underweight among UK youth.Methods:Anonymous surveys were conducted among students (n=2104) attending schools in a Greater London borough in Fall 2007. Students’ perceptions of the weight norm for same sex peers in their year in their school (years 5 through 11) are compared with the aggregate self-reports of weight for these same sex and year cohorts in each school. Variation in perceptions is compared with personal body mass index (BMI) on the basis of self-reported height and weight.Results:A total of 34% of males and 32% of females overestimated peer weight norms by more than 5% (10 kg on average). Similarly, 37% of males and 43% of females underestimated peer weight norms by more than 5% (7 kg on average). For both males and females, overestimating peer weight norms was associated with a greater risk for being overweight and underestimating peer weight norms was associated with a greater risk for being underweight. Perceived peer weight norm was the strongest predictor of BMI among females compared with estimated actual weight norms of peers (based on the mean of self-reported weight) and demographic factors, and one of the two strongest predictors among males in linear regression analyses, including schools as fixed effects.Conclusions:Pervasive misperceptions of peer weight norms may contribute to unhealthy weight-related behaviors and help perpetuate students’ overweight or underweight status. Future research should examine perceptions of other weight-related peer norms and explore what may create misperceptions. Addressing pervasive misperceptions of weight could perhaps be included as a part of interventions aimed at reducing unhealthy weight and related behaviors.

Patterns and distribution of HIV among adult men and women in India.

Background While the estimated prevalence of HIV in India experienced a downward revision in 2007, the patterning and distribution of HIV in the population remains unclear. We examined the individual and state-level socioeconomic patterning of individual HIV status among adult men and women in India as well as the patterning of other individual demographic and behavioral determinants of HIV status. Methodology/Principal Findings We conducted logistic regression models accounting for the survey design using nationally representative, cross-sectional data on 100,030 women and men from the 2005–2006 India National Family Health survey which, for the first time, provided objective assessments of HIV seroprevalence. Although there was a weak relationship between household wealth and risk of being HIV-positive, there was a clear negative relationship between individual education attainment and risk of being HIV-positive among both men and women. A 1000 Rupee change in the per capita net state domestic product was associated with a 4% and 5% increase in the risk for positive HIV status among men and women, respectively. State-level income inequality was associated with increased risk of HIV for men. Marital status and selected sexual behavior indicators were significant predictors of HIV status among women whereas the age effect was the most dominant predictor of HIV infection among men. Conclusions/Significance Although the prevalence of HIV in India is low, the lack of strong wealth patterning in the risk of HIV suggests a more generalized distribution of HIV risk than some of Indias high-risk group HIV prevention policies have assumed. The positive association between state economic development and individual risk for HIV is intriguing and requires further scrutiny.

Are republicans healthier than democrats

was 0.68 (95% CI 0.55, 0.85), 0.63 (95% CI 0.51, 0.76) and 0.71 (95% CI 0.56, 0.90), respectively. The differential for not very strong democrat was not statistically, significantly different from the reference group (strong democrat). However, independent near democrats had a lower OR of reporting poor health than strong democrats (OR 0.77, 95% CI 0.63 and 0.95). Independents (with no democrat or republican leaning) did not have a statistically, significant differential from strong democrats. In adjusted models, using ‘strong democrat’ as a reference, the OR for reporting smoking by strong republicans, not very strong republicans and independent near republicans was 0.76 (95% CI 0.65, 0.89), 0.76 (95% CI 0.66, 0.86) and 0.81 (95% CI 0.70, 0.95), respectively. The differential

Association between political ideology and health in Europe

Studies have largely examined the association between political ideology and health at the aggregate/ecological level. Using individual-level data from 29 European countries, we investigated whether self-reports of political ideology and health are associated. In adjusted models, we found an inverse association between political ideology and self-rated poor health; for a unit increase in the political ideology scale (towards right) the odds ratio (OR) for reporting poor health decreased (OR 0.95, 95% confidence interval 0.94-0.96). Although political ideology per se is unlikely to have a causal link to health, it could be a marker for health-promoting latent attitudes, values and beliefs.