استكشف المجموعة الواسعة من العناوين المتاحة.

This article seeks to elucidate the relationship between socioeconomic position and health by showing how different facets of socioeconomic position (education and income) affect different stages (onset vs. progression) of health problems. The biomedical literature has generally treated socioeconomic position as a unitary construct. Likewise, the social science literature has tended to treat health as a unitary construct. To advance our understanding of the relationship between socioeconomic position and health, and ultimately to foster appropriate policies and practices to improve population health, a more nuanced approach is required—one that differentiates theoretically and empirically among dimensions of both socioeconomic position and health. Using data from the Americans' Changing Lives Study (1986 through 2001/2002), we show that education is more predictive than income of the onset of both functional limitations and chronic conditions, while income is more strongly associated than education with the progression of both.

Objective To assess the 1‐year impacts of a healthy marriage and relationship education (HMRE) program for high school students. Background Research on HMRE programming for youth has found that programs can improve youth's relationship skills, attitudes, and knowledge around the time the program ends. However, there is less evidence on whether these impacts are sustained over time or when providers do not have enough time to deliver the full program. Method A three‐arm cluster randomized trial involving 1,862 students from two schools. The two intervention groups received either a 12‐lesson HMRE curriculum or a shortened eight‐lesson version of the same curriculum. Students completed surveys at baseline and 1 year later. Results Students in all three groups reported similar levels of relationship skills, attitudes, and knowledge for 9 of the 10 outcomes examined at the one‐year follow up. For the one exception, students offered the 12‐lesson curriculum were more likely than students in the control group to disagree that feelings of love are enough to sustain a happy marriage. Conclusion We found limited evidence of sustained impacts and no evidence of an effect from shortening the curriculum. Implications Offering HMRE to high school students might plant the seeds of healthy relationships, but more programming will probably be needed to sustain the types of short‐term impacts found in prior research.

Readers of this supplemental issue of AJPH will naturally wonder what to make of these studies in the context of the broader research literature on adolescent pregnancy and sexually transmitted infections (STIs), which has grown dramatically in the past 25 years.1 Since 2009, the US Department of Health and Human Services (HHS) has sponsored the Teen Pregnancy Prevention (TPP) Evidence Review-an ongoing systematic review of the research literature on programs to prevent adolescent pregnancy, STIs, and associated sexual risk behaviors. For this review, my colleagues and I have identified and assessed more than 250 impact studies of adolescent pregnancy prevention programs. These studies were released over a 26-year period from 1989 through 2015 and share similar designs, measures, and research questions as the studies featured in this supplemental issue of AJPH. We have documented our review findings on a public website and through a series of technical and substantive research briefs and articles.2 4 From our experience conducting the review, we have learned several lessons that may be useful for interpreting this supplemental issue of AJPH in the context of the broader research literature.

Fresh data sources on cross-national income are examined to document recent changes in the composition of world income inequality within and between nations. New evidence shows that during the 1980s and 1990s the composition of world income inequality experienced a fundamental change, characterized by the diminishing significance of between-nation income differences and the growing prominence of within-nation inequalities.

Research on inequality in America shows evidence of a growing social and economic divide between college graduates and people without college degrees. This article examines whether disparities in health between education groups have also recently increased. Pooled cross- sectional regression analyses of data from the National Health Interview Survey (NHIS) show that educational disparities in self-reported health status increased from 1982 to 2004 among older adults but held relatively steady or narrowed among younger adults. Sensitivity analyses show that the trends do not totally or primarily reflect change in the demographic composition of education groups. The trend of increasing disparities among older adults might reflect large and growing educational disparities in economic resources, health-promoting behaviors, or the use of health services and medical technology.

Based on 1970s data, the \"Heyneman-Loxley (HL) effect\" proposed that in developing nations, school variables were more important than family socioeconomic status in determining academic achievement. A reassessment of the HL effect using 1990s TIMSS data found the relationship between family background and student achievement to be similar across nations regardless of national income, suggesting that the spread of mass schooling has reduced the HL effect. (SV)

Objective The goal was to assess if integrating healthy marriage and relationship education (HMRE) into an employment program for young adults could improve their relationship and employment outcomes. Background Many HMRE programs offer economic stability services, yet this approach often does not consider that HMRE participants have different employment needs. There is little evidence on the alternative approach of adding HMRE to an employment program. Method We conducted a randomized controlled trial involving 908 participants seeking employment services. We randomly assigned them to (a) an intervention group offered an integrated HMRE and employment program or (b) a control group offered an employment program without HMRE. We measured outcomes 1 year later with survey and administrative data. Results The integrated program reached participants for whom both employment services and HMRE had relevance. However, program attendance was irregular, and participants in both research groups had similar outcomes after 1 year. Conclusion Integrating HMRE into an employment program is feasible but supporting regular attendance and meeting the needs of job seekers can be challenging. Implications Results suggest the need for new approaches to meeting the employment needs and supporting the economic stability of HMRE participants with low incomes. Results also contribute to emerging evidence on how a person's life circumstances might moderate the impacts of HMRE programming.

School violence is a problem in many nations, and rates of school violence in the United States are not among the highest in the world. The authors utilize a section of the TIMSS survey data to (a) explore the amount of school violence among the 37 nations in the study; (b) ascertain whether the traditional national-level predictors of crimes and delinquency explain cross-national variation in school violence; and (c) test whether factors related to the educational system are associated with levels of school violence cross-nationally. The results show that national patterns of school violence are not strongly related to general patterns of violence or lack of social integration in society. However, national systems of education that produce greater achievement differences between high-achieving and low-achieving students tend to record more violence. The authors suggest further studies and testing of one possible remedy for school violence: equalizing the quality of education that all students receive. (DIPF/ Orig.).

Objective This study examined the impacts of different types of text message reminders on couples' attendance at healthy marriage and relationship education (HMRE) workshops. Background Regular attendance is often a challenge for couples participating in HMRE workshops. Studies suggest that nudges can increase attendance at appointments, but there has been little research on their application to family support programs. Method We conducted a Bayesian adaptive randomized controlled trial involving 1,742 couples in Florida. We assigned couples to either a control group that received no reminders or one of several treatment groups that received different types of reminders. We compared attendance across groups to estimate impacts of the messages on couples' initial and continued attendance. Results Simple reminders that provided only the date and time of the first session increased couples' initial session attendance by 12% compared with the control group. None of the reminders increased continued attendance among couples who attended the first session. Conclusion Simple reminders worked best for increasing initial attendance compared with messages with enhanced content, such as motivational messages, graphics, or peer testimonials. Couples that attended the first session had similarly high rates of continued session attendance regardless of the reminders. Implications Text message reminders show potential as a tool for boosting initial attendance at voluntary family support programs.

Objectives. To evaluate the impacts of an enhanced version of the Family Life and Sexuality Module of the HealthTeacher middle school curriculum. Methods. We conducted a cluster randomized trial of Chicago, Illinois, middle schools. We randomly assigned schools to a treatment group that received the intervention during the 2010–2011 school year or a control group that did not. The primary analysis sample included 595 students (7 schools) in the treatment group and 594 students (7 schools) in the control group. Results. Students in the treatment schools reported greater exposure to information on reproductive health topics such as sexually transmitted infections (STIs; 78% vs 60%; P < .01), abstinence (64% vs 37%; P < .01), and birth control (45% vs 29%; P < .01). They also reported higher average scores on an index of knowledge of contraceptive methods and STI transmission (0.5 vs 0.3; P = .02). We found no statistically significant differences in rates of sexual intercourse (12% vs 12%; P = .99), oral sex (12% vs 9%; P = .18), or other intermediate outcomes. Conclusions. The program had modest effects when tested among Chicago middle school students.