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The intergenerational production of depression in South Korea: results from a cross-sectional study Jeong, B. G; Veenstra, G. Jan 13, 2017

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RESEARCH Open AccessThe intergenerational production ofdepression in South Korea: results from across-sectional studyB. G. Jeong1* and G. Veenstra2AbstractBackground: Although a number of studies have uncovered relationships between parental capital and themanifestation of depression in their children, little is known about the mechanisms that undergird the relationships.This study investigates the intergenerational effects of the cultural and economic capitals of South Korean parentson depressive symptoms in their adult children and the degree to which the capitals of the adult children explainthem.Methods: We employed nationally representative cross-sectional survey data from the 2006 Korea Welfare PanelStudy. A sample of 11,576 adults over thirty years of age was used to investigate the intergenerational productionof depression in South Korea. We applied binary logistic regression modelling to the Center for EpidemiologicalStudies Depression Scale (CES-D).Results: Parental education (institutionalized cultural capital) manifested an independent and statistically significantinverse association with depressive symptoms [OR = 1.680 (95% CI: 1.118-2.523) for men; OR = 2.146 (95% CI: 1484–3.102) for women]. Childhood economic circumstances (economic capital) had an independent and statisticallysignificant inverse association with depressive symptoms among adult women only [OR = 2.009 (95% CI: 1.531-2.635)]. The education of the adult children themselves was strongly associated with depressive symptoms in theexpected direction [OR = 4.202 (95% CI: 2.856-6.181) for men; OR = 4.058 (95% CI: 2.824-5.830)] and the most of theassociation between parental capitals and depressive symptoms was explained by the educational attainment ofthe children. Receipt of monetary inheritance from parents had a weak but statistically significant association withdepression among men [OR = 1.248 (95% CI: 1.041-1.496)] but was unrelated to depression among women. A largeportion of the association between respondent education and depressive symptoms was explained by householdincome. Finally, childhood economic circumstances were associated with depressive symptoms among women overand above the cultural and economic capitals held by the women themselves [OR = 1.608 (95% CI: 2.08-2.139)].Conclusions: Our study illuminates the importance of the intergenerational transmission of capitals for thedevelopment of depressive symptoms among adults in South Korea.Keywords: South Korea, Depressive symptoms, Capitals, Intergenerational processes* Correspondence: jjbkkr@yahoo.co.kr1Department of Preventive Medicine, School of Medicine & Institute ofHealth Science, Gyeongsang National University, 15, 816 Beon-Gil,Jinjudae-Ro, Jinju-si, Gyeongsangnam-Do 660-751, South KoreaFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 DOI 10.1186/s12939-016-0513-7BackgroundDepression is a mood disorder characterized by over-whelmingly negative emotions and a sustained loss ofpleasure [1–3]. At any given point in time, approximatelyone to three percent of the residents of industrializedcountries experience persistent, recurring symptoms ofdepression [4, 5]. Depression can have a dramatic effecton people’s lives, impairing social, work and family func-tioning [6–8] and negatively affecting physical health andwell-being [9].Although a large body of research indicates that heredi-tary factors can predispose people to depression [10, 11], agrowing body of evidence suggests that socioeconomicconditions are also important factors in the onset of de-pression. For instance, a number of studies have uncoveredrelationships between parental socioeconomic status andthe manifestation of depression in their children [12, 13],associations that persist after controlling for parental de-pression [14, 15]. Other studies have determined that therisk of depression among adults is higher among peoplewith lower levels of education, less prestigious occupationsand lower incomes [16–18].Children and adults living in poor socioeconomic cir-cumstances typically experience more stressful livingconditions [19], possess relatively low levels of controlover their physical and social environments [20], facemore difficulties creating intimate relationships [21] andexperience poorer health than do people living in goodsocioeconomic circumstances [22, 23]. These factors canincrease a person’s vulnerability to depression and reducetheir ability to cope with it once manifested. In short, de-pression appears to be affected by socioeconomic circum-stances at multiple stages of the life course.However, the socioeconomic status of adults is shapedby the socioeconomic status of their parents [24–26],suggestive of a more complex causal storyline that runsfrom parental capitals to the capitals of the children andsubsequently to the manifestation of depression in thechildren in adulthood. Capitals can be transmitted fromparents to children through various processes. For in-stance, wealth can be directly transmitted to children bymeans of inheritance. Wealthier parents can also investmore money and time in educating their children. Morehighly educated parents have a greater capacity to de-velop linguistic and other cultural skills and talents intheir children that can subsequently affect the latter’sperformance in the education system and in the labormarket. In other words, the capital resources possessedby parents can be transmitted to the next generationthrough a variety of processes that effectively serve to re-produce socioeconomic inequality across generations.Accordingly, depression in adults may be partly reflect-ive of intergenerational capital transmission processesfrom parents to children.The plausibility of this multigenerational line of caus-ality notwithstanding, empirical studies that relate pro-cesses of intergenerational transmission of capital toadult health are rare [27, 28]. In particular, research onthe relationship between processes of intergenerationalcapital transmission and depression, an important do-main of mental health, is nonexistent. To address thisgap, we use cross-sectional survey data from the 2006Korean Welfare Panel Study to investigate the degree towhich the capitals of South Korean parents are relatedto the capitals of their adult children and, ultimately, tothe manifestation of depressive symptoms in them.MethodsData and study populationOur study uses data from the 2006 wave of the KoreaWelfare Panel Study which has a response rate of 71.3%.We restricted our investigation to survey respondents(n = 12,292) who were thirty years of age or older at thetime of the survey in order to produce stable measuresof educational attainment. We further restricted ouranalyses to the 11,576 respondents (94.2% of the sample)who provided valid information for all of the variablesused in our study. Table 1 describes characteristics ofthe latter sample.MeasuresCultural capitalAccording to Bourdieu [29], cultural capital can exist inthree forms. Cultural tastes and inclinations, a kind ofembodied cultural capital, are lasting dispositions ofmind and body. Objectified cultural capital refers to thepossession of valued cultural goods. Institutionalizedcultural capital is a “form of objectification which mustbe set apart because, as will be seen in the case of educa-tional qualification, it confers entirely original propertieson the cultural capital which it is presumed to guaran-tee” ([29], p. 248). In our study, respondents were askedabout their mother and father’s levels of educational at-tainment, measures of institutionalized cultural capitalfrom which we created a single variable assessing paren-tal highest level of education. We also assessed the insti-tutionalized cultural capital of the survey respondentsthemselves in the form of personal highest level of edu-cational attainment. Both variables distinguished be-tween seven levels of education: did not completeelementary school, completed elementary school, com-pleted middle school, completed high school, completedtechnical college, completed university and completedgraduate school. For use in regression modelling, wecombined the elementary school and middle school cat-egories for both variables and the university and gradu-ate school categories for the parental education variable.Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 2 of 8Table 1 Characteristics of the survey sample (n = 11,576; un-weighted data)Variable Categories Men Womenn % n %Age less than 40 1374 26.0 1430 22.740 to 59 2095 39.6 2293 36.560 and older 1819 34.4 2565 40.8Marital status married 4378 82.8 4294 68.3widowed 151 2.9 1442 22.9separated 52 1.0 82 1.3divorced 218 4.1 268 4.3single 489 9.3 202 3.2Highest parental education did not complete elementary school 2280 43.1 2932 46.6elementary school 1500 28.4 1617 25.7middle school 585 11.1 709 11.3high school 644 12.2 703 11.2technical college 56 1.1 75 1.2university 203 3.8 231 3.7graduate school 20 0.4 21 0.3Economic conditions in childhood very poor 566 10.7 581 9.2poor 1899 35.9 1914 30.4average 2228 42.1 2843 45.2rich 542 10.3 859 13.7very rich 53 1.0 91 1.5Educational attainment did not complete elementary school 420 7.9 1485 23.6elementary school 901 17.0 1373 21.8middle school 658 12.4 782 12.4high school 1792 33.9 1722 27.4technical college 407 7.7 298 4.7university 956 18.1 577 9.2graduate school 154 2.9 51 0.8Received inheritance yes 1452 27.5 960 15.3no 3836 72.5 5328 84.7Household income <1000 1205 22.8 1985 31.61000-1999 1199 22.7 1418 22.62000-2999 972 18.4 998 15.93000-3999 680 12.9 654 10.44000-4999 479 9.1 476 7.65000-5999 246 4.7 246 3.96000-6999 193 3.7 199 3.27000-7999 139 2.6 127 2.08000-8999 67 1.3 63 1.09000-999 33 0.6 38 0.6>10000 75 1.4 84 1.3Depressive symptoms few (0–8 on the CES-D) 4154 78.6 4258 67.7regular (9 or more on the CES-D) 1134 21.4 2030 32.3Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 3 of 8Economic capitalTo assess parental economic capital, respondents wereasked “What were your economic living conditions duringchildhood (0–17 years of age)?” with response categories‘very poor,’ ‘poor,’ ‘average,’ ‘rich’ and ‘very rich.’ We com-bined the latter two categories for use in our regressionanalyses. The current household incomes of respondentswere also calculated from a series of questions assessingincome from multiple sources including employment, in-vestments, pensions, social insurance, etc. Assessed in10,000,000 won units, this right-skewed continuous vari-able ranged from a low of zero to a high of 30.8. A cat-egorical version of household income is described inTable 1. Respondents were also asked “Have you ever re-ceived an inheritance or donation from your parents?” towhich they could reply ‘yes’ or ‘no.’DepressionDepression was measured by calculating the sum of 11items derived from the Center for Epidemiological Stud-ies Depression Scale (CES-D). The CES-D scale was de-veloped to diagnose depression by way of assessing arange of depressive symptoms. This scale is a widelyused measure of depression and several short CES-Dforms have been developed from it [30, 31]. Each itemwas answered using a 4-point scale (0 = less than oneday in the past week; 1 = two or three days in the pastweek; 2 = four or five days in the past week; 3 = six orseven days in the past week). Cronbach’s alpha for the11 items from the CES-D scale in this sample was highat 0.88. Consistent with previous research [32–34], re-spondents were categorized into two groups: few depres-sive symptoms (72.7% of the sample scored 0–8 on theCES-D) and regular depressive symptoms (27.3% of thesample had a score of 9 or higher).Data analysisWe created a series of binary logistic regression modelson depression separately for men (n = 5288) and women(n = 6288). These models are described in Tables 2 and3. The first model in each table describes the effects ofparental education and childhood economic circum-stances on depression while controlling for age andmarital status. The second model adds personal educa-tion to the first model, the third model adds receipt ofinheritance money to the second model and the fourthmodel adds household income to the third model. Thissequence of models enables us to identify the independ-ent effects of parental cultural and economic capitals ondepression and then investigate the degree to which vari-ous forms of capital held by the respondents potentiallyexplain them. However, the problem of residual variancein logistic regression means that changes in regressioncoefficients across nested models can reflect changes inthe scaling of the dependent variable [35]. Accordingly,we also applied the Karson/Holm/Breen (KHB) methodof decomposing effects in non-linear probability models[36, 37] via the khb command in Stata [38] when investi-gating mediation. In all of our analyses we utilized themaster weight variable provided with the Korea WelfarePanel Study to produce estimates that more closely rep-resent the adult South Korean population.ResultsModel 1 in Table 2 and Model 1 in Table 3 indicate thatparental education manifests an independent and statis-tically significant association with depression amongmen and among women. Childhood economic condi-tions have an independent and statistically significant as-sociation with depression among women only.1Model 2 in Table 2 and Model 2 in Table 3 indicatethat personal education has a strong association with de-pression for both men and women. The declines in theeffect sizes of parental education from Model 1 to Model2 in both tables suggest that much of the association be-tween parental resources and depression is explained bypersonal educational attainment. The KHB decompos-ition indicates that 73.1% of the association between par-ental education (most versus least educated) anddepression is caught up in the educational attainment ofthe men; for women this percentage is 62.0%. A declinein the effect size of childhood economic conditions fromModel 1 to Model 2 in Table 3 suggests that some of theassociation between childhood economic conditions anddepression is explained by the educational attainment ofthe women; the KHB decomposition indicates that30.1% of the association between childhood economicconditions (very poor versus rich or very rich) and de-pression is caught up in the educational attainment ofthe women (Additional file 1). However, childhood eco-nomic circumstances retain a statistically significant as-sociation with depression over and above theeducational attainment of the respondents themselves,but only for women.Model 3 of Table 2 indicates that receipt of inheritancefrom parents has a weak but statistically significant asso-ciation with depression among men; inheritance is unre-lated to depression among women. The fourth modelsin Tables 2 and 3 indicate that household income has astrong association with depression for both men andwomen, and the declines in effect size for respondenteducation from Model 3 to Model 4 in these tables sug-gest that some of the association between respondenteducation and depression is explained by respondent in-come. For men, the KHB decomposition indicates that44.7% of the association between respondent education(most versus least educated) and depression is caught upJeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 4 of 8in the incomes of the respondents; for women this per-centage is 42.7% (Additional file 1).Lastly, Model 4 in Tables 3 and 4 indicate that theeconomic capital of parents manifests a statistically sig-nificant association with depressive symptoms in therespondents over the capitals held by the respondentsthemselves for women but not for men.DiscussionWe find that personal educational attainment and house-hold income are both strongly and negatively related todepressive symptoms in our representative sample ofSouth Korean adults. These findings are consistent withprevious research in South Korea [39–41]. Plausible expla-nations for these associations are that higher educationcan foster intellectual and coping skills that serve asprotective factors against depression [15, 18], high incomereduces debilitating financial stressors that can contributeto the onset of depression [42] and well-paying jobs affordgreater social prestige and better psychosocial and physicalworking conditions which in turn can be protectiveagainst depression [43].We also find that a third or more of the associationbetween the educational attainment of respondents anddepressive symptoms is potentially mediated by house-hold income. This is an example of what have been else-where referred to as capital conversions [44] or capitalacquisition interplays [28], social processes wherebyone form of capital facilitates the successful acquisi-tion of another form of capital and consequently goodhealth. In this case, institutionalized cultural capital inthe form of educational credentials is presumablyused by men and women to procure high-paying jobs(or spouses with high-paying jobs) and amass financialwealth which then mitigate the development of depressivesymptoms.Table 2 Binary logistic regression models on presence of depression in men (weighted data)Variable Categories Model 1 Model 2 Model 3 Model 4OR 95% CI OR 95% CI OR 95% CI OR 95% CIHighest parentaleducationdid not completeelementary school1.680 * 1.118 2.523 1.150 0.754 1.755 1.147 0.752 1.750 1.004 0.653 1.545elementary ormiddle school1.479 * 1.004 2.179 1.180 0.793 1.757 1.176 0.790 1.750 1.079 0.720 1.616high school 1.273 0.835 1.940 1.141 0.746 1.747 1.129 0.738 1.729 1.050 0.680 1.621technical college 1.772 0.873 3.597 1.724 0.843 3.527 1.751 0.854 3.590 1.773 0.852 3.691university(reference)1.000 1.000 1.000 1.000Economicconditions inchildhoodvery poor 1.196 0.867 1.650 0.932 0.669 1.298 0.893 0.639 1.247 0.946 0.673 1.329poor 1.035 0.801 1.337 0.906 0.698 1.176 0.874 0.672 1.137 0.924 0.707 1.209average 0.863 0.672 1.109 0.836 0.649 1.076 0.823 0.639 1.060 0.845 0.653 1.093rich or very rich(reference)1.000 1.000 1.000 1.000Educationalattainmentdid not completeelementary school4.202 *** 2.856 6.181 4.165 *** 2.832 6.126 2.356 *** 1.584 3.502elementary ormiddle school2.655 *** 2.048 3.441 2.634 *** 2.033 3.414 1.670 *** 1.274 2.190high school 1.583 *** 1.269 1.974 1.571 *** 1.259 1.960 1.171 0.932 1.471technical college 1.649 ** 1.211 2.245 1.650 ** 1.212 2.246 1.312 0.957 1.797university(reference)1.000 1.000 1.000Receivedinheritanceno 1.248 * 1.041 1.496 1.270 * 1.056 1.526yes (reference) 1.000 1.000Householdincome… 0.687 *** 0.644 0.734Householdincome squared… 1.013 *** 1.010 1.017Hosmer andLemeshow testχ2 = 7.087(p = 0.527)χ2 = 4.268(p = 0.832)χ2 = 10.281(p = 0.246)χ2 = 27.638(p = 0.001)−2 log likelihood 4597.925 4524.390 4518.519 4367.795Each model controls for age, square of age, and marital status. N = 5288 in each model. *p < 0.05, **p < 0.01, ***p < 0.001Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 5 of 8In regards to intergenerational processes, we find thatmonetary inheritances or gifts from parents correspondwith a lesser risk of depression for men. This is an ex-ample of what Veenstra and Abel [28] refer to as capitaltransmission processes, social processes whereby thecapital of one party is transmitted to another person andthen generates good health in the recipient. The absenceof an association between inheritance and depressivesymptoms among women may reflect the fact that mon-etary inheritances in South Korea tend to be much largerfor sons than for daughters [45]. The largest transfer offinancial assets from parents to children typically occurswhen children marry. The parents of the groom oftenprovide substantial economic support in the form of ahouse while the parents of the bride often provide house-hold items. Unfortunately, our blunt measure of monetaryinheritance does not allow us to empirically investigatethe importance of the differential magnitude of inheri-tances for the mental health of men and women.Finally, we find strong associations between parentaleducational capital and depressive symptoms amongboth men and women, associations that are almost en-tirely explained by the educational attainment of theadult children. In this case, we contend that parentsstrategically use their cultural capital to facilitate the ac-quisition of educational credentials by their children. InSouth Korea, educational qualifications virtually deter-mine a person’s economic status in adulthood [46, 47]and, accordingly, South Korean parents are inclined toinvest hugely in the education of their children. Ourstudy indicates that this strategy tends to pay off in thepositive mental health of their children later in life.Our study has several limitations. First, the analysisutilizes cross-sectional data and as such causality cannotbe confidently ascertained. Second, the measures of par-ental cultural capital and economic capital used in ourstudy are based on respondent recall, an issue of meas-urement that may be especially problematic for olderTable 3 Binary logistic regression models on presence of depression in women (weighted data)Variable Categories Model 1 Model 2 Model 3 Model 4OR 95% CI OR 95% CI OR 95% CI OR 95% CIHighest parentaleducationdid not completeelementary school2.146 *** 1.484 3.102 1.331 .901 1.967 1.324 .896 1.957 1.226 .824 1.824elementary or middleschool1.725 ** 1.211 2.456 1.238 .856 1.791 1.232 .851 1.784 1.163 .798 1.694high school 1.710 ** 1.172 2.494 1.378 .937 2.028 1.373 .933 2.022 1.319 .889 1.955technical college 1.165 .606 2.238 1.067 .549 2.073 1.065 .548 2.071 .906 .465 1.767university (reference) 1.000 1.000 1.000 1.000Economicconditions inchildhoodvery poor 2.009 *** 1.531 2.635 1.637 ** 1.237 2.166 1.627 ** 1.228 2.155 1.608 ** 1.208 2.139poor 1.200 .979 1.470 1.059 .860 1.303 1.054 .855 1.298 1.134 .918 1.402average .978 .807 1.186 .940 .774 1.141 .936 .770 1.137 .995 .816 1.214rich or very rich(reference)1.000 1.000 1.000 1.000Educationalattainmentdid not completeelementary school4.058 *** 2.824 5.830 4.031 *** 2.803 5.796 2.260 *** 1.551 3.293elementary or middleschool2.481 *** 1.844 3.339 2.468 *** 1.833 3.324 1.557 ** 1.142 2.121high school 2.066 *** 1.607 2.656 2.059 *** 1.601 2.648 1.574 ** 1.216 2.038technical college 1.056 .716 1.558 1.054 .714 1.555 .873 .589 1.295university (reference) 1.000 1.000 1.000Receivedinheritanceno 1.052 .875 1.266 1.052 .873 1.269yes (reference) 1.000 1.000Householdincome… .732 *** .693 .774Householdincome squared… 1.010 *** 1.007 1.014Hosmer andLemeshow testχ2 = 10.247(p = 0.248)χ2 = 14.232(p = 0.076)χ2 = 18.322(p = 0.019)χ2 = 12.817(p = 0.118)−2 loglikelihood6029.167 5957.404 5957.110 5794.076Each model controls for age, square of age, and marital status. N = 6288 in each model. *p < 0.05, **p < 0.01, ***p < 0.001Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 6 of 8adults. Third, our measure of parental economic capitalis a subjective judgement on the part of the adult chil-dren rather than an objective assessment of parentalwealth. As a result we may have misrepresented, perhapseven underrepresented, the true nature of the associ-ation between parental economic capital and respondentdepression. Fourth, our measure of monetary inheritancedoes not assess the magnitude of inheritances. Fifth,obtaining a degree from a prestigious university is anextremely important indicator of institutionalized cul-tural capital in South Korea. Unfortunately, the KoreanWelfare Panel Study did not ask university educatedsurvey respondents to identify the universities fromwhich they obtained their degrees. In spite of these limi-tations, our study is the first, to our knowledge, thatmeasures the parental economic capitals using economicconditions in childhood, monetary inheritance to investi-gate the intergenerational effects of the parental capitalson depressive symptoms in their adult children and thedegree to which the capitals of the adult children explainthem.ConclusionsOur study provides evidence for the intergenerationalproduction of inequalities in depression in South Korea,findings that are consistent with studies conducted in theUnited States [12] and Finland [48]. Parental capitals areused to shape the accumulation of capitals by children,processes that militate against intergenerational mobilityin South Korean society and ultimately produce inequal-ities in depression. In other words, socioeconomic in-equalities in depression reflect a kind of social heredity inthe accumulation of capitals in South Korean society.Endnotes1In supplementary analyses, multinomial and orderedlogistic regression models which distinguish betweenCES-D scores of 0, 1–8, and 9 or higher did not improveupon models that simply distinguish between CES-Dscores of 0–8 and 9 or higher.Additional fileAdditional file 1: The KHB results. (DOCX 232 kb)AbbreviationsCES-D: Center for Epidemiological Studies Depression Scale; KHBdecomposition: Karson/Holm/Breen decomposition; KHB method: Karson/Holm/Breen methodAcknowledgementsNone.FundingNot applicable.Availability of data and materialsThese datasets were derived from the following public domain resources:[Korea Welfare Panel Study, https://www.koweps.re.kr:442/data/data/list.do].Authors’ contributionsThis study received no external funding. BJ developed the idea andparticipated in the design of the study and interpretation of results andconducted the statistical analyses. GV participated in the design of the studyand interpretation of results and drafted the manuscript. Both authors readand approved the final manuscript.Competing interestsThe authors declare that they have no competing interests.Consent for publicationNot applicable.Ethics approval and consent to participateEthical approval was not necessary since it is a secondary analysis of a publicuse database (https://www.koweps.re.kr:442/main.do) with anonymous data.Author details1Department of Preventive Medicine, School of Medicine & Institute ofHealth Science, Gyeongsang National University, 15, 816 Beon-Gil,Jinjudae-Ro, Jinju-si, Gyeongsangnam-Do 660-751, South Korea. 2Departmentof Sociology, University of British Columbia, 6303 NW Marine Drive,Vancouver, BC V6T 1Z1, Canada.Received: 2 August 2016 Accepted: 28 December 2016References1. 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Education as a social pathway fromparental socioeconomic position to depression in late adolescence andearly adulthood: a Finnish population-based register study. Soc PsychiatryPsychiatr Epidemiol. 2016. doi:10.1007/s0012701612962.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:Jeong and Veenstra International Journal for Equity in Health  (2017) 16:13 Page 8 of 8

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