A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden

Association between Living with Children and the Health and Health Behavior of Women and Men. Are There Differences by Age? Results of the "German Health Update" (GEDA) Study

Does the health of women and men living with and without minor children differ, and are age differences evident in the association? For self-rated general health, depression, back pain, overweight, smoking and sporting inactivity, the GEDA data 2009-2012 (18-54 years, n = 39,096) were used to calculate prevalence for women and men stratified by parental status (living with children: yes/no) and age. Moreover, we calculated odds ratios and predictive margins, performing logistic regressions with interaction terms of parental status and age. Women and men aged 45-54 living with children are healthier than those not living with children. Parents aged 18-24 smoke more frequently and do less sport; young mothers are also more likely to be overweight and suffer from back pain than women not living with children. In multivariable analysis, the interaction of living with children and age is significant for all outcomes (except depression and back pain in men). Living with children is an important social determinant of health, highly dependent on age. It is to be discussed whether the bio-psycho-social situation has an influence on becoming a parent, or whether parenthood in different phases of life strains or enhances health.

Inequalities in health and health behaviours between couple and lone mothers before and during the financial crisis in Spain (2003-2012)

Lone mothers report worse health and adopt more risky health behaviours than couple mothers, as largely documented in several European countries, but not deeply in Spain. The primary aim of this study was to identify the possible existence of inequalities in health and health behaviours between couple and lone mothers in Spain by occupational social class and employment status. A second aim was to explore whether any inequalities were influenced by the economic crisis beginning in 2008, analysing changes in inequalities between 2003–2004 and 2011–2012.

Two waves of the cross-sectional Spanish National Health Survey data were used. Analyses were restricted to mothers aged 16–64 years, with at least one child aged 18 years or younger. The sample consisted of 2982 mothers in 2003–2004 and 3070 in 2011–2012, representing more than 80% of couple mothers. Two health outcomes and two health behaviour measurements were used. Robust Poisson regression was run to estimate inequalities between couple and lone mothers, calculating prevalence ratios adjusted by age and stratified by social class and employment status.

We found inequalities in health and health behaviours between couple and lone mothers in Spain amongst the manual social class, with lone mothers reporting a more than 30% higher prevalence of poor self-perceived health and being smoker in both time points of study compared with couple mothers. Furthermore, lone mothers were at 50% higher risk of having at least one selected chronic condition and 86% higher probability of sleeping less than 6 hours/day in 2011–2012 This study could not confirm that inequalities between couple and lone mothers changed in Spain during the study period, although some patterns were noticeable. Inequalities pointed towards an increase amongst mothers in the manual social class with paid employment, while inequalities amongst unemployed mothers (both manual and non-manual social class) pointed towards a decrease.

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In Spain, there are inequalities in health between couple and lone mothers.

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These inequalities might be influenced by social class and employment status.

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Lone mothers in the manual social class showed worse health and health behaviours.

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Lone mothers in the non-manual social class and employed reported better health.

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Changes in inequalities were not confirmed (2003–2012), despite the economic crisis.

Life course indices for social determinants of self-rated health trajectory in Korean elderly

OBJECTIVES

This study investigated the self-rated health trajectories of the Korean older population and revealed life-course factors that affect the trajectories over the life course.

METHODS

Around 1000 older adults were randomly allocated by stratified multi-stage sampling based on the population census, and underwent face-to-face interviews. Self-rated health status, socioeconomic variables over the life course, and demographic variables were included in the analysis. A group-based trajectory model was used to investigate the association between self-rated health and explanatory variables.

RESULTS

The enrolled men and women were divided into three groups by trajectory analysis, which showed marked differences in self-rated health trajectories from childhood to senescence. Among older men, those who experienced skipping meals in childhood and those with chronic disease conditions were more likely to be in the lower trajectory groups. Compared to the older men, the likelihood of being in the lower trajectory groups in older women was increased by experience of skipping meals, lower household income, housekeeping labor, receiving Basic Livelihood Security and chronic disease conditions.

CONCLUSION

Various self-rated health trajectories of the Korean older population were identified, and differed according to socioeconomic variables during their life course. Therefore, socioeconomic variables during the life course should be monitored, and health policies directed at the elderly should focus on initial health status from the perspective of a life-course approach.

Association of partner, parental, and employment statuses with self-rated health among German women and men

The association of partner, parental, and employment statuses with health is usually discussed in terms of either the multiple role burden hypothesis or the multiple role attachment hypothesis. The first hypothesis states that combining work and family roles increases the burden of responsibility, which in turn increases the pressure and stress associated with competing roles, leading to poorer health. The multiple role attachment hypothesis argues that multiple responsibilities provide attachment to broader networks, which then provide social support and resources that enhance health. We analyzed pooled data from the German Health Update carried out by the Robert Koch Institute in 2009, 2010, and 2012. The data were collected by computer-assisted telephone interviews. The sample comprised 28,086 people aged 30-54 years. The data were assessed with logistic regression analysis and interaction models. The gender-differentiated analysis of partnership, parenthood, and employment, after adjusting for social and demographic characteristics, revealed small interaction effects among all three social roles with self-rated health in women and men. Non-employment showed the strongest relationship with poor self-rated health. It was significantly associated with lower self-rated health in both men and women in most of the family arrangements. These associations were higher in men than in women. Furthermore, in all family arrangements, female part-time employees were as healthy as female fulltime employees. A more subtle association was found in men: the odds of reporting poorer self-rated health were greater among non-parents employed part time than among those employed full time, but lower than among those who were non-employed. Among fathers, part-time employees did not have statistically better health than full-time employees.The findings support somewhat the multiple role attachment hypothesis, rather than the multiple role burden hypothesis. Because employment has great importance for both women's and men's health, the compatibility of work and family roles should be improved.

Association of Women's Reproductive History With Long-term Mortality and Effect of Socioeconomic Factors

OBJECTIVE

To assess the effects of socioeconomic factors on the association between parity and long-term maternal mortality.

METHODS

This was a population-based cohort study of mothers with births registered in the Medical Birth Registry of Norway during the period 1967-2009. We estimated age-specific (40-69 years) cardiovascular and noncardiovascular mortality ratios by number of births using Cox proportional hazard models. To assess effect modification by mothers' attained education, we stratified on low (less than 11 years) and high (11 years or greater) educational level. We further evaluated fathers' mortality by number of births using the same analytical approach.

RESULTS

Mothers with low education had higher mortality (cardiovascular: hazard ratio 2.62, 95% confidence interval [CI] 2.34-2.93, noncardiovascular: hazard ratio 1.67, 95% CI 1.62-1.73). Among mothers with low education, cardiovascular mortality increased linearly with each additional birth above one (P trend=.02). In contrast, among mothers with high education, cardiovascular mortality declined with added births (P trend=.045). For noncardiovascular mortality there was no association among mothers with low education, whereas mortality declined with increasing number of births among mothers with high education (P trend<.01). Father's mortality showed similar associations with number of births when stratified on maternal education.

CONCLUSION

Women's long-term mortality rose with number of births only for cardiovascular causes of death and only among mothers with low education. Partners of women with low education had similar increasing risk with increasing number of births. Maternal educational level is a strong modifier of the association between parity and long-term mortality.

LEVEL OF EVIDENCE

II.

Association of social support and socio-demographic characteristics with poor self-rated health and depressive symptomatology among single mothers in Cyprus: a descriptive cross-sectional study

BACKGROUND

The number of single-parent families headed by mothers is rapidly growing worldwide. A large part of the international literature reveals that single motherhood is associated with increased levels of chronic stress, mainly due to economic distress and reduced levels of social support, which may eventually lead to physical and psychological illness. Most published research comes from Northern Europe and the US, while it is accepted that both social welfare systems and societal factors vary substantially across countries. These issues haven't been explored in Southern Europe and this study aims to fill this gap by a) assessing the health of single mothers in Cyprus in terms of self-assessed general health and the prevalence of clinical depressive symptoms and b) investigating the effect of perceived social support relation to their health status.

METHODS

General health was assessed in terms of Self-Rated Health (SRH), while the prevalence of clinical depressive symptoms was assessed with the Center of Epidemiological Studies-Depression Scale (CES-D). Perceived social Support was assessed with the Social Provision Scale. All scales were completed anonymously and voluntary by 316 single mothers. Univariable and multivariable associations between SRH and depressive symptoms with socio-demographic characteristics were investigated using chi-square tests and in multivariable backward stepwise logistic regression models respectively. Odd ratio of clinically significant depressive symptoms and SRH across decreasing levels of social support were estimated in logistic regression models.

RESULTS

The prevalence of depressive symptoms (CES-D score ≥ 22) was 38.9 %, which is almost three times greater than the general population. Strong associations with all health assessment tools were observed with variables relating to the lowest monthly family income and the presence of economic difficulties, unemployment, the single motherhood status and pre-existing illness. Social support as perceived by the mothers displayed a strong negative independent association with all tools, even after adjusting confounders.

CONCLUSION

These findings can be a challenge for health care professionals, especially those working in the field of community-family nursing and highlight the necessity of interventions and strategies at community level in order to support this vulnerable population group.

Poor quality in the reporting and use of statistical methods in public health - the case of unemployment and health

BACKGROUND

It has previously been reported that many research articles fail to fulfill important criteria for statistical analyses, but, to date, these reports have not focused on public health problems. The aim of this study was to investigate the quality of reporting and use of statistical methods in articles analyzing the effect of unemployment on health.

METHODS

Forty-one articles were identified and evaluated in terms of how they addressed 12 specified criteria.

RESULTS

For most of these criteria, the majority of articles were inadequate. These criteria were conformity with a linear gradient (100 % of the articles), validation of the statistical model (100 %), collinearity of independent variables (97 %), fitting procedure (93 %), goodness of fit test (78 %), selection of variables (68 % for the candidate model; 88 % for the final model), and interactions between independent variables (66 %). Fewer, but still alarmingly many articles, failed to fulfill the criteria coefficients presented in statistical models (48 %), coding of variables (34 %) and discussion of methodological concerns (24 %). There was a lack of explicit reporting of statistical significance/confidence intervals; 34 % of the articles only presented p-values as being above or below the significance level, and 42 % did not present confidence intervals. Events per variable was the only criterion met at an undoubtedly acceptable level (2.5 %).

CONCLUSIONS

There were critical methodological shortcomings in the reviewed studies. It is difficult to obtain unbiased estimates, but there clearly needs to be some improvement in the quality of documentation on the use and performance of statistical methods. A suggestion here is that journals not only demand that articles fulfill the criteria within the STROBE statement, but that they include additional criteria to decrease the risk of incorrect conclusions being drawn.

Work-family life courses and markers of stress and inflammation in mid-life: evidence from the National Child Development Study

Background: This study investigated associations between work-family life courses and biomarkers of inflammation and stress in mid-life among British men and women. Gender differences in these associations were also explored.

Methods: A novel statistical method—multi-channel sequence analysis—defined work-family life courses between the ages of 16 and 42 years, combining annual information on work, partnership and parenthood. Associations between work-family life courses and inflammation [C-reactive protein (CRP), fibrinogen and von Willebrand factor] and cortisol at age 44/45 years were tested using multivariate linear regression using multiply-imputed data on almost 6500 participants from the National Child Development Study 1958 British birth cohort.

Results: Compared with those who combined strong ties to paid work with later transitions to stable family lives (‘Work, later family’ group), ‘Teen parents’ had higher CRP [40.6% higher, 95% confidence interval (CI): 5.6, 87.0] and fibrinogen (7.8% higher, 95% CI: 2.3, 13.5) levels, and homemakers (‘No paid work, early family’) had raised fibrinogen levels (4.7% higher, 95% CI: 0.7, 9.0), independent of childhood health and socioeconomic position, adult socioeconomic position, health behaviours and body mass index (BMI). Those who combined later transitions to stable family ties with a career break for childrearing had higher post-waking cortisol than the ‘Work, later family’ group; however, no associations were seen for other work-family types, therefore suggesting a null finding with cortisol. No statistically significant gender interactions in associations between work-family types and inflammatory or cortisol outcomes were found.

Conclusions: Work-family life courses characterised by early parenthood or weak work ties were associated with a raised risk profile in relation to chronic inflammation.

How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects

BACKGROUND

Almost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups.

METHODS

A search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level.

RESULTS

Most of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender, age, education level, household income, and geographic location. However, this effect differed between studies and no clear pattern on who benefits or suffers more among these groups could be determined. The result instead seemed to depend on the study context. The only clear patterns of association found were for socioeconomic status (manual workers suffer more), reason for unemployment (being unemployed due to health reasons is worse), and social network (a strong network is beneficial).

CONCLUSIONS

Unemployment affects groups of individuals differently. We believe that a greater effort should be spent on specific groups of individuals, such as men or women, instead of the population as a whole when analysing the effect of unemployment on health.

Are two a family? Older single mothers assisted by sperm donation and their children revisited

This study follows 40 older single-mother families created with the aid of sperm donation using either insemination or in vitro fertilization. The study is based on qualitative data obtained from the mothers 3 years after a previous study with these families. The mean age of the mothers at this time was about 47 years and of the children 7 years. The findings provide insights into the mothers' and children's current sociodemographic characteristics, physical health, socioemotional development and the children's reactions to the absence of a father at follow-up time. The majority of the children raised by these older single mothers have good health. The salient result is that at follow-up, 45% of these older single-mother families comprise a family unit with more than 1 child, clearly demonstrating these families' desire for a larger family than a mother-child unit. The desire and attempts of the mothers in the sample to give birth to additional children using assisted conception demonstrate the divergence in the fertility patterns of Israeli society from other developed countries.

Employment and health status changes among women with fibromyalgia: a five-year study

OBJECTIVE

To assess changes in health status of women with fibromyalgia (FM) over 5 years and determine whether baseline employment status influences health outcomes adjusting for other baseline factors.

METHODS

Two hundred eighty-seven women with FM were recruited from a national sample of rheumatologists and interviewed by phone at baseline and annually for 4 years. Data were collected on pain, fatigue, Center for Epidemiologic Studies Depression Scale and Modified Health Assessment Questionnaire (M-HAQ) scores, demographic characteristics, and employment status. At the end of the study, 211 participants remained. Data were analyzed using multilevel modeling techniques. Bootstrap methods adjusted for the cluster sampling.

RESULTS

The participants' mean +/- SD age was 47 +/- 11 years, their mean +/- SD education level was 14 +/- 2 years, 90% were white, 50% employed, 64% married, and their median household income was >or=$50,000. Mean +/- SD scores at baseline were 57.2 +/- 24 for pain, 75.4 +/- 22 for fatigue, 22.9 +/- 13 for depression, and 0.73 +/- 0.5 for the M-HAQ. Multilevel modeling indicated that all health status measures declined significantly over time except for pain. Rates of change varied from -1.22 for fatigue to -0.03 for the M-HAQ. Except for pain, patients who were employed at baseline had better health status over time. The employment and time interaction was not significant, indicating that health status changed at the same rate regardless of employment status. Other significant factors were age and income.

CONCLUSION

Employed women with FM have better health status at baseline and maintain that advantage over time. Employment does not seem to provide a protective health benefit.

From macro to micro: the health of Swedish lone mothers during changing economic and social circumstances

The deep recession in Sweden in the early 1990s led to high unemployment levels. In addition, policy changes and reductions in welfare benefits increased costs of living. These changes may have affected lone mothers to a greater extent than other groups. How have these changes in the social context and policy context impacted on the health of lone mothers in comparison with couple mothers in Sweden between 1983 and 2001? Survey data on 19,192 mothers over the period of 1983-2001 were used to study changes in individual economic and social circumstances and self-rated health (SRH) with multivariate logistic regression. In addition, all-cause mortality, cause-specific mortality and severe morbidity were studied using registers for the whole population. Three cohorts of mothers aged 20-54 years (starting 1985, 1990 and 1996) were formed. Age-adjusted risk ratios were calculated using Poisson regression. The employment rate among lone mothers declined from 1983 to 2001. At the same time, prevalence of self-reported financial problems and exposure to violence increased. Lone mothers reported worse SRH and had higher risks of hospitalisation and mortality than couple mothers in all time periods. Despite changes in social context and policy context causing an increase of health detrimental exposures, and deteriorated levels of SRH 1980-2001 for lone mothers, there was no evidence of increased differentials over time between lone and couple mothers in less than good SRH, hospitalisation or mortality. Three alternative explanations are discussed: the Swedish welfare state still acts as a buffer for ill health; latency makes the follow-up time too short; and finally, the lack of increased differentials is due to methodological reasons.

The incorporation of gender perspective into Spanish health surveys

BACKGROUND

Most studies into social determinants of health conducted in Spain based on data from health surveys have focused on social class inequalities. This paper aims to review the progressive incorporation of gender perspective and sex differences into health surveys in Spain, and to suggest design, data collection and analytical proposals as well as to make policy proposals.

METHODS

Changes introduced into health surveys in Spain since 1995 to incorporate gender perspective are examined, and proposals for the future are made, which would permit the analysis of differences in health between women and men as a result of biology or because of gender inequalities.

RESULTS

The introduction of gender perspective in health surveys requires the incorporation of questions related to family setting and reproductive work, workplace and society in general to detect gender differences and inequalities (for example, domestic work, intimate partner violence, discrimination, contract type or working hours). Health indicators reflecting differential morbidity and taking into account the different life cycle stages must also be incorporated. Analyses ought to be disaggregated by sex and interpretation of results must consider the complex theoretical frameworks explaining the differences in health between men and women based on sex differences and those related to gender.

CONCLUSIONS

Analysis of survey data ought to consider the impact of social, political and cultural constructs of each society. Any significant modification in procedures for collection of data relevant to the study of gender will require systematic coordination between institutions generating the data and researchers who are trained in and sensitive to the topic.

Cause-specific mortality of grand multiparous women in Finland

Knowledge is limited on mortality of grand multiparous women (> or =5 deliveries), whose hormonal, metabolic, and social conditions differ from the average. The authors studied overall and cause-specific mortality in 1974-2001 among 87,922 grand multiparous women including 3,678 grand grand multiparous women (> or =10 deliveries) in Finland. Standardized mortality ratios were defined as ratios of observed to expected numbers of deaths, both derived from national cause-of-death files. During follow-up, 18,870 grand multiparous women and 625 grand grand multiparous women died (standardized mortality ratios (SMRs) = 0.95 and 1.01, respectively). Decreased mortality among grand multiparous women was found for cancers of the breast (SMR = 0.64, 95% confidence interval (CI): 0.59, 0.69), corpus uteri (SMR = 0.68, 95% CI: 0.56, 0.80), ovary (SMR = 0.68, 95% CI: 0.60, 0.75), bladder (SMR = 0.59, 95% CI: 0.41, 0.82), and respiratory tract (SMR = 0.80, 95% CI: 0.72, 0.88). The only malignant tumor associated with elevated mortality was kidney cancer (SMR = 1.38, 95% CI: 1.21, 1.56). The standardized mortality ratio was also low for dementia (SMR = 0.78, 95% CI: 0.72, 0.84), respiratory diseases (SMR = 0.80, 95% CI: 0.75, 0.85), and accidents and violent causes (SMR = 0.79, 95% CI: 0.73, 0.84). Mortality from diabetes mellitus (SMR = 1.42, 95% CI: 1.29, 1.55) and ischemic heart disease (SMR = 1.10, 95% CI: 1.08, 1.13) was increased. According to this study, overall mortality among grand multiparous women is not elevated. Low mortality from cancers is offset by higher mortality from cardiovascular conditions and diabetes mellitus.