Comparing Antonovsky's sense of coherence scale across three UK post-industrial cities

The 'Glasgow effect': the controversial cultural life of a public health term

The question of why more people in Glasgow were dying, and younger, compared with English cities with almost identical levels of deprivation, was a hot topic in Scottish public health debates in the early 21st century. Public health researchers, particularly the Glasgow Centre of Population Health (GCPH), used the terms 'Glasgow effect' and 'Scottish effect' as placeholders while identifying the unknown factors behind Scotland's excess mortality. Yet the terms took on a colourful life of their own in the press and larger culture and continue to circulate, despite GCPH's attempts to retire them. This paper is the first to analyse the cultural life of the 'Glasgow effect' and 'Scottish effect' terms. Looking primarily at the Scottish press 1998-2022, I analyse the politically charged and often controversial debates and lay recommendations around the concepts. I also trace the terms' parallel usage, and indeed origin, in contexts unrelated to health. I argue that the 'Glasgow effect' functions as a myth. This myth emphasises Scottish exceptionalism in public health and larger culture, at a time when devolution and the prospect of independence heightened optimism and anxiety about Scotland's future. It overlaps with a larger and longstanding myth of Scottish cultural pathology, or the pathological Scot. The flexibility of the 'Glasgow effect' and 'Scottish effect' terms is exploited by journalists, academics and artists to serve competing agendas, establish their own expertise and influence public opinion. While it may now be challenging to eradicate these terms, especially in lay contexts, researchers and policy makers should avoid using these unstable terms uncritically. The example of the 'Glasgow effect' shows how health concepts can become wrapped in larger national or political narratives and highlights the difficulties for public health communicators in introducing complex and emerging public health ideas into a dynamic landscape of lay beliefs.

Socioeconomic Status and the Sense of Coherence among Japanese People Living with HIV

People living with HIV (PLWH) are forced to live with multiple and severe stressors. Focusing on sense of coherence (SOC), which is a concept of salutogenic and stress coping capacity, is useful in PLWH support. This study aimed to examine the association between SOC and socioeconomic status (SES) for Japanese PLWH. Methods: This study used data from the HIV Futures Japan national survey, which is an online survey with a cross-sectional design. This survey of PLWH in Japan was conducted from July 2013 to February 2014 and December 2016 to July 2017, resulting in 1422 valid responses. The mean age (SD) was 38.6 years (8.3). The 13-item SOC scale score was divided into two groups, based on Japanese standard score in a previous study, and logistic regression analysis was performed. Results: Education levels were indirectly associated with SOC through occupation. Compared to freelance-profession/self-employed, “unemployed job seekers” (OR [95%CI] = 2.16 [1.16, 4.04]) and “homemaker/recuperating/student” (2.09 [1.09, 4.02]) were directly related to poor SOC, regardless of income. Also, there is a clear SOC disparity in income (compared to “>8 million yen/year”, “<1 million yen/year” was 2.94 [1.46, 5.92], and “1−2.99 million yen/year” was 2.49 [1.33, 4.68]). Conclusion: It became clear that there is a relationship between SOC and SES. The results of this research provide important evidence for health promotion measures for PLWH.

Association between forest and greenspace walking and stress-coping skills among workers of Tsukuba Science City, Japan: A cross-sectional study

Objectives

Study design

Methods

Results

Conclusions

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“Sense of coherence” (SOC) as a concept of stress-coping, has been gaining attention.

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There is little evidence about the associations between SOC and habits that are easy to perform in everyday life.

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Forests occupy 67% of the landmass and greenspace has been increasing every year in Japan.

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Forest/greenspace walking may enhance stress-coping skills.

Low sense of coherence is associated with anxiety among adults: Results based on data from all 47 prefectures of Japan

BACKGROUND

Anxiety disorder is a major societal, economic, and healthcare burden, so it is essential to identify underlying risk factors. Sense of coherence (SOC), defined as an individual's perceived ability to control events and cope with challenges, is strongly associated with healthcare outcomes.

METHODS

This study investigated the association between SOC and anxiety among adults in all 47 prefectures of Japan using a cross-sectional online panel survey. SOC was assessed using the University of Tokyo Health Sociology version of the SOC Scale and anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale.

RESULTS

Among 2100 participants (1051 males and 1049 females), 475 (22.6%) were identified with anxiety (scoring 8 points or higher on the GAD-7 scale). Before adjustment for potential confounders, there was a significant negative association between SOC and presence of anxiety. Even after adjustment, the presence of anxiety was significantly higher among the lower SOC subgroup than the higher SOC subgroup.

CONCLUSIONS

These results indicate that approximately one-fifth of adults in Japan suffer from anxiety and that low SOC is a significant risk factor.

A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study

OBJECTIVE

Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women's risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk.

DESIGN

Large, population study.

SETTING

UK population-based cohort.

PARTICIPANTS

30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996-2000. 10 183 women had data on all variables.

MAIN OUTCOME MEASURE

Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

RESULTS

In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91).

CONCLUSION

The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety.

Perspectives on differing health outcomes by city: accounting for Glasgow's excess mortality

Several health outcomes (including mortality) and health-related behaviors are known to be worse in Scotland than in comparable areas of Europe and the United Kingdom. Within Scotland, Greater Glasgow (in West Central Scotland) experiences disproportionately poorer outcomes independent of measurable variation in socioeconomic status and other important determinants. Many reasons for this have been proposed, particularly related to deprivation, inequalities, and variation in health behaviors. The use of models (such as the application of Bradford Hill's viewpoints on causality to the different hypotheses) has provided useful insights on potentially causal mechanisms, with health behaviors and inequalities likely to represent the strongest individual candidates. This review describes the evolution of our understanding of Glasgow's excess mortality, summarizes some of the key work in this area, and provides some suggestions for future areas of exploration. In the context of demographic change, the experience in Glasgow is an important example of the complexity that frequently lies behind observed variations in health outcomes within and between populations. A comprehensive explanation of Glasgow's excess mortality may continue to remain elusive, but is likely to lie in a complex and difficult-to-measure interplay of health determinants acting at different levels in society throughout the life course. Lessons learned from the detailed examination of different potentially causative determinants in Scotland may provide useful methodological insights that may be applied in other settings. Ongoing efforts to unravel the causal mechanisms are needed to inform public health efforts to reduce health inequalities and improve outcomes in Scotland.