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Jia F, Liu X, Wang Y. Social integration as a mediator of the association between housing tenure and health inequalities among China's migrants: A housing discrimination perspective. SSM Popul Health 2024; 25:101614. [PMID: 38317772 PMCID: PMC10839530 DOI: 10.1016/j.ssmph.2024.101614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
Due to the housing affordability crisis and institutional discrimination embedded in China's housing system, which refers to the unequal rights between homeowners and renters, migrant renters face greater social exclusion and health inequalities compared to migrant homeowners. Although housing tenure is considered an important determinant of health, along with other socioeconomic factors, the pathways underlying the association between housing tenure and health remain overlooked. Using data from the 2017 China Migrants Dynamic Survey of 62,268 participants, this study examined the mediating effects of social integration between housing tenure and self-rated health, and whether housing affordability moderated the mediating effects. Simple mediation models showed that social integration partly mediated the association between housing tenure and self-rated health. Moderated mediation models revealed that housing affordability moderated the association between housing tenure and social integration, and did not moderate the association between social integration and self-rated health. Compared with migrants living in affordable housing, the mediating effect of social integration was significantly smaller among migrants living in unaffordable housing. The results add knowledge to previous literature by uncovering the underlying mechanisms between housing tenure and health and linking housing studies to social inequalities in health. Our study suggested that diminishing housing discrimination and improving housing affordability could not only be beneficial for migrants' health but also be helpful to narrowing the health inequalities among migrants.
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Affiliation(s)
- Fulin Jia
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
| | - Xiaonan Liu
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
| | - Yuxiang Wang
- School of Management, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
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Jia F, Liu X, Wang Y, Ma M. The effect of housing tenure on health status of migrant populations in China: are health service utilization and social integration mediating factors? Arch Public Health 2023; 81:200. [PMID: 37981711 PMCID: PMC10659080 DOI: 10.1186/s13690-023-01218-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Current research suggests that there is an association between housing tenure and the health status of migrant populations, but the potential mediators of this association remain to be explored. We aimed to examine the effect of housing tenure on migrant populations' health in China and how this effect is mediated by health service utilization and social integration. METHODS Data from the 2017 China Migrants Dynamic Survey of 47,459 participants was used. Logistic regression models were used to explore the effects of housing tenure, health service utilization, and social integration on the health status of migrant populations. Mediated effects models were used to explore the association among them. This study used the bootstrap method and KHB method to test the mediating effect of health service utilization and social integration. RESULTS Compared to private renters, owners with mortgages (OR: 0.828, 95% CI: 0.765-0.896) were significantly associated with a higher risk of poor health. Compared with private renters, outright owners were associated with a lower risk of poor health (OR: 1.016, 95% CI: 0.935, 1.104), but the association was not statistically significant (p > 0.05). Moreover, health service utilization (OR: 1.422, 95% CI: 1.268, 1.594) and social integration (OR: 4.357, 95% CI: 3.555, 5.341) were both significantly associated with a higher probability of good health (p < 0.001). CONCLUSION Among migrant populations, homeowners with mortgages had a lower likelihood of good health than private renters, while there was no significant difference in the health status between outright owners and private renters. Moreover, health service utilization and social integration mediate the effect of housing tenure on the health status of migrant populations. Policies and interventions can be designed to improve the health service utilization and social inclusion of migrant populations to reduce health disparities across housing tenure types.
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Affiliation(s)
- Fulin Jia
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China
| | - Xiaonan Liu
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China
| | - Yuxiang Wang
- School of Management, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China
| | - Mingze Ma
- Department of Health Management, College of Public Health, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China.
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3
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Bodryzlova Y, Mehrabi F, Bosson A, Maïano C, André C, Bélanger E, Moullec G. The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis. J Aging Soc Policy 2023:1-22. [PMID: 37622436 DOI: 10.1080/08959420.2023.2245672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 08/26/2023]
Abstract
Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.
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Affiliation(s)
| | - Fereshteh Mehrabi
- École de santé publique, Université de Montréal, Montreal, Canada
- Centre de Recherche En santé Publique (CReSp), Université de Montréal Et CIUSSS du Centre-Sud-de-L'île-de-Montréal, Montreal, Canada
| | - Anthony Bosson
- Université de Montréal, Département de Neurosciences, Pavillon Paul-G.-Desmarais, Montreal, Canada
| | - Christophe Maïano
- Campus de Saint-Jérôme, Département de Psychoéducation Et de Psychologie, Université du Québec En Outaouais, Saint-Jérôme, Canada
| | - Claire André
- Centre de recherche, CIUSSS du Nord-de-l'Ile-de-Montréal, Department of Psychology, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA
| | - Grégory Moullec
- École de santé publique, Université de Montréal, Montreal, Canada
- Centre de recherche, CIUSSS du Nord-de-l'Ile-de-Montréal, Department of Psychology, Université de Montréal, Montreal, Canada
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4
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Vuong NX, Woods NK. On the Relationship Between Stakeholder Affiliation and Attitudes Toward Behavioral Health Reform in Kansas. Kans J Med 2023; 16:28-34. [PMID: 36845265 PMCID: PMC9957591 DOI: 10.17161/kjm.vol16.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The lack of access to behavioral health care, trends in behavioral health issues, and the impact of social determinants of health underlie the need for behavioral health reform in Kansas. However, stakeholders may affect progress toward behavioral health reform. This study examined stakeholders' attitudes toward behavioral health reform. Methods The authors analyzed data from a survey administered to elected officials, members of health advocacy groups, state employees, and payers in Kansas. Main outcome measures included attitudes toward the perceived benefit of certain behavioral health and social determinants of health policies and the perceived performance of the primary care and behavioral health care systems in Kansas. Results Payers perceived legislation to improve insurance coverage for behavioral health issues as less beneficial than state employees and members of health advocacy groups. Elected officials perceived legislation to address various social determinants of health as less beneficial than health advocates. Members of health advocacy groups rated the behavioral health care system more poorly than elected officials did. Conclusions Preliminary findings reflected both the barriers and facilitators to behavioral health reform in Kansas. However, several limitations undermined the generalizability of these findings. Future studies should consider more representative sample sizes, additional variables in behavioral health and social determinants of health policies, and more comprehensive, validated measures.
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Affiliation(s)
- Ngoc X. Vuong
- Dorothy and Bill Cohen Honors College, Wichita State University, Wichita, KS
| | - Nikki K. Woods
- Department of Public Health Sciences, Wichita, KS,Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Self-rated Health and Objective Health Status Among Rural-to-Urban Migrants in China: A Healthy Housing Perspective. POPULATION RESEARCH AND POLICY REVIEW 2023. [DOI: 10.1007/s11113-023-09752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Monitoring socioeconomic inequalities in health in Hong Kong: insights and lessons from the UK and Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100636. [PMID: 36879790 PMCID: PMC9985041 DOI: 10.1016/j.lanwpc.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
In many developed countries such as the UK and Australia, addressing socioeconomic inequalities in health is a priority in their policy agenda, with well-established practices and authorities to collect and link selected health and social indicators for long-term monitoring. Nonetheless, the monitoring of socioeconomic inequalities in health in Hong Kong remains in a piecemeal manner. Also, the common international practice to monitor inequalities at area level appears to be unsuitable in Hong Kong due to its small, compact, and highly interconnected built environment that limits the variation of neighbourhood deprivation level. To enhance inequality monitoring in Hong Kong, we aim to draw reference and lesson from the UK and Australia to explore the feasible steps forward regarding collection of health indicators and contextually appropriate equity stratifiers with strong implication on policy actions, and discuss potential strategies to promote the public awareness and motivations for a more comprehensive inequality monitoring system.
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Rana K, Page A, Kent JL, Arora A. Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16627. [PMID: 36554503 PMCID: PMC9779591 DOI: 10.3390/ijerph192416627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Several high-income countries are currently experiencing an unprecedented and multifaceted housing crisis. The crisis is escalating rapidly, and its negative ramifications are shared disproportionately by migrant and refugee communities. Although housing is often cited as an important social determinant of health, the relationship between housing inequalities and health outcomes in the context of migrant and refugee populations remain under-explored, particularly in high-income countries. This paper presents a protocol for a mixed-methods systematic review which will synthesize the evidence on the key housing and health inequalities faced by migrant and refugee populations in high-income countries. It will inform the identification of pathways linking housing inequalities to health outcomes. The protocol for this systematic review was developed with guidance from the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration, and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. Quantitative, qualitative and mixed-methods studies reporting the association of housing inequalities with physical and mental health outcomes among refugee and migrant populations in high-income countries will be included. Medline, Web of Science, Embase, PsycINFO, Scopus and CINAHL will be searched for peer-reviewed literature. This will be supplemented by gray literature searches using Google Scholar, MedNar and WHOLIS. Two reviewers will independently screen and select studies, assess the methodological quality and conduct data extraction. This systematic review will elucidate the different pathways linking housing inequalities and health outcomes, which may guide the development of targeted housing and public health interventions to improve the health and wellbeing of migrant and refugee populations. The review is registered with PROSPERO (CRD42022362868).
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jennifer L. Kent
- The University of Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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Seo BK, Hwang IH, Sun Y, Chen J. Homeownership, Depression, and Life Satisfaction in China: The Gender and Urban-Rural Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14833. [PMID: 36429551 PMCID: PMC9690236 DOI: 10.3390/ijerph192214833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
This study examines how depression and life satisfaction are associated with assets in the form of homeownership in China and whether their relationships differ between men and women, and between urban and rural areas. While the psychological benefits of homeownership are well-documented, how gender makes a difference in this relationship remains unclear. Given the dynamic housing market conditions characterized by the urban-rural divide and the notable gender gap in psychological well-being, China can provide a relevant context to address this knowledge gap. A series of linear regression analyses based on the China Family Panel Studies (CFPS) data show that homeownership is positively associated with life satisfaction and negatively related to depression, and this relationship is driven by men. While the homeownership-life satisfaction relation does not differ between urban and rural areas, the negative association between homeownership and depression is seen only among rural residents. The gender difference could be explained by the salient role of the financial security obtained from homeownership, whereas the regional difference seems to be supported by the social comparison theory. This study contributes to the knowledge of how a biological determinant, i.e., gender, interacts with a social determinant, i.e., homeownership, to affect psychological well-being.
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Affiliation(s)
- Bo Kyong Seo
- Department of Applied Social Sciences, Centre for Social Policy and Social Entrepreneurship, The Hong Kong Polytechnic University, Hong Kong, China
| | - In Hyee Hwang
- Department of Political Science, Sogang University, Seoul 04107, Korea
| | - Yi Sun
- Department of Building and Real Estate, Research Institute for Land and Space, The Hong Kong Polytechnic University, Hong Kong, China
| | - Juan Chen
- Department of Applied Social Sciences, Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, China
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Effect of Residual Stress Induced by Different Cooling Methods in Heat Treatment on the Fatigue Crack Propagation Behaviour of GH4169 Disc. MATERIALS 2022; 15:ma15155228. [PMID: 35955161 PMCID: PMC9369495 DOI: 10.3390/ma15155228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022]
Abstract
In this study, the effects of residual stress induced by three different cooling methods during heat treatment on the crack propagation behaviour of the GH4169 disc were investigated. Different levels of stress fields were induced to the specially designed discs by using air cooling (AC), air jetting cooling (AJC) and water quenching (WQ) methods and were quantitated by numerical simulation. These discs were then subjected to prefabricated cracking, and crack propagation tests were conducted on a spin tester with two load spectrums. Crack growth behaviour was depicted via the surface replica technique and fracture morphology. Regarding the linear superposition of residual stress and centrifugal force, the crack propagation behaviour of different discs was simulated using the FRANC3D software. AJC and WQ introduced compressive residual stress (−259 MPa and −109 MPa, respectively) into the disc compared with the AC method (about −1.5 MPa). The AJC method increases the crack propagation life of the disc by introducing residual compressive stress into the area near the surface of the central hole to inhibit the opening of the crack surface. When the fatigue load was low, this inhibition effect was more significant.
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Dotsikas K, Osborn D, Walters K, Dykxhoorn J. Trajectories of housing affordability and mental health problems: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:769-778. [PMID: 35767014 PMCID: PMC10097755 DOI: 10.1007/s00127-022-02314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health. METHODS We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009-2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018-2020). RESULTS We found six distinct trajectories of housing affordability problems. Those in the 'stable low' group had a consistently low probability of affordability problems, whilst those in 'high falling' group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018-2020 (Wave 10). Compared to the 'stable low' group, those in the 'high falling' group had a GHQ score that was 1.06 (95% CI 0.53-1.58) points higher. CONCLUSION This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.
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Affiliation(s)
- Kate Dotsikas
- Division of Psychiatry, University College London, London, W1T 7NF, UK.
| | - David Osborn
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jennifer Dykxhoorn
- Division of Psychiatry, University College London, London, W1T 7NF, UK
- Department of Primary Care and Population Health, University College London, London, UK
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Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127095. [PMID: 35742339 PMCID: PMC9222799 DOI: 10.3390/ijerph19127095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05-3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18-2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85-3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14-2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.
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Elliott S, West SM, Castro AB. Rent Burden and Depression Among Mothers: an Analysis of Primary Caregiver Outcomes. JOURNAL OF POLICY PRACTICE AND RESEARCH 2021. [PMCID: PMC8435361 DOI: 10.1007/s42972-021-00040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Using national longitudinal survey data from the Fragile Families & Child Wellbeing Study (FFCWS), this study builds on existing knowledge about housing insecurity, female caregivers, and well-being. The study analyzed the relationship between housing cost burdens (HCB) and depression among a sample (N = 399) of predominantly (67.6%) Black non-Hispanic mothers and other female primary caregivers. A generalized estimating equation (GEE) model yielded results that indicate housing cost burden among mothers and other female primary caregivers has a statistically significant association with meeting symptoms of depression and liberal criteria for depression as measured by the CIDI-SF survey instrument. This study contributes to the knowledge base of health outcomes related to housing cost burden by providing a unique analysis of the association of depression and housing cost burden at an unprecedented scale by using data from several consecutive waves of survey responses of a large, multi-city, longitudinal study. The findings hold implications that may inform future policy and research concerning the affordable housing crisis, which disproportionately affects mothers and other female heads of household. Considering the prevalence of housing cost burden in the USA and the disproportionate indications of depression found among housing burdened mothers/female caregivers, the findings of this study may hold implications for housing and health policies that address U.S. communities as diverse as the wide range of communities from which the FFCWS respondents were drawn.
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Chung RYN, Chung GKK, Chan SM, Chan YH, Wong H, Yeoh EK, Allen J, Woo J, Marmot M. Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city. Sci Rep 2021; 11:23161. [PMID: 34848754 PMCID: PMC8633192 DOI: 10.1038/s41598-021-02342-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adults in Hong Kong were recruited via a cross-sectional population-wide telephone survey. The inter-relationship between deprivation, types of worry, mental health disorders, and subjective well-being was assessed using structural equation modelling. Results showed significant total effects of deprivation on worries about being infected (p = 0.002), economic activities and livelihood (p < 0.001), and personal savings (p < 0.001), as well as mental health disorders (p < 0.001) and subjective well-being (p < 0.001). Specifically, worry about economic activities and livelihood partly mediated the total effect of deprivation on mental health disorders (p = 0.004), whereas worry about personal savings and worry about economic activities and livelihood partially mediated the total effect of deprivation on subjective well-being (p = 0.007 and 0.002, respectively). Socioeconomic inequality, particularly in mental health and well-being, could be exacerbated via people's economic concerns during the pandemic, which was largely induced by the COVID-19 containment measures rather than the pandemic per se given the relatively low COVID-19 incidence in Hong Kong.
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Affiliation(s)
- Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China. .,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China. .,4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China.
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu-Ming Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,CityU Department of Social and Behavioural Sciences, The City University of Hong Kong, Hong Kong SAR, China
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eng Kiong Yeoh
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Allen
- Department of Epidemiology and Public Health, UCL Institute of Health Equity, UCL Research, London, UK
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Epidemiology and Public Health, UCL Institute of Health Equity, UCL Research, London, UK
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Chung GKK, Lai FTT, Yeoh EK, Chung RYN. Gender-specific trends of educational inequality in diagnosed diabetes from 1999 to 2014 in Hong Kong: a serial cross-sectional study of 97,481 community-dwelling Chinese adults. Popul Health Metr 2021; 19:37. [PMID: 34629087 PMCID: PMC8504033 DOI: 10.1186/s12963-021-00268-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.
Methods A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes. Results Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02–1.07, annual SII change = 0.36%; 95% CI = 0.16–0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83–3.24, SII = 9.21%; 95% CI = 6.47–11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality. Conclusions Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00268-x.
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Affiliation(s)
- Gary Ka-Ki Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. .,CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China.
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15
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Parry J, Vanstone M, Grignon M, Dunn JR. Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature. Int J Equity Health 2021; 20:219. [PMID: 34620188 PMCID: PMC8496150 DOI: 10.1186/s12939-021-01546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it. PURPOSE OF STUDY This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation. METHODS Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes. RESULTS Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs. CONCLUSION Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.
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Affiliation(s)
- Jane Parry
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - James R. Dunn
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
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16
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Nie P, Li Y, Ding L, Sousa-Poza A. Housing Poverty and Healthy Aging in China: Evidence from the China Health and Retirement Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9911. [PMID: 34574834 PMCID: PMC8471028 DOI: 10.3390/ijerph18189911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over. METHODS Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period. RESULTS We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time. CONCLUSIONS The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.
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Affiliation(s)
- Peng Nie
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China; (Y.L.); (L.D.); (A.S.-P.)
- Institute for Health Care & Public Management, University of Hohenheim, 70599 Stuttgart, Germany
| | - Yan Li
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China; (Y.L.); (L.D.); (A.S.-P.)
| | - Lanlin Ding
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China; (Y.L.); (L.D.); (A.S.-P.)
| | - Alfonso Sousa-Poza
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China; (Y.L.); (L.D.); (A.S.-P.)
- Institute for Health Care & Public Management, University of Hohenheim, 70599 Stuttgart, Germany
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17
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Chung GKK, Chan SM, Chan YH, Woo J, Wong H, Wong SY, Yeoh EK, Marmot M, Chung RY. Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong. Emerg Infect Dis 2021; 27:2874-2877. [PMID: 34469286 PMCID: PMC8544972 DOI: 10.3201/eid2711.204840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation policies had differential socioeconomic effects.
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18
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From Comparative and Statistical Assessments of Liveability and Health Conditions of Districts in Hong Kong towards Future City Development. SUSTAINABILITY 2021. [DOI: 10.3390/su13168781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Liveability is an indispensable component in future city planning and is practically linked with the health status of individuals and communities. However, there was nor comprehensive and universal district-level framework for assessing liveability due to geospatial and social discrepancies among different countries. In this study, using Hong Kong, a highly dense and international city as an example, the Liveability and Health Index (LHI-HK) consisting of 30 indicators was established, with 21 of them related to education, economy, housing, walkability/transport, environment, and health facilities aspects, while the health conditions of citizens in individual districts were examined by other 9 indicators. Respective scoring allocation was determined by statistical reasoning, and was applied to quantify the connections between liveability and health among the 18 districts of Hong Kong in both 2016 and 2019. Temporal changes of spatial features could be traced by this quantitative framework, and obvious correlations between liveability and health were attained, with R values of 0.496 and 0.518 in 2016 and 2019, and corresponding slopes of 0.80 and 0.88, respectively. Based on the statistical results, it was found that Sai Kung and Kwun Tong are the most and the least liveable district of Hong Kong in 2019. The LHI-HK index was well-validated by renowned AARP liveability index and The California Healthy Places Index (HPI), with R values of 0.90 and 0.70, and the potential uncertainties due to data projection were less than 2.5% for all districts, which implicates its relevancy and appropriateness in conducting similar spatial assessments in international cities. Further, both favorable and unfavorable spatial arrangements of each of the 3 district types in Hong Kong were identified, namely residential, commercial, and industrial districts. This opens new windows in enhancing liveability and health status within communities, with the aim of promoting the sustainability of cities in the long run.
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19
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Chan SM, Wong H, Chung RYN, Au-Yeung TC. Association of living density with anxiety and stress: A cross-sectional population study in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1019-1029. [PMID: 32783296 DOI: 10.1111/hsc.13136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
This study aims to enrich the comprehension of the effect of living density on anxiety and stress among adults in a global city. A random sample of 1,978 Hong Kong adults was interviewed in a cross-sectional population study in 2014-2015. Descriptive statistics and logistic regressions were used to investigate the association between housing variables and mental health indicators, namely, anxiety and stress. Logistic regression analysis results have shown that by controlling the confounding effect of demographic variables, income poverty, housing ownership and housing cost, the living density was significantly associated with anxiety and stress of residents. Compared with those living in high density of <7 m2 , living in medium density of ≥7 and <13 m2 was significantly associated with lower risk of anxiety (adjusted OR 0.52, 95% CI 0.30-0.88), and the risk was less for those living in low density of ≥13 m2 (adjusted OR 0.41, 95% CI 0.23-0.72). Meanwhile, living in low density of ≥13 m2 was significantly associated with a lower risk of stress (adjusted OR 0.44, 95% CI 0.20-0.97). These results highlighted the significant impact of living density on personal anxiety and stress. Moreover, female, younger adults or those living in income poverty were also at risk of anxiety and stress. In conclusion, our findings implied that improving housing policies, such as building public housing with adequate living areas and market regulation of living density of private housing, would help enhance the mental well-being of residents.
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Affiliation(s)
- Siu Ming Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Tat Chor Au-Yeung
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, China
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20
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Chung RYN, Chung GKK, Marmot M, Allen J, Chan D, Goldblatt P, Wong H, Lai E, Woo J, Yeoh EK, Wong SYS. COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong. J Epidemiol Community Health 2021; 75:616-623. [PMID: 33402396 DOI: 10.1136/jech-2020-215392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence. METHODS 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested. RESULTS Deprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=-0.154, p<0.001) and mental health (β=-0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=-0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life. CONCLUSION Even if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people's concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.
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Affiliation(s)
- Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jessica Allen
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Dicken Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter Goldblatt
- UCL Institute of Health Equity, Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Lai
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eng-Kiong Yeoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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21
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Seo BK, Park GR. Housing, Living Arrangements and Mental Health of Young Adults in Independent Living. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105250. [PMID: 34069214 PMCID: PMC8156951 DOI: 10.3390/ijerph18105250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Young adults are prone to psychological stress and anxiety induced by major transitions to adulthood. While employment has predominated in previous research on the social determinants of young people’s mental health, this study examines the association between young people’s housing problems and mental health in the context of an unaffordable housing market. Using the Survey on the Living Conditions and Welfare Needs of Youths (n = 1308) in Korea, the study found that perceived poor housing quality and material hardship are negatively associated with the mental health of young adults living independently. Specifically, while poor housing quality and material hardship induced by housing cost burden were negatively associated with single-person households’ mental health, only poor housing quality was associated with non-single-person households’ mental health. This study is one of the few studies examining the linkage between housing problems and mental health of young adults and informs the interventions aimed at promoting the psychological well-being of young adults in the transition from parents’ homes to independent living.
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Affiliation(s)
- Bo-Kyong Seo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Correspondence:
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong 30147, Korea
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22
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Hou WK, Lee TMC, Liang L, Li TW, Liu H, Ettman CK, Galea S. Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1499-1508. [PMID: 33590313 PMCID: PMC7884208 DOI: 10.1007/s00127-021-02037-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/29/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine the joint associations of civil unrest and COVID-19 with probable anxiety and depression during the first half of 2020 in Hong Kong. Associations were compared between persons with low or high assets. METHODS A population-representative sample of 4011 Hong Kong Chinese residents aged 15 years or older were recruited between February and May 2020. Respondents reported current anxiety and depressive symptoms, unrest stress, COVID-19 stress, assets (savings and home ownership), and demographics. RESULTS Stress due to unrest and COVID-19 was associated with higher prevalence of probable anxiety and depression; persons with both stressors had higher prevalence. This pattern was consistent among persons with low or high assets, but the probabilities of mental disorder were substantially higher among persons with fewer assets. CONCLUSIONS The effect of stressors on probable anxiety and depression are cumulative: persons with stress due to civil unrest and to COVID-19 reported more mental disorders than persons with stress due to only one, or none of these factors. Overall high assets appear to buffer the consequences of stressors, lowering the risk of mental disorder.
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Affiliation(s)
- Wai Kai Hou
- Department of Psychology, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po NT, Hong Kong SAR, China. .,Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
| | - Tatia Mei-Chun Lee
- grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences and Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Li Liang
- grid.419993.f0000 0004 1799 6254Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tsz Wai Li
- grid.419993.f0000 0004 1799 6254Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- grid.419993.f0000 0004 1799 6254Department of Psychology, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po NT, Hong Kong SAR, China ,grid.419993.f0000 0004 1799 6254Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Catherine K. Ettman
- grid.189504.10000 0004 1936 7558School of Public Health, Boston University, Boston, MA USA ,grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI USA
| | - Sandro Galea
- grid.189504.10000 0004 1936 7558School of Public Health, Boston University, Boston, MA USA
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23
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Wei G, Zhu H, Han S, Chen J, Shi L. Impact of house price growth on mental health: Evidence from China. SSM Popul Health 2020; 13:100696. [PMID: 33532536 PMCID: PMC7823040 DOI: 10.1016/j.ssmph.2020.100696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Housing boom has raised global attention in the past two decades. A number of studies attempted to analyse the effect of house price increase. However, little is known about the health consequence as a result of housing boom, likely due to the scarcity of the data. The objective of this paper is to investigate the relationship between housing affordability and mental health as a result of house price increase. Methods Based on a panel dataset of 32 Chinese cities from January 2013 to December 2017, we used a fixed effect model adjusting for per capita disposable income to estimate the impact of house price growth rate on mental health, and applied the Instrumental Variable (IV) method to address the endogeneity problem. Results From both Ordinary Least Squares (OLS) and IV estimations, the results suggested that a one standard deviation increase in house price increase rate in the past three months is associated with a 0.443 standard deviation increase in people consulting with doctors about their mental disorders in the city. This effect does not vary by gender, but was more pronounced in residents older than 40 years. Conclusion These results revealed the potential negative consequences in people's mental health due to house price increase, necessitate appropriate policy responses.
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Affiliation(s)
- Guoxu Wei
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - He Zhu
- International Research Center for Medicinal Administration, Peking University Health Science Center, Beijing, 100191, China
| | - Sheng Han
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University Health Science Center, Beijing, 100191, China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University Health Science Center, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University Health Science Center, Beijing, 100191, China
- Corresponding author. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
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24
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Park GR, Seo BK. Revisiting the relationship among housing tenure, affordability and mental health: Do dwelling conditions matter? HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2225-2232. [PMID: 32511845 DOI: 10.1111/hsc.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Despite growing attention to housing as a social determinant of health, few studies have featured the interplay of its diverse impacts on health. Using the Korea Welfare Panel Study, this study used logistic regression analysis for examining how housing tenure and affordability are associated with depressive symptoms under different physical dwelling conditions among low-income households in Korea. In our findings, renters, compared with homeowners, were more likely to report depressive symptoms, and housing unaffordability was associated with a higher likelihood of having depressive symptoms. When dwelling conditions were considered, housing tenancy, compared with ownership, tended to be associated with depressive symptoms among adequate housing dwellers, whereas housing unaffordability was associated with depressive symptoms mainly among those living in substandard housing conditions. The findings suggest that the linkage of multiple housing problems to psychological well-being is dynamic. Public health policies and housing subsidy programs should, therefore, be designed based on a comprehensive account of not only tenure or income status, but also dwelling conditions.
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Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Bo Kyong Seo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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25
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Wu Y, Yan X, Zhao S, Wang J, Ran J, Dong D, Wang M, Fung H, Yeoh EK, Chung RYN. Association of time to diagnosis with socioeconomic position and geographical accessibility to healthcare among symptomatic COVID-19 patients: A retrospective study in Hong Kong. Health Place 2020; 66:102465. [PMID: 33130449 PMCID: PMC7568172 DOI: 10.1016/j.healthplace.2020.102465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
Early diagnosis is important to control COVID-19 outbreaks. This study aimed to assess how individual and area socioeconomic position and geographical accessibility to healthcare services were associated with the time to diagnosis among symptomatic COVID-19 patients in Hong Kong. Multivariable generalized linear regression was used to estimate the associations while adjusting for sociodemographic characteristics and case classification. This study found living in public rental housing and living in an area with low education were associated with longer time to diagnosis in the first wave of infections. Specifically, the risk of delayed diagnosis for public rental housing residents was mitigated by the higher density of public clinics/hospitals but was slightly increased by the higher density of private medical practitioners nearby. No such relations were found in the second wave of infections when the surveillance measures were enhanced. Given the grave impact of pandemics around the world, our findings call on taking inequalities into account when public health policies are being devised.
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Affiliation(s)
- Yushan Wu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China
| | - Xiang Yan
- Department of Urban Planning and Design, The Social Infrastructure for Equity and Wellbeing (SIEW) Lab, The University of Hong Kong, Pokfulam Road, Hong Kong, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Shenzhen Research Institute, Shenzhen, China
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinjun Ran
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China
| | - Maggie Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Shenzhen Research Institute, Shenzhen, China
| | - Hong Fung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Medical Centure, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China; CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China; CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China.
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Chung GKK, Dong D, Wong SYS, Wong H, Chung RYN. Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong. Int J Equity Health 2020; 19:13. [PMID: 31992307 PMCID: PMC6986077 DOI: 10.1186/s12939-020-1127-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. METHODS Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. RESULTS In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. CONCLUSIONS The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
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Affiliation(s)
- Gary Ka-Ki Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
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