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Feng Y, Bowden JL, Hunter DJ, Ferreira P, Duncan GE. Does neighbourhood deprivation influence low back pain and arthritis: An empirical study using multilevel twin design. PLoS One 2024; 19:e0298356. [PMID: 38669221 PMCID: PMC11051583 DOI: 10.1371/journal.pone.0298356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/23/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Neighbourhood deprivation has been found to be associated with many health conditions, but its association with low back pain (LBP) and arthritis is unclear. This study aimed to examine the association between neighbourhood deprivation with LBP and arthritis, and its potential interaction with individual socioeconomic status (SES) on these outcomes. METHODS Monozygotic (MZ) twins from the Washington State Twin Registry were used to control for genetic and common environmental factors that could otherwise confound the purported relationship. Multilevel models were employed to examine the association between neighbourhood deprivation as well as individual-level SES with LBP/arthritis, adjusting for age, sex, body mass index (BMI) and residence rurality. RESULTS There were 6,380 individuals in the LBP sample and 2,030 individuals in the arthritis sample. Neighbourhood deprivation was not associated with LBP (P = 0.26) or arthritis (P = 0.61), and neither was its interaction with individual-level SES. People without a bachelor's degree were more likely to report LBP (OR 1.44, 95% CI 1.26-1.65) or both LBP and arthritis (OR 1.67, 95% CI 1.14-2.45) than those with a bachelor's degree, but not for arthritis alone (P = 0.17). Household income was not significantly associated with LBP (P = 0.16) or arthritis (p = 0.23) independent of age, sex, and BMI. CONCLUSION Our study did not find significant associations between neighbourhood deprivation and the presence of LBP or arthritis. More research using multilevel modelling to investigate neighbourhood effects on LBP and arthritis is recommended.
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Affiliation(s)
- Yingyu Feng
- Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Jocelyn L. Bowden
- Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - David J. Hunter
- Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Paulo Ferreira
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Glen E. Duncan
- Department of Nutrition and Exercise Physiology, Washington State University Health Sciences Spokane, Spokane, Washington, United States of America
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Zhang Y, Chen YC, Wang JSH. Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality. Int J Health Policy Manag 2023; 12:7938. [PMID: 38618772 PMCID: PMC10843175 DOI: 10.34172/ijhpm.2023.7938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/21/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Evidence of the impact of long-term care insurance (LTCI) on health and well-being has predominantly come from developed countries. China officially launched its city-level LTCI policy in 2016. Recent evidence in China has shown that having an LTCI program contributes to positive health. However, it is unclear whether such positive policy effects were attributed to policy announcement or implementation effects, and whether the policy effects vary by locality, chronic conditions, and their intersectionality. This study examines whether there are longitudinal health benefits for older Chinese who are participating in LTCI, particularly considering their city location (urban/rural), whether they have chronic conditions, and the intersectionality. METHODS Following the Andersen Behavioral Model, health and satisfaction outcomes of 9253 adults aged 60+ years were extracted from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Individual data were linked to census socioeconomic data with city-level characteristics and LTCI policy variable. Multilevel lagged regression models investigated the impact of LTCI policy on health and satisfaction with health services, after controlling for baseline individual- and city-level covariates. RESULTS Of 125 cities in the dataset, 21 (16.8%) had adopted LTCI. These city inhabitants had significantly better self-rated health and higher satisfaction relative to cities without LTCI policies when environmental- and personal-level characteristics were modeled. Health benefits of LTCI were stronger after policy announcement and were particularly observed among rural older adults and those with chronic conditions. Results also suggest that LTCI's positive effects on satisfaction spill over to middle-aged adults. CONCLUSION Expanding coverage and eligibility to LTCI for all older Chinese could improve health and well-being.
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Affiliation(s)
- Yinkai Zhang
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Chih Chen
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Social Policy Institute, Washington University in St. Louis, St. Louis, MO, USA
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Herlitz S, Ohm J, Häbel H, Ekelund U, Hofmann R, Svensson P. Socioeconomic status is associated with process times in the emergency department for patients with chest pain. J Am Coll Emerg Physicians Open 2023; 4:e13005. [PMID: 37426554 PMCID: PMC10329481 DOI: 10.1002/emp2.13005] [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: 02/09/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Emergency department length of stay (EDLOS) is linked to crowding and patient outcomes whereas worse prognosis in low socioeconomic status remains poorly understood. We studied whether income was associated with ED process times among patients with chest pain. Methods This was a registry-based cohort study on 124,980 patients arriving at 14 Swedish EDs between 2015 and 2019 with chest pain as their chief complaint. Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles, whether the time to physician assessment exceeded triage priority recommendations as well as EDLOS were evaluated using crude and multivariable regression models adjusted for age, gender, sociodemographic variables, and ED-management circumstances. Results Patients with the lowest income were more likely to be assessed by physician later than triage recommendations (crude odds ratio [OR] 1.25 (95% confidence interval [CI] 1.20-1.29) and have an EDLOS exceeding 6 h (crude OR 1.22 (95% CI 1.17-1.27). Among patients subsequently diagnosed with major adverse cardiac events, patients with the lowest income were more likely to be assessed by a physician later than triage recommendations, crude OR 1.19 (95% CI 1.02-1.40). In the fully adjusted model, the average EDLOS was 13 min (5.6%) longer among patients in the lowest income quintile, 4:11 [h:min], (95% CI 4:08-4:13), compared to patients in the highest income quintile, 3:58 (95% CI 3:56-4:00). Conclusions Among ED chest pain patients, low income was associated with longer time to physician than recommended by triage and longer EDLOS. Longer process times may have a negative impact due to crowding in the ED and delay diagnosis and timely treatment of the individual patient.
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Affiliation(s)
- Sebastian Herlitz
- Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Joel Ohm
- Department of Medicine, SolnaKarolinska InstitutetStockholmSweden
- Coagulation Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Henrike Häbel
- Department of Learning, Informatics, Management, and Ethics, SolnaKarolinska InstitutetStockholmSweden
| | - Ulf Ekelund
- Emergency Medicine, Department of Clinical Sciences Lund, Lund UniversitySkåne University HospitalLundSweden
| | - Robin Hofmann
- Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
- Department of CardiologySödersjukhusetStockholmSweden
| | - Per Svensson
- Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
- Department of CardiologySödersjukhusetStockholmSweden
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Guindon GE, Montreuil A, Driezen P, Stahlbaum R, Giolat D, Baskerville NB. Do cigarette prices near secondary schools vary by area-level socioeconomic status? Findings from a field study in Ontario and Québec, Canada. Health Place 2023; 79:102936. [PMID: 36493496 DOI: 10.1016/j.healthplace.2022.102936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine, in the context of youth smoking, whether cigarette prices near secondary schools varied by area-level socioeconomic status in Southwestern and Central Ontario, and the greater Montréal region. METHODS We collected cigarette prices four times between 2016 and 2019 from stores near secondary schools and used mixed-effects and ordinary least squares regressions. RESULTS We found consistent evidence that cigarette prices near secondary schools were lower in neighbourhoods with lower area-level household income, and that differences were large enough to be meaningful. In Ontario and Québec, our results indicate a Can$0.26 [0.04, 0.47] to Can$0.51 [0.33, 0.69] and Can$0.10 [-0.04, 0.24] to Can$0.37 [0.22, 0.52] difference in prices for a pack of 25 cigarettes between neighbourhoods with a median household income standard deviation below/above the provincial median, respectively. CONCLUSION Policy changes that limit area-level cigarette price differences without lowering cigarette prices may reduce inequities in youth smoking.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Annie Montreuil
- Institut national de santé publique du Québec, Montréal, QC, Canada; Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Stahlbaum
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Didier Giolat
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - N Bruce Baskerville
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada; Canadian Institutes of Health Research, Ottawa, ON, Canada
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Chen N, Kim CG. The Moderating Effect of Community-Level Deprivation on the Association between Individual Characteristics and Smoking Behavior among Chinese Adults: A Cross-Level Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115785. [PMID: 34072249 PMCID: PMC8199057 DOI: 10.3390/ijerph18115785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
China joined the World Health Organization (WHO) Framework Convention on Tobacco Control in 2006; however, the overall Chinese smoking rate is still high. The aim of this study is to provide new evidence for the direct effects of community-level deprivation, and the effects of interactions between community-level deprivation and individual characteristics, on smoking intensity, by using cross-sectional data from the 2015 China Health and Nutrition Survey (CHNS). The results show that there is a strong association between community-level deprivation and individual smoking intensity, and that community deprivation moderates the relationship between individual perceived stress and smoking intensity. The findings imply that adequate interventions should be conducted in the context of deprived neighborhoods, and should consider differences between levels of individual perceived stress and between sexes, especially focusing on highly stressed women who live in deprived communities.
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Affiliation(s)
- Nan Chen
- Major in Chinese Studies, Department of Global Business, Kosin University, Busan 49104, Korea;
| | - Chang-Gyeong Kim
- Department of Chinese Studies, Pukyong National University, Busan 48513, Korea
- Correspondence: ; Tel.: +82-51-629-5342
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Anokye R, Radavelli-Bagatini S, Bondonno CP, Sim M, Blekkenhorst LC, Connolly E, Bondonno NP, Schousboe JT, Woodman R, Zhu K, Szulc P, Jackson B, Dimmock J, Schlaich MP, Cox KL, Kiel DP, Lim WH, Devine A, Thompson PL, Gianoudis J, De Ross B, Daly RM, Hodgson JM, Lewis JR, Stanley M. Implementation, mechanisms of impact and key contextual factors involved in outcomes of the Modification of Diet, Exercise and Lifestyle (MODEL) randomised controlled trial in Australian adults: protocol for a mixed-method process evaluation. BMJ Open 2020; 10:e036395. [PMID: 33177130 PMCID: PMC7661373 DOI: 10.1136/bmjopen-2019-036395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Modification of Diet, Exercise and Lifestyle (MODEL) study aims to examine the impact of providing visualisation and pictorial representation of advanced structural vascular disease (abdominal aortic calcification), on 'healthful' improvements to diet and lifestyle. This paper reports the protocol for the process evaluation for the MODEL study. METHODS AND ANALYSIS The overall aim of the process evaluation is to understand the processes that took place during participation in the MODEL study trial and which elements were effective or ineffective for influencing 'healthful' behavioural change, and possible ways of improvement to inform wider implementation strategies. A mixed-method approach will be employed with the use of structured questionnaires and semistructured in-depth interviews. All 200 participants enrolled in the trial will undertake the quantitative component of the study and maximum variation sampling will be used to select a subsample for the qualitative component. The sample size for the qualitative component will be determined based on analytical saturation. Interviews will be digitally recorded and transcribed verbatim. Qualitative data will be analysed thematically and reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. ETHICS AND DISSEMINATION The MODEL study process evaluation has received approval from Edith Cowan University Human Research Ethics Committee (Project Number: 20513 HODGSON). Written informed consent will be obtained from all participants before they are included in the study. The study results will be shared with the individuals and institutions associated with this study as well as academic audiences through peer-reviewed publication and probable presentation at conferences. TRIAL REGISTRATION NUMBER ACTRN12618001087246.
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Affiliation(s)
- Reindolf Anokye
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Simone Radavelli-Bagatini
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Catherine P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Emma Connolly
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicola P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Health Partners Institute and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Pawel Szulc
- INSERM UMR1033, University of Lyon, Lyon, France
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - James Dimmock
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Markus P Schlaich
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kay L Cox
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter L Thompson
- Department of Cardiology, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Gianoudis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Belinda De Ross
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Guindon GE, Fatima T, Abbat B, Bhons P, Garasia S. Area-level differences in the prices of tobacco and electronic nicotine delivery systems - A systematic review. Health Place 2020; 65:102395. [PMID: 32858241 DOI: 10.1016/j.healthplace.2020.102395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine associations between area-level characteristics (socioeconomic status, racial or ethnic characteristics, age, and any other characteristics that may be associated with vulnerability) and the prices of tobacco products and electronic nicotine delivery systems (ENDS). DATA SOURCES We searched MEDLINE, EconLit and Scopus, unpublished and grey literature, hand-searched four specialty journals, examined references of relevant studies, and contacted key informants. STUDY SELECTION We considered all studies that quantitatively examined area-level variations in the prices of tobacco products and ENDS. We included all studies that examined any area-level measures regardless of the geographic location, language or time of publication. At least two reviewers independently screened the articles. We identified 20 studies. DATA EXTRACTION At least two reviewers independently extracted the characteristics, methods, and main results and assessed the quality of each included study. DATA SYNTHESIS Overall, cigarette prices were found to be lower in lower socioeconomic status neighbourhoods, and in neighbourhoods with a higher percentage of youth, and Blacks or African Americans. We identified too few studies that examined price differences for cigarillos, chewing tobacco, roll-your-own, and ENDS to reach any conclusions. CONCLUSIONS Our findings are in keeping with tobacco industry documents that detailed how manufacturers used race, class, and geography to target vulnerable populations and suggest that regulations that can limit industry price manipulation such as minimum, maximum, and uniform prices, and high specific excise taxes should be considered. More frequent and systematic monitoring of tobacco prices and ENDS is warranted.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Tooba Fatima
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Bipandeep Abbat
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Prabhnoor Bhons
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
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Singh A, Arora M, Bentley R, Spittal MJ, Do LG, Grills N, English DR. Geographic variation in tobacco use in India: a population-based multilevel cross-sectional study. BMJ Open 2020; 10:e033178. [PMID: 32565446 PMCID: PMC7307551 DOI: 10.1136/bmjopen-2019-033178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE This study aims to quantify the extent to which people's use of tobacco products varies by local areas (city ward and village) across India and the variation in this clustering by tobacco products. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data on 73 954 adults across 2547 city wards and villages were available for analysis from 30 states and 2 union territories in India. PRIMARY AND SECONDARY OUTCOME MEASURES We included as primary outcomes self-reported any tobacco use, current cigarette smoking, current bidi smoking, current smokeless tobacco use and a derived variable for dual use describing respondents who engaged in both smoking and smokeless tobacco use. RESULTS The median risk of an individual using tobacco was 1.64 times greater if a person hypothetically moved from an area of low to high risk of tobacco use (95% CI: 1.60 to 1.69). Area-level partitioning of variation differed by tobacco product used. Median ORs ranged from 1.77 for smokeless tobacco use to 2.53 for dual use. CONCLUSIONS Tobacco use is highly clustered geographically in India. To be effective in India, policy interventions should be directed to influence specific local contextual factors on adult tobacco use. Where people live in India influences their use of tobacco, and this association may be greater than has been observed in other settings. Tailoring tobacco control policies for local areas in India may, therefore, provide substantial public health benefits.
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Affiliation(s)
- Ankur Singh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Loc G Do
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nathan Grills
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australia India Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Council Victoria, Melbourne, Victoria, Australia
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The role of individual, household, and area of residence factors on self-rated health in Colombian adults: A multilevel study. ACTA ACUST UNITED AC 2020; 40:296-308. [PMID: 32673458 PMCID: PMC7505506 DOI: 10.7705/biomedica.4818] [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: 11/01/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals’ social surroundings and environment. Objective: To investigate individual, household, and locality factors associated with self- rated health in Colombian adults. Materials and methods: We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression. Results: The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables. Conclusions: These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.
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Defoe IN, Dubas JS, Dalmaijer ES, van Aken MAG. Is the Peer Presence Effect on Heightened Adolescent Risky Decision-Making only Present in Males? J Youth Adolesc 2019; 49:693-705. [PMID: 31863339 PMCID: PMC7064458 DOI: 10.1007/s10964-019-01179-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/07/2019] [Indexed: 11/26/2022]
Abstract
Social neurodevelopmental imbalance models posit that peer presence causes heightened adolescent risk-taking particularly during early adolescence. Evolutionary theory suggests that these effects would be most pronounced in males. However, the small but growing number of experimental studies on peer presence effects in adolescent risky decision-making showed mixed findings, and the vast majority of such studies did not test for the above-described gender and adolescent phase moderation effects. Moreover, most of those studies did not assess the criterion validity of the employed risky decision-making tasks. The current study was designed to investigate the abovementioned hypotheses among a sample of 327 ethnically-diverse Dutch early and mid-adolescents (49.80% female; Mage = 13.61). No main effect of peer presence on the employed risky-decision making task (i.e., the stoplight game) was found. However, the results showed a gender by peer presence moderation effect. Namely, whereas boys and girls engaged in equal levels of risks when they completed the stoplight game alone, boys engaged in more risk-taking than girls when they completed this task together with two same-sex peers. In contrast, adolescent phase did not moderate peer presence effects on risk-taking. Finally, the results showed that performance on the stoplight game predicted self-reported real-world risky traffic behavior, alcohol use and delinquency. Taken together, using a validated task, the present findings demonstrate that individual differences (i.e., gender) can determine whether the social environment (i.e., peer presence) affect risk-taking in early- and mid-adolescents. The finding that performance on a laboratory risky decision-making task can perhaps help identify adolescents that are vulnerable to diverse types of heightened risk behaviors is an important finding for science as well as prevention and intervention efforts.
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Affiliation(s)
- Ivy N Defoe
- University of Amsterdam, Postbus 15776, 1001 NG, Amsterdam, The Netherlands.
| | | | - Edwin S Dalmaijer
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Kashem T, Al Sayah F, Tawiah A, Ohinmaa A, Johnson JA. The relationship between individual-level deprivation and health-related quality of life. Health Qual Life Outcomes 2019; 17:176. [PMID: 31783859 PMCID: PMC6883516 DOI: 10.1186/s12955-019-1243-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the association between individual-level deprivation and health-related quality of life (HRQL) in the general population. METHODS Data from a population-based survey in the Canadian province of Alberta were used. Individual-level deprivation was assessed using the Canadian Deprivation Index (CDI) and the Ontario Deprivation Index (ODI). HRQL was assessed using the EQ-5D-5 L. Differences in problems in the EQ-5D-5 L dimensions, index and visual analogue scale (VAS) scores across levels of deprivation were examined. Multivariate logistic and linear regression models adjusted for socio-demographic and other characteristics were used to examine the independent association between deprivation and HRQL. RESULTS Of the 6314 respondents, 39% were aged between 18 and 44 years and 38% between 45 and 64 years; 60% were female. Mean EQ-5D-5 L index and VAS scores were 0.85 (standard deviation [SD] 0.14) and 79.6 (SD 17.7), respectively. Almost one-third (30.6%) of respondents reported no problems on all EQ-5D-5 L dimensions. Few participants reported some problems with mobility (23.8%), self-care (6.2%) and usual activities (25.2%), while 59.3 and 35.5% reported some levels of pain/discomfort and anxiety/depression, respectively. Differences between the most and least deprived in reporting problems in EQ-5D-5 L dimensions, index and VAS scores were statistically significant and clinically important. In adjusted regression models for both deprivation indices, the least well-off, compared to the most well-off, had higher likelihood of reporting problems in all EQ-5D-5 L dimensions. Compared to the most well-off, the least well-off had an EQ-5D-5 L index score decrement of 0.18 (p < 0.01) and 0.17 (p < 0.01) for the CDI and ODI, respectively. Similarly, an inverse association was found between the VAS score and the CDI (β = - 17.3, p < 0.01) as well as the ODI (β = - 13.3, p < 0.01). CONCLUSION Individual-level deprivation is associated with worse HRQL. Poverty reduction strategies should consider the effects of not only neighbourhood-level deprivation, but also that of individual-level deprivation to improve overall health.
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Affiliation(s)
- Tahmid Kashem
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Andrews Tawiah
- Faculty of Rehabilitation Medicine, University of Alberta, 3-44 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Jeffery A Johnson
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Roth C, Berger R, Kuhn M. The role of the socio-economic environment on medical outcomes after ST-segment elevation myocardial infarction. BMC Public Health 2019; 19:630. [PMID: 31122225 PMCID: PMC6533747 DOI: 10.1186/s12889-019-6966-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background According to the World Health Organization, coronary artery disease (CAD), including ST-segment elevation myocardial infarction (STEMI), is the most common cause of death worldwide as well as in Europe and Austria. There is valid data on the impact of conventional risk factors on the medical outcomes for STEMI patients. However, only few studies examine the role of the socio-economic environment for medical outcomes. The main task of this study is to investigate if the socio-economic environment of patients who underwent percutaneous coronary intervention (PCI) after STEMI has an impact on the distribution of risk factors and medical outcomes. Methods The study focuses on the population of the City of Vienna, Austria, and includes 870 STEMI patients, who underwent PCI at the General Hospital of Vienna (AKH Wien) between 2008 and 2012. The following data were collected: conventional risk factors (hypertension, hyperlipidemia, diabetes, overweight, smoking, family history and vascular disease) and socio-economic indicators of the patient’s residential district (number of residents, income pre-tax, residents per general practitioner, residents per internal specialist, compulsory education only, academic degree and rate of unemployment). Cox regressions were performed to evaluate the impact of socio-economic environment and conventional risk factors on survival. Results Most of the conventional risk factors show a significant difference between deceased and surviving patients. The study revealed significant differences across districts in relation to the socio-economic background of STEMI patients. Surprisingly, medical outcomes, as measured by the survival of patients, are significantly related to a patient’s district of residence (p-Value = 0.028) but not in a systematic way as far as the socio-economic environment of these districts is concerned. Conclusions The study provides intuitive evidence for a hitherto understudied Central European context on the link between socio-economic environment and conventional risk factors at population level and the link between conventional risk factors and survival both at the population at the individual level. While this is in line with previous evidence and suggestive of the incorporation of measures of socio-economic status (SES) into policy & guidelines toward the management of CAD, more data on the SES – STEMI nexus are needed at individual level.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Rudolf Berger
- Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Johannes von Gott-Platz 1, 7000, Eisenstadt, Austria
| | - Michael Kuhn
- Wittgenstein Centre (WU, VID/ÖAW, IIASA), Institute for Applied Systems Analysis and Vienna Institute of Demography, Welthandelsplatz 2/Level 2, 1020, Vienna, Austria
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Chen Y, Chen H, Li Z. Effect of characteristics and life in cities in China on residents' smoking behaviour. J Int Med Res 2018; 46:4226-4234. [PMID: 30111202 PMCID: PMC6166327 DOI: 10.1177/0300060518791702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to identify the relationship between city-level economic
development and smoking behaviour. Methods Using multilevel mixed-effects logistic methods, we examined the relationship
between smoking/passive smoking and respondents’ lifestyles in the city. Results We found that respondents living in cities with higher per capita gross
domestic product (GDP) were less likely to smoke than those living in cities
with lower per capita GDP (odds ratio [OR] = 0.977, 95% confidence interval
[CI]: 0.958–0.997). Further, respondents with higher levels of life
satisfaction and subjective social status were less likely to smoke than
those with lower levels of these variables (OR = 0.942, 95% CI: 0.893–0.994;
OR = 0.955, 95% CI: 0.928–0.983, respectively). In terms of passive smoking,
respondents with higher levels of subjective social status in their cities
were less likely to smoke than those with lower levels (OR = 0.972, 95% CI:
0.948–0.996). Smoking and exposure to second-hand smoke were more common
among those with lower socioeconomic status. Conclusions Smoking is one of the most serious public health hazards in China. People’s
smoking behaviour is significantly related to characteristics of their
cities and their socioeconomic status. Improved smoking-prevention measures
are urgently required in China.
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Affiliation(s)
- Yang Chen
- 1 School of Architecture, Southeast University, Xuanwu District, Nanjing, China
| | - Hongsheng Chen
- 1 School of Architecture, Southeast University, Xuanwu District, Nanjing, China
| | - Zhigang Li
- 2 School of Urban Design, Wuhan University, Wuhan, China
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Myhr A, Haugan T, Lillefjell M, Halvorsen T. Non-completion of secondary education and early disability in Norway: geographic patterns, individual and community risks. BMC Public Health 2018; 18:682. [PMID: 29855297 PMCID: PMC5984305 DOI: 10.1186/s12889-018-5551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 05/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background School non-completion and early work disability is a great public health challenge in Norway, as in most western countries. This study aims to investigate how medically based disability pension (DP) among young adults varies geographically and how municipal socioeconomic conditions interact with non-completion of secondary education in determining DP risk. Methods The study includes a nationally representative sample of 30% of all Norwegians (N = 350,699) aged 21–40 in 2010 from Statistic Norway’s population registries. Multilevel models incorporating factors at the individual, neighbourhood and municipal levels were applied to estimate the neighbourhood and municipality general contextual effects in DP receipt, and detect possible differences in the impact of municipal socioeconomic conditions on DP risk between completers and non-completers of secondary education. Results A pattern of spatial clustering at the neighbourhood (ICC = 0.124) and municipality (ICC = 0.021) levels are clearly evident, indicating that the underlying causes of DP receipt have a systematic neighbourhood and municipality variation in Norway. Non-completion of secondary education is strongly correlated with DP receipt among those younger than 40. Socioeconomic characteristics of the municipality are also significantly correlated with DP risk, but these associations are conditioned by the completion of secondary education. Living in a socioeconomically advantageous municipality (i.e. high income, high education levels and low unemployment and social security payment rates) is associated with a higher risk of DP, but only among those who do not complete their secondary education. Although the proportion of DPs was equal in rural and urban areas, it is evident that young people living in urban settings are more at risk of early DP than their counterparts living in rural parts of the country when controlling for other risk factors. Conclusion The association between school non-completion and DP risk varies between municipalities and local socioeconomic environments. The interplay between personal characteristics and the local community is important in DP risk among young adults, implying that preventive measures should be directed not only at the individual level, but also include the educational system and the local community.
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Affiliation(s)
- Arnhild Myhr
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tommy Haugan
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Technology and Society, Trondheim, Norway
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Santos SM, Werneck GL, Faerstein E, Lopes CS, Chor D. Focusing neighborhood context and self-rated health in the Pró-Saúde Study. CAD SAUDE PUBLICA 2018; 34:e00029517. [DOI: 10.1590/0102-311x00029517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/31/2017] [Indexed: 11/22/2022] Open
Abstract
The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial ‘K’luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.
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Behanova M, Reijneveld SA, Nagyova I, Katreniakova Z, van Ameijden EJC, Dijkshoorn H, van Dijk JP. Are area-level and individual-level socioeconomic factors associated with self-rated health in adult urban citizens? Evidence from Slovak and Dutch cities. Eur J Public Health 2018; 27:86-92. [PMID: 26250706 DOI: 10.1093/eurpub/ckv095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Evidence shows that living in disadvantaged areas is associated with poor health. This may be due to the socioeconomic (SE) characteristics of both these residents and the areas where they live. Evidence regarding this on Central European (CE) countries is scarce. Our aim was to assess whether the prevalence of poor self-rated health (SRH) was higher in deprived urban areas, whether this can be explained by individual SE status (SES) and whether this differed between Slovakia and the Netherlands per age group. We examined the association of urban-level data and individual-level SE factors from different urban areas in different countries (Slovakia, the Netherlands) using comparable urban health indicators and area indicators. We also obtained unique data from the EU-FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that poor SRH was associated with area deprivation in both countries. Regarding age by country, poor SRH occurred more frequently in the more deprived areas for the younger age group (≤64) in the Netherlands but for the older age group (≥65 years) in Slovakia. Moreover, Slovak citizens reported poor SRH significantly more often than Dutch residents. Individual SES was significantly associated with poor SRH in both age groups and both countries for most area-level SE measures. Individual SES is associated with SRH more strongly than area deprivation. Therefore, it is important to account for relative deprivation at an individual level when considering health-enhancing activities. Moreover, the effect of urban-area deprivation seems to differ between CE and WE countries.
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Affiliation(s)
- Martina Behanova
- 1 Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.,2 Department of Social Medicine, Faculty of Medicine, Institute of Public Health, Safarik University, Kosice, Slovak Republic.,3 Slovak Public Health Association - SAVEZ, Kosice, Slovak Republic
| | - Sijmen A Reijneveld
- 4 Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Iveta Nagyova
- 1 Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.,2 Department of Social Medicine, Faculty of Medicine, Institute of Public Health, Safarik University, Kosice, Slovak Republic.,3 Slovak Public Health Association - SAVEZ, Kosice, Slovak Republic
| | - Zuzana Katreniakova
- 1 Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.,2 Department of Social Medicine, Faculty of Medicine, Institute of Public Health, Safarik University, Kosice, Slovak Republic.,3 Slovak Public Health Association - SAVEZ, Kosice, Slovak Republic
| | - Erik J C van Ameijden
- 5 Department of Epidemiology and Information, Municipal Health Service, Utrecht, The Netherlands
| | - Henriëtte Dijkshoorn
- 6 Department of Epidemiology Municipal Health Service, Amsterdam, The Netherlands
| | - Jitse P van Dijk
- 1 Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.,4 Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, The Netherlands
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Nayan M, Juurlink DN, Austin PC, Macdonald EM, Finelli A, Kulkarni GS, Hamilton RJ. Medication use and kidney cancer risk: A population-based study. Eur J Cancer 2017; 83:203-210. [DOI: 10.1016/j.ejca.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 02/08/2023]
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18
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Carrà G, Crocamo C, Borrelli P, Tabacchi T, Bartoli F, Popa I, Montomoli C, Clerici M. Area-Level Deprivation and Adverse Consequences in People With Substance Use Disorders: Findings From the Psychiatric and Addictive Dual Disorder in Italy (PADDI) Study. Subst Use Misuse 2017; 52:451-458. [PMID: 27849429 DOI: 10.1080/10826084.2016.1240696] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Environmental factors may operate with individual ones to influence the risk of substance use. Research has focused on severe adverse consequences influenced by contextual variables. However, the literature on community level factors influencing substance use behaviors is relatively limited across Europe so far. OBJECTIVE We capitalized on data from a National survey, exploring individual and contextual characteristics, to study adverse consequences among people with substance use disorders. METHODS The impact of area-level deprivation on nonfatal overdose, hepatitis C or B infections, and major involvement with the criminal justice system, was explored. Logistic regression models with cluster-robust errors, modeling subject-level and area-level effects, were used. RESULTS Living in deprived and intermediate areas, as compared with affluent ones, was associated with greater likelihood of both nonfatal overdose and jail sentences longer than 6 months, though not of active viral hepatitis. CONCLUSIONS Area-level deprivation may play an important role in determining adverse consequences in people with substance use disorders, also after controlling for individual-level characteristics. More research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed.
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Affiliation(s)
- Giuseppe Carrà
- a Division of Psychiatry , University College London , London , United Kingdom.,b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Cristina Crocamo
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.,c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Paola Borrelli
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Tommaso Tabacchi
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Francesco Bartoli
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Ioana Popa
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Cristina Montomoli
- c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy
| | - Massimo Clerici
- b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
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Cubbin C, Sundquist K, Ahlén H, Johansson SE, Winkleby MA, Sundquist J. Neighborhood deprivation and cardiovascular disease risk factors: Protective and harmful effects. ACTA ACUST UNITED AC 2016; 34:228-37. [PMID: 16754580 DOI: 10.1080/14034940500327935] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population. METHODS Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996-2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25-64 (n = 18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure. RESULTS Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living in a neighborhood with high deprivation was harmful (i.e. higher odds) for smoking, physical inactivity, and obesity (compared with living in a neighborhood with moderate deprivation). These associations were significant after adjustment for individual-level characteristics. There was no evidence that the neighborhood deprivation associations varied by individual-level SES or length of neighborhood exposure. CONCLUSIONS Neighborhood-level deprivation exerted important protective and harmful associations with health behaviors/risk factors related to CVD. The significance to public health is substantial because of the number of persons at risk as well as the serious health consequences of CVD. These results suggest that interventions focusing on changing contextual aspects of neighborhoods, in addition to changing individual behaviors, may have a greater impact on CVD than a sole focus on individuals.
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Affiliation(s)
- Catherine Cubbin
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California 94143-0900, USA.
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Yen IH, Scherzer T, Cubbin C, Gonzalez A, Winkleby MA. Women's Perceptions of Neighborhood Resources and Hazards Related to Diet, Physical Activity, and Smoking: Focus Group Results from Economically Distinct Neighborhoods in a Mid-Sized U.S. City. Am J Health Promot 2016; 22:98-106. [DOI: 10.4278/0890-1171-22.2.98] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate women's perceptions of neighborhood resources and hazards associated with poor diet, physical inactivity, and cigarette smoking. Design. After interviewing city officials and analyzing visual assessments, three economically distinct neighborhoods in a mid-sized city were selected. Setting. Salinas, California, a predominantly Latino city. Methods. Eight focus groups, conducted in Spanish or English in the three neighborhoods. Thematic coding of focus group transcripts identified key concepts. Women also mapped their perceived neighborhood boundaries. Participants. Women who had at least one child under age 18 living with them. Results. Women identified food stores, parks, recreation areas, and schools as key resources in their neighborhoods. They identified fast food restaurants, convenience stores, violent crime, gangs, and drug-associated issues as “hazards.” Distinctions between resources and hazards were not always clear cut. For example, parks were sometimes considered dangerous, and fast food restaurants were sometimes considered a convenient and inexpensive way to feed one's family. Women's perceptions of their neighborhood boundaries differed greatly by type of neighborhood—the perceived neighborhood area (in acres) drawn by women in the lower-income neighborhood was one-fourth the size of the area drawn by women in the higher-income neighborhood. Conclusion. This qualitative, exploratory study illustrates how resources and hazards in one's neighborhood cannot be viewed as having solely one dimension—each may influence health behaviors both positively and negatively.
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Affiliation(s)
- Irene H. Yen
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Teresa Scherzer
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Catherine Cubbin
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Alma Gonzalez
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Marilyn A. Winkleby
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
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Rachele JN, Wood L, Nathan A, Giskes K, Turrell G. Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics. Health Place 2016; 40:98-105. [PMID: 27228312 DOI: 10.1016/j.healthplace.2016.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage. METHODS This cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models. RESULTS Smoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect. CONCLUSIONS Some neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.
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Affiliation(s)
- Jerome N Rachele
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia; School of Population and Global Health, University of Melbourne, Australia.
| | - Lisa Wood
- School of Population Health, University of Western Australia, Perth, Australia.
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
| | - Katrina Giskes
- Faculty of Medicine, University of Sydney, Sydney, Australia.
| | - Gavin Turrell
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia; School of Population and Global Health, University of Melbourne, Australia.
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Oberoi SS, Sharma G, Oberoi A. A cross-sectional survey to assess the effect of socioeconomic status on the oral hygiene habits. J Indian Soc Periodontol 2016; 20:531-542. [PMID: 29242690 PMCID: PMC5676336 DOI: 10.4103/0972-124x.201629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: It is widely accepted that there are socioeconomic inequalities in oral health. A socioeconomic gradient is found in a range of clinical and self-reported oral health outcomes. Aim: The present study was conducted to assess the differences in oral hygiene practices among patients from different socioeconomic status (SES) visiting the Outpatient Department of the Sudha Rustagi College of Dental Sciences. Materials and Methods: A cross-sectional survey was conducted from June to October 2014 to assess the effect of SES on the oral hygiene habits. The questionnaire included the questions related to the demographic profile and assessment of the oral hygiene habits of the study population. Results: Toothbrush and toothpaste were being used significantly (P < 0.05) more by lower middle class (84.4%) and upper middle class (100.0%). A significantly higher frequency of cleaning teeth (twice a day) was reported among the lower middle class (17.2%) and upper middle class (21.5%). The majority (34.3%) of the study population changed their toothbrush once in 3 months. The cleaning of tongue was reported by patients belonging to the upper middle (62.0%), lower middle (52.1%), and upper lower class (30.0%). The use of tongue cleaner was reported to be significantly (P < 0.05) more among upper middle (10.1%) class patients. A significantly higher number of patients from the lower class (81.3%) never visited a dentist. Conclusion: The oral hygiene practices of the patients from upper and lower middle class was found to be satisfactory whereas it was poor among patients belonging to lower and upper lower class.
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Affiliation(s)
- Sukhvinder Singh Oberoi
- Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Gaurav Sharma
- Department of Oral Medicine and Radiology, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Avneet Oberoi
- Private Practitioner, Oberoi Dental Clinic and Orthodontic Centre, New Delhi, India
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Diminished Alternative Reinforcement as a Mechanism Underlying Socioeconomic Disparities in Adolescent Substance Use. Prev Med 2015; 80:75-81. [PMID: 26051200 PMCID: PMC4592420 DOI: 10.1016/j.ypmed.2015.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/22/2015] [Accepted: 05/30/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined socioeconomic disparities in adolescent substance use utilizing a behavioral economic theoretical framework. We tested the hypothesis that teens of lower (vs. higher) socioeconomic status (SES) are vulnerable to substance use because they engage in fewer pleasurable substance-free activities that provide reinforcement and may deter substance use. METHOD In a cross-sectional correlational design, 9th grade students (N=2839; mean age=14.1years) in Los Angeles, California, USA completed surveys in Fall 2013 measuring SES (i.e., parental education), alternative reinforcement (engagement in pleasurable substance-free activities, e.g., hobbies), substance use susceptibility, initiation, and frequency, and other factors. RESULTS For multi-substance composite outcomes, lower parental education was associated with greater likelihood of substance use initiation in the overall sample, frequency of use among lifetime substance users, and susceptibility to substance use in never users. Substance-specific analyses revealed that lower parental education was associated with higher likelihood of initiating cigarettes, alcohol, and marijuana use as well as greater susceptibility to use cigarettes in never smokers. Each inverse association between parental education and substance-related outcomes was statistically mediated by diminished alternative reinforcement; lower parental education was associated with lower engagement in alternative reinforcers, which, in turn, was associated with greater substance use susceptibility, initiation, and frequency. CONCLUSION These results point to a behavioral economic interpretation for socioeconomic disparities in adolescent substance use. Replication and extension of these findings would suggest that prevention programs that increase access to and engagement in healthy and fun activities may reduce youth socioeconomic health disparities related to substance use.
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Hu W, Lu J. Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health. BMC Geriatr 2015; 15:137. [PMID: 26503029 PMCID: PMC4623290 DOI: 10.1186/s12877-015-0132-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 10/14/2015] [Indexed: 12/29/2022] Open
Abstract
Background Self-rated health (SRH) has been widely used to measure the overall health status of older adults. Research has shown that SRH is determined by a large array of factors, such as chronic disease conditions, genetic markers (e.g., Apolipoprotein E, APOE, NM_000041), stress factors, and health behaviors. However, few studies have incorporated these factors simultaneously in the analytic framework of SRH. The aim of this study is to examine the associations of these four sets of factors with SRH. Methods Using a dataset from a population-based, random-cluster survey of 1,005 elderly respondents aged 54–91 conducted in Taiwan in 2000, we use logistic regressions to examine associations of chronic health conditions, the APOE4 allele stress factors, and health behaviors with SRH. The four disease conditions include diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease. Stress factors are measured by traumatic events (having an earthquake-damaged house) and chronic life stress (financial difficulty). Health behaviors include smoking, drinking alcohol, vegetable and fruit intake, daily milk intake, and physical exercise. Results Diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease are found to be associated with 2.63 (95 % CI: 1.75–3.95), 1.72 (95 % CI: 1.15–2.58), 1.94 (95 % CI: 1.35–2.80), and 2.54 (95 % CI: 1.66–3.92) odds ratios of poor SRH. The APOE4 allele is found to be significantly associated with poor SRH with odd ratio of 1.58 (95 % CI: 1.02–2.41). Financial difficulty is associated with increased likelihood of poor SRH, with odds ratios of 1.76 (95 % CI: 1.22–2.54) Doing exercise more than 5 times per week are associated with reduced likelihood of poor SRH by 44 % (odds ratio is 0.56, 95 % CI: 0.39–1.82). The interaction term between gender and gastric ulcer showed that the impact of gastric ulcer on SRH is more pronounced in women than in men, with an odds ratio of 2.63 (95 % CI: 1.24–5.58). Conclusions Chronic conditions and the APOE4 allele are significantly associated with increased likelihood of reporting poor health, and the associations appear differently among women and men. To better understand the mechanism of how people self-assess their overall health, chronic conditions and genetic components should be considered together with conventional factors such as life stress and health behaviors.
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Affiliation(s)
- Wen Hu
- Department of Social Work, Zhou Enlai School of Government, Nankai University, Tianjin, 300071, China. .,Department of Sociology, the University of North Carolina, Chapel Hill, NC, USA.
| | - Jiehua Lu
- Department of Sociology, Peking University, Beijing, 100871, China.
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Honjo K, Iso H, Nakaya T, Hanibuchi T, Ikeda A, Inoue M, Sawada N, Tsugane S. Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan. J Epidemiol 2015; 25:254-60. [PMID: 25757802 PMCID: PMC4341003 DOI: 10.2188/jea.je20140117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries. Methods This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied. Results The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified. Conclusions Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.
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Affiliation(s)
- Kaori Honjo
- Global Collaboration Center, Osaka University
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Meng G, Brown KS, Thompson ME. Spatial and temporal patterns of smoking prevalence in Ontario. BMC Public Health 2015; 15:182. [PMID: 25886190 PMCID: PMC4349672 DOI: 10.1186/s12889-015-1526-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking prevalence varies over time and place due to various social, environmental and policy influences. However, its spatio-temporal patterns at small-area level are poorly understood. This paper attempts to describe spatio-temporal patterns of adult (age > 18) and youth (age 12-18) smoking prevalence at the municipality level in Ontario, Canada and identify potential socio-demographic, environmental, and policy factors that may affect the patterns. METHODS Multilevel temporal and spatio-temporal models were fitted to the Canadian Community Health Surveys (2000-2008) data. In total, approximately 160,000 respondents 12 years of age and over living in Ontario were used for this analysis. RESULTS The results indicate that during the time period 2003-2008, age-sex stratified smoking prevalence dropped for both the adult and youth populations in Ontario. The tendency is more obvious for youth than for adults. Smoking restriction at home is a leading factor associated with the decline of adult smoking prevalence, but does not play the same role for youth smoking. Despite the overall reduction, smoking prevalence varies considerably across the province and inequalities among municipalities have increased. Clusters of high and low smoking prevalence are both found within the study region. CONCLUSION The identified spatial and temporal variations help to indicate problems at the local level and suggest future research directions. Identifying these variations helps to strengthen surveillance and monitoring of smoking behaviours and the evaluation of policy and program development at the small-area level.
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Affiliation(s)
- Gang Meng
- PROPEL Center for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1, Canada.
| | - K Stephen Brown
- PROPEL Center for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1, Canada. .,Ontario Tobacco Research Unit, Toronto, Ontario, Canada. .,Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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Verhagen I, Ros WJG, Steunenberg B, de Wit NJ. Ethnicity does not account for differences in the health-related quality of life of Turkish, Moroccan, and Moluccan elderly in the Netherlands. Health Qual Life Outcomes 2014; 12:138. [PMID: 25269442 PMCID: PMC4190285 DOI: 10.1186/s12955-014-0138-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on how different groups of elderly immigrants perceive health-related quality of life (HRQOL) is scarce and research on the influence of ethnicity on HRQOL across ethnic groups is missing. Measuring HRQOL may help to detect cross-cultural differences and to decide whether ethnic-specific health and prevention programmes are required to improve HRQOL. We investigated differences in HRQOL among three elderly immigrant populations with a special focus on the contribution of ethnicity, in addition to other well-known determinants, to HRQOL. METHODS Data were collected between October 2011 and July 2012 as part of the project entitled "Stem van de oudere migrant", a quasi-experimental study in the Netherlands focussing on health of immigrant elderly. A survey was conducted among 201 elderly (aged 55 years and older) Moroccans (98), Turks (69), and Moluccans (34). HRQOL was assessed using the SF-12, measuring physical and mental health composite scores (PCS resp. MCS). Chi-square tests and ANOVAs were performed for group comparison. Hierarchical multiple linear regressions were conducted to examine whether ethnicity uniquely contributed to the observed variance in HRQOL when multimorbidity, loneliness, socio-demographics, and acculturation were taken into account. RESULTS Moroccans had the lowest scores on PCS (34.3 ± 31.4) and MCS (42.1 ± 27.0), followed by Turks (45.7 ± 27.0 for PCS and 54.7 ± 22.2 for MCS), and Moluccans (71.7 ± 21.2 for PCS and 74.4 ± 22.1 for MCS). Ethnicity was not independently associated with PCS and MCS scores, in contrast to loneliness (PCS β -0.461, p < 0.001 and MCS β -0.435, p < 0.001) and multimorbidity (PCS β -0.380, p < 0.001 and MCS β -0.398, p < 0.001). Gender was independently associated with PCS (β 0.148, p = 0.026) and attachment to Dutch culture with MCS (β 0.144, p = 0.029). CONCLUSIONS The lower level of HRQOL reported by elderly immigrant populations was affected by multimorbidity and loneliness but not ethnicity. Similar to native elders, interventions aiming at improving HRQOL for immigrant elderly should focus on loneliness and (mental and physical) disease. Finally, health literacy deserves attention to maintain health. TRIAL REGISTRATION ISRCTN89447795.
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Affiliation(s)
- Ilona Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, the Netherlands.
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Räisänen S, Kramer MR, Gissler M, Saari J, Hakulinen-Viitanen T, Heinonen S. Smoking during pregnancy was up to 70% more common in the most deprived municipalities - a multilevel analysis of all singleton births during 2005-2010 in Finland. Prev Med 2014; 67:6-11. [PMID: 24983887 DOI: 10.1016/j.ypmed.2014.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state. METHODS Data were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005-2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models. RESULTS In total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493-1.583) and 71.5% (aOR 1.715, 95% CI 1.647-1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities. CONCLUSIONS Individual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence.
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Affiliation(s)
- Sari Räisänen
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 100, FI-70029 Kys Kuopio, Finland.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Mika Gissler
- National Institute for Health and Welfare (THL), P.O. Box 30, Paciuksenkatu 21, FI-00271 Helsinki, Finland; Nordic School of Public Health, Box 121 33, SE-402 42 Gothenburg, Sweden.
| | - Juho Saari
- Kuopio Welfare Research Centre (KWRC), Department of Social Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Tuovi Hakulinen-Viitanen
- National Institute for Health and Welfare (THL), P.O. Box 30, Mannerheimintie 170, FI-00271 Helsinki, Finland.
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 100, FI-70029 Kys Kuopio, Finland; School of Medicine, University of Eastern Finland,P.O. Box 1627, FI-70211 Kuopio, Finland.
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Omariba DWR, Ross NA, Sanmartin C, Tu JV. Neighbourhood immigrant concentration and hospitalization: a multilevel analysis of cardiovascular-related admissions in Ontario using linked data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2014; 105:e404-11. [PMID: 25560885 PMCID: PMC6972400 DOI: 10.17269/cjph.105.4616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the influence of neighbourhood immigrant concentration on cardiovascular-disease-related hospitalizations in Canada (CVDH), while adjusting for individual-level immigrant status and socio-economic indicators at individual and neighbourhood levels. METHODS Data were from the 2006 Canadian Census linked to the hospital Discharge Abstract Data (DAD) for the province of Ontario. Adults (n=1,459,950) aged ≥18 years at baseline and grouped by place of birth (Canada, China, South Asia, Europe, and other) were followed between Census Day May 16, 2006 and March 31, 2008. Information on CVDH was obtained from the DAD, while that on immigration and socio-economic indicators was obtained from the Census. The analysis used multilevel logistic regression. RESULTS Unadjusted results showed that CVDH was significantly lower among people living in neighbourhoods with medium and high immigrant concentration. Neighbourhood immigrant concentration tended to have no independent effect on CVDH after adjustment for individual-level immigrant status. Immigrants were less likely to experience CVDH irrespective of their country of birth. However, cross-level interaction showed that neighbourhood immigrant concentration provided additional protection to individual-level immigrant status against CVDH for most female immigrant groups, but only for South Asian males. CONCLUSION This study resulted from the first-ever linkage of census data to hospitalization data in Canada. It is also the first Canadian study to report on neighbourhood variation and the effect of immigrant concentration on CVDH. The study shows that understanding immigrant health requires both individual and neighbourhood approaches, and a consideration of country of origin.
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Fleischer NL, Thrasher JF, Sáenz de Miera Juárez B, Reynales-Shigematsu LM, Arillo-Santillán E, Osman A, Siahpush M, Fong GT. Neighbourhood deprivation and smoking and quit behaviour among smokers in Mexico: findings from the ITC Mexico Survey. Tob Control 2014; 24 Suppl 3:iii56-iii63. [PMID: 25170022 DOI: 10.1136/tobaccocontrol-2013-051495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 08/08/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated with higher levels of smoking. Few studies in low-income and middle-income countries (LMICs) have investigated the role of the neighbourhood environment on smoking behaviour. OBJECTIVE To determine whether neighbourhood socioeconomic deprivation is related to smoking intensity, quit attempts, quit success and smoking relapse among a cohort of smokers in Mexico from 2010 to 2012. METHODS Data were analysed from adult smokers and recent ex-smokers who participated in waves 4-6 of the International Tobacco Control (ITC) Mexico Survey. Data were linked to the Mexican government's composite index of neighbourhood socioeconomic deprivation, which is based on 2010 Mexican Census data. We used generalised estimating equations to determine associations between neighbourhood deprivation and individual smoking behaviours. FINDINGS Contrary to past findings in HICs, higher neighbourhood socioeconomic deprivation was associated with lower smoking intensity. Quit attempts showed a U-shaped pattern whereby smokers living in high/very high deprivation neighbourhoods and smokers living in very low deprivation neighbourhoods were more likely to make a quit attempt than smokers living in other neighbourhoods. We did not find significant differences in neighbourhood deprivation on relapse or successful quitting, with the possible exception of people living in medium-deprivation neighbourhoods having a higher likelihood of successful quitting than people living in very low deprivation neighbourhoods (p=0.06). CONCLUSIONS Neighbourhood socioeconomic environments in Mexico appear to operate in an opposing manner to those in HICs. Further research should investigate whether rapid implementation of strong tobacco control policies in LMICs, as occurred in Mexico during the follow-up period, avoids the concentration of tobacco-related disparities among socioeconomically disadvantaged groups.
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Affiliation(s)
- Nancy L Fleischer
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | | | - Edna Arillo-Santillán
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Amira Osman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada School of Public health and Health Systems, University of Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Lee J, Lee WY, Noh M, Khang YH. Does a geographical context of deprivation affect differences in injury mortality? A multilevel analysis in South Korean adults residing in metropolitan cities. J Epidemiol Community Health 2014; 68:457-65. [PMID: 24550434 DOI: 10.1136/jech-2013-203082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to examine whether the socioeconomic context of urban areas affects differences in adult mortality from injuries in the districts of all seven South Korean metropolitan cities, after adjusting for individual demographic and socioeconomic indicators. METHODS Two different sets of data were used in this study: (1) the National Death Registration data from 2003 to 2008; and (2) the National Census in 2005. Variables for individual characteristics were gender, age, residential area and educational level. A geographic deprivation index was calculated based on the Carstairs Index. Multilevel Poisson regression models were used to analyse the relationship between area deprivation levels and injury mortality. RESULTS Greater mortality risks of traffic accidents, falls, suicide and all injuries were found in the elderly, the less educated and men, compared with their counterparts. The most deprived districts were at greater risks of death due to traffic accidents (risk ratio (RR)=1.34; 95% CI 1.05 to 1.73), falls (RR=1.63; 95% CI 1.20 to 2.20), suicide (RR=1.09; 95% CI 1.01 to 1.17) and all injuries (RR=1.14; 95% CI 1.07 to 1.22) compared with the least deprived districts, even after individual level socioeconomic variables were controlled for. However, area level deprivation did not show cross level interactions with the individual level education in estimating fatal injury risks. CONCLUSIONS Both contextual and compositional effects of socioeconomic status on injury mortality among urban areas in South Korea should be considered in allocating resources for injury prevention.
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Affiliation(s)
- JeSuk Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, , Seoul, Korea
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Behanova M, Nagyova I, Katreniakova Z, van Ameijden EJC, van Dijk JP, Reijneveld SA. The effect of urban-area unemployment on the mental health of citizens differs between Slovak and Dutch cities. Health Place 2013; 24:210-5. [PMID: 24157958 DOI: 10.1016/j.healthplace.2013.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/25/2013] [Accepted: 09/29/2013] [Indexed: 10/26/2022]
Abstract
Conclusive evidence on the association of mental health problems (MHP) with area unemployment is lacking in regard to Central European cities. We obtained data on residents aged 19-64 from Slovak and Dutch cities from the FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that the association between MHP (GHQ-12-total score ≥2) and area unemployment was strong in the Netherlands, but absent in Slovakia. Slovak citizens from the most favourable neighbourhoods had nearly double the risk of MHP than their Dutch counterparts. Individual-level socioeconomic characteristics did not explain area differences. The effect of urban-area unemployment seems to differ between Central European and Western European countries.
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Affiliation(s)
- Martina Behanova
- Graduate School Kosice Institute for Society and Health, Safarik University, Trieda SNP 1, 040 11 Kosice, Slovak Republic; Department of Social Medicine, Medical Faculty, PJ Safarik University Kosice, Trieda SNP 1, 040 11 Kosice, Slovak Republic; Slovak Public Health Association - SAVEZ, Trieda SNP 1, 040 11 Kosice, Slovak Republic.
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Cai L, Wu X, Goyal A, Han Y, Cui W, He J, Xiao X, Zhao K, Jiao F, Song Y. Multilevel analysis of the determinants of smoking and second-hand smoke exposure in a tobacco-cultivating rural area of southwest China. Tob Control 2013; 22 Suppl 2:ii16-20. [PMID: 23708268 PMCID: PMC3756459 DOI: 10.1136/tobaccocontrol-2012-050850] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 03/07/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine contextual and individual demographical predictors of smoking and exposure to second-hand smoke (SHS) in a tobacco-cultivating rural area of southwest China. METHODS A cross-sectional survey of 4070 consenting individuals aged 18 years or more was conducted in 2010. Information on demographical characteristics, tobacco smoking status and SHS exposure were obtained by a standard questionnaire. Multilevel logistic regression was used to model the variation in prevalence of smoking and SHS exposure. RESULTS In the study population, the prevalence rates of smoking and exposure to SHS were 63.5% and 74.7% for men, and 0.6% and 71.2% for women, respectively. Men were more likely to use tobacco than women: OR 8.27, 95% CI (4.83 to 10.97). Age was inversely associated with the probability of tobacco use (OR 0.98, 95% CI 0.97 to 0.99), and exposure to SHS (OR 0.97, 95% CI 0.96 to 0.99). Individual educational level was inversely associated with smoking, but showed no association with exposure to SHS. Adults who did not grow tobacco were less likely to consume tobacco (OR 0.75, 95% CI 0.57 to 0.99) and to be exposed to SHS (OR 0.76, 95% CI 0.58 to 0.99). Living in a high-income community was associated with a low rate of current smoking (OR 0.66, 95% CI 0.57 to 0.77) and SHS exposure (OR 0.58, 95% CI 0.52 to 0.65). CONCLUSIONS Future interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities.
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Affiliation(s)
- Le Cai
- School of Public Health, Kunming Medical University, Kunming, China.
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Smoking initiation, continuation and prevalence in deprived urban areas compared to non-deprived urban areas in The Netherlands. Soc Sci Med 2013; 87:132-7. [PMID: 23631788 DOI: 10.1016/j.socscimed.2013.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/21/2013] [Accepted: 03/23/2013] [Indexed: 11/21/2022]
Abstract
Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived areas.
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Hetlevik Ø, Gjesdal S. Does socioeconomic status of list populations affect GP practice? A register-based study of 2201 Norwegian GPs. Eur J Gen Pract 2012; 18:212-8. [DOI: 10.3109/13814788.2012.702208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study. Cancer Causes Control 2012; 23:1475-87. [PMID: 22806257 DOI: 10.1007/s10552-012-0021-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations. METHODS This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final. RESULTS In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final. CONCLUSION These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.
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Takeuchi K, Aida J, Morita M, Ando Y, Osaka K. Community-level socioeconomic status and parental smoking in Japan. Soc Sci Med 2012; 75:747-51. [PMID: 22595071 DOI: 10.1016/j.socscimed.2012.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 04/04/2012] [Accepted: 04/11/2012] [Indexed: 11/16/2022]
Abstract
Community-level social environment has been considered to be associated with smoking behavior. However, no study has examined the association between community-level environmental factors and parental smoking behavior in families with young children. The aim of the present study was to examine the association between community-level socioeconomic status (SES) and parental smoking behavior. We used data from a cross-sectional study conducted from 2005 to 2006. We randomly selected 44 Japanese municipalities, 39 of which municipalities agreed to participate in this survey. The study subjects were participants in health check-ups for three-year-old children. Smoking status and individual demographic characteristics were obtained using self-administered questionnaires. Community-level variables were obtained from national census data for 2005. The prevalence of employment in tertiary industries and of unemployment was used to measure community-level SES. Multilevel Poisson regression models were used to calculate prevalence ratios (PRs) for smoking. Of 4143 subjects, a total of 3301 parents in 39 municipalities participated in our survey. Among the 2975 participants (71.8%) included in our analysis, 59.0% were smokers. There was no association between the job of the head of the household considered as an indicator of individual-level SES and smoking. By contrast, when we examined the relationship between prevalence of employment in tertiary industries as community-level SES and smoking, parents living in low middle SES municipalities had a significantly higher prevalence ratio for smoking, compared to parents living in the highest SES municipalities. This result suggested that those with lower community-level SES tended to have a higher prevalence of parental smoking regardless of individual-level SES.
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Affiliation(s)
- Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
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Turrell G, Hewitt BA, Miller SA. The influence of neighbourhood disadvantage on smoking cessation and its contribution to inequalities in smoking status. Drug Alcohol Rev 2012; 31:645-52. [PMID: 22507105 DOI: 10.1111/j.1465-3362.2012.00452.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Individual smokers from disadvantaged backgrounds are less likely to quit, which contributes to widening inequalities in smoking. Residents of disadvantaged neighbourhoods are more likely to smoke, and neighbourhood inequalities in smoking may also be widening because of neighbourhood differences in rates of cessation. This study examined the association between neighbourhood disadvantage and smoking cessation and its relationship with neighbourhood inequalities in smoking. DESIGN AND METHODS A multilevel longitudinal study of mid-aged (40-67 years) residents (n = 6915) of Brisbane, Australia, who lived in the same neighbourhoods (n = 200) in 2007 and 2009. Neighbourhood inequalities in cessation and smoking were analysed using multilevel logistic regression and Markov chain Monte Carlo simulation. RESULTS After adjustment for individual-level socioeconomic factors, the probability of quitting smoking between 2007 and 2009 was lower for residents of disadvantaged neighbourhoods (9.0-12.8%) than their counterparts in more advantaged neighbourhoods (20.7-22.5%). These inequalities in cessation manifested in widening inequalities in smoking: in 2007 the between-neighbourhood variance in rates of smoking was 0.242 (P ≤ 0.001) and in 2009 it was 0.260 (P ≤ 0.001). In 2007, residents of the most disadvantaged neighbourhoods were 88% (OR 1.88, 95% credible intervals (CrI) 1.41-2.49) more likely to smoke than residents in the least disadvantaged neighbourhoods: the corresponding difference in 2009 was 98% (OR 1.98, 95% CrI 1.48-2.66). CONCLUSION Fundamentally, social and economic inequalities at the neighbourhood and individual levels cause smoking and cessation inequalities. Reducing these inequalities will require comprehensive, well-funded and targeted tobacco control efforts and equity-based policies that address the social and economic determinants of smoking.
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Affiliation(s)
- Gavin Turrell
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia.
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Muscat JE, Liu HP, Stellman SD, Richie JP. Menthol smoking in relation to time to first cigarette and cotinine: results from a community-based study. Regul Toxicol Pharmacol 2012; 63:166-70. [PMID: 22487419 DOI: 10.1016/j.yrtph.2012.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/27/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Smokers who have their first cigarette shortly after waking, an indicator of nicotine dependence, have substantially higher cotinine levels. There is controversy regarding the role of menthol in nicotine dependence. We hypothesized that menthol smokers have a shorter time to first cigarette (TTFC), and tested whether any statistical association actually reflects increased dependence by measuring nicotine uptake (e.g. cotinine) in the same group of smokers. A cross-sectional community-based study was conducted that included 495 black and white daily cigarette smokers. Results showed a trend between menthol smoking and a shorter TTFC (P < 0.04 in blacks). Menthol was not an independent predictor of cotinine or an effect modifier with TTFC on cotinine levels in blacks and whites. These results show that while menthol in tobacco is associated with an indicator of nicotine dependence in blacks, menthol was not associated with biological uptake of nicotine in black and white smokers.
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Affiliation(s)
- Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Reijneveld SA, van Nieuwenhuijzen M, Klein Velderman M, Paulussen TWGM, Junger M. Clustering of health and risk behaviour in immigrant and indigenous Dutch residents aged 19-40 years. Int J Public Health 2012; 57:351-61. [PMID: 22371004 PMCID: PMC3313033 DOI: 10.1007/s00038-012-0350-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/01/2012] [Accepted: 02/12/2012] [Indexed: 12/02/2022] Open
Abstract
Objectives Studies on the co-occurrence, ‘clustering’ of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults. Methods A representative sample (N = 2,982; response 71%) of the Dutch population aged 19–40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch. Results Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rule-breaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity. Conclusions This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people.
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Affiliation(s)
- Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.
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Zeng Y, Hughes CL, Lewis MA, Li J, Zhang F. Interactions between life stress factors and carrying the APOE4 allele adversely impact self-reported health in old adults. J Gerontol A Biol Sci Med Sci 2011; 66:1054-61. [PMID: 21768502 DOI: 10.1093/gerona/glr106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Based on the multiple logistic regression analysis of data from a random sample of 1,023 old adults collected in Taiwan in 2000, we found that interactions between carrying the APOE4 allele and one of four life stress factors (relocated mainlander, living in a crowded household with six or more persons, living in an earthquake-damaged house, and monthly financial difficulty) significantly increased the odds ratio of poor self-reported health. Correlations between carrying the APOE4 allele and the life stress factors were ruled out by statistical tests. These life stress factors had a substantially larger adverse impact on self-reported health in APOE4 allele carriers than in noncarriers. This study provides evidence that interaction between carrying APOE4 allele and chronic life stressors has significant impacts on self-reported health while controlling for various sociodemographic and health behavior factors. Further studies with richer biomarkers are warranted for deeper understanding of the biological mechanisms.
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Affiliation(s)
- Yi Zeng
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, NC 27710, USA.
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Borrell LN, Baquero MC. Self-rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors. Community Dent Oral Epidemiol 2011; 39:361-71. [PMID: 21219373 DOI: 10.1111/j.1600-0528.2010.00603.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED OBJECTIVE This study investigates the independent and joint effects of individual and neighborhood socioeconomic characteristics on self-rated general and oral health before and after controlling for selected characteristics in adults aged 18 years and older in New York City. METHODS Data for 1168 individuals who participated in the 2004 Social Indicators Survey were linked to neighborhood data from the 2000 US Census. Log-binomial regression models fitted using generalized estimating equations were used to calculate prevalence ratios (PR) and 95% confidence intervals (CI). sudaan was used to accommodate the complex sampling design of the survey and the intra-neighborhood correlation of outcomes of individuals residing within the same neighborhoods. RESULTS After adjusting for selected characteristics, survey participants with 12 years of education or less were almost twice more likely to rate their general health as fair/poor than counterparts with more than 12 years of education [PRs 1.86 (95%CI: 1.16, 3.00) and 1.82 (95%CI: 1.18, 2.82)]. Participants earning <$20,000 (PR: 2.29; 95%CI: 1.23, 4.29) or between $20,000 to $39,999 yearly (PR: 2.24; 95%CI: 1.11, 4.53) were more than twice as likely to rate their general health as fair/poor compared to their counterparts earning over $40,000 yearly. When compared to participants with more than 12 years of education and those reporting an annual income ≥$40,000, the probability of rating oral health as fair/poor was at least 50% greater in participants with <12 years of education (PR: 1.58; 95%CI: 1.11, 2.26) and in participants earning an annual income of <$20,000 (PR: 1.55; 95%CI: 1.10, 2.19). No association was found between neighborhood characteristics for either self-rated general or oral health. CONCLUSIONS Individual socioeconomic characteristics may be important for both self-rated general and oral health by affecting individuals' behaviors and access to resources.
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Affiliation(s)
- Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA.
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Nkansah-Amankra S. Neighborhood Contextual Factors, Maternal Smoking, and Birth Outcomes: Multilevel Analysis of the South Carolina PRAMS Survey, 2000–2003. J Womens Health (Larchmt) 2010; 19:1543-52. [DOI: 10.1089/jwh.2009.1888] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen Nkansah-Amankra
- School of Human Sciences/Colorado School of Public Health, University of Northern Colorado, Greeley, Colorado
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Paul CL, Mee KJ, Judd TM, Walsh RA, Tang A, Penman A, Girgis A. Anywhere, anytime: retail access to tobacco in New South Wales and its potential impact on consumption and quitting. Soc Sci Med 2010; 71:799-806. [PMID: 20554363 DOI: 10.1016/j.socscimed.2010.05.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 04/07/2010] [Accepted: 05/11/2010] [Indexed: 11/21/2022]
Abstract
Relatively little attention has been given to the retail availability of tobacco products despite the likelihood that ubiquitous supply may represent a primary form of tobacco promotion in Australia. This study aimed to explore the number and distribution of tobacco outlets, smokers' perceptions about the availability of tobacco and the role availability may play in tobacco consumption and quitting attempts in Australia. The study comprised two parts: Part A involved mapping retail tobacco outlets in the Hunter Region of NSW, Australia. Part B involved a statewide telephone survey of 539 current smokers aged 18 years and over in NSW. Part A identified 1270 retail tobacco outlets, giving a density of one outlet per 384 persons aged over 15 years, or one outlet per 77 smokers. Associations between socioeconomic status of areas and retail availability of tobacco were not found. Of the survey respondents in Part B, 87.5% indicated that they would be within walking distance of a retail tobacco outlet during their daily activities. Those who were younger, male and single were more likely to purchase tobacco at convenience-type outlets. We therefore conclude that some groups of smokers appear vulnerable to the availability of tobacco and a reduction in the availability of tobacco is likely to benefit smokers who wish to quit.
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Affiliation(s)
- Christine L Paul
- Centre for Health Research & Psych-oncology (CHeRP), Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia.
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Neighbourhood effects on hospitalization in early childhood. Canadian Journal of Public Health 2010. [PMID: 20524375 DOI: 10.1007/bf03404355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether characteristics of neighbourhoods in which children live, such as socio-economic disadvantage, physical infrastructure, programs and services, social disconnection, smoking prevalence, and overcrowding, are related to hospitalization rates from birth to age six, independent of individual-level factors. METHODS We studied a population of 8,504 children born in Saskatoon, Canada, over a three-year period (1992-1994). The birth cohort was retrospectively followed until children reached age six. Birth registry records were linked to health care utilization files to create continuous histories of health care utilization for each child. Information on the neighbourhood in which the child's family resided at his or her birth was extracted from Statistics Canada's 1991 Census and numerous local sources. A longitudinal and multilevel design was employed to examine the effect of neighbourhood characteristics and individual-level factors on childhood hospitalization rate. RESULTS Male children, children born to mothers under 20 years of age, Aboriginal children, children in low-income families, and those with adverse birth outcomes had significantly higher rates of hospitalization. In addition to these individual factors, children living in economically disadvantaged neighbourhoods, neighbourhoods in poor physical condition, and neighbourhoods with higher average household size had significantly higher rates of hospitalization. CONCLUSIONS The kind of neighbourhood families live in has an impact on their children's risk of hospitalization, above and beyond the family's own characteristics. These findings provide additional support for a 'healthy community' approach that uses community development and healthy public policy to create safe, health-promoting neighbourhoods for all families.
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Geographical and household variation in health-related quality of life in Hong Kong. Health Place 2010; 16:315-20. [DOI: 10.1016/j.healthplace.2009.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 11/19/2022]
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Kravdal O. Mortality effects of average education: a multilevel study of small neighbourhoods in rural and urban areas in Norway. Int J Equity Health 2009; 8:41. [PMID: 20003181 PMCID: PMC2797775 DOI: 10.1186/1475-9276-8-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/09/2009] [Indexed: 11/28/2022] Open
Abstract
Background The intention was to find out whether there was an association between the socio-economic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. The possibility of a rural-urban difference in the health effect of community resources has not been checked earlier. Methods Discrete-time hazard models for mortality at age 60-89 were estimated for 1990-1992 and 2000-2002, using register data that cover the entire Norwegian population. For each person, the educational level and the municipality and BSU of residence in 1990 and 2000 were known. Average education was computed by aggregating over the individual data. In total, there were about 200000 deaths in more than 13000 BSUs during 5 million person-years of observation. Results There was a significant relationship between average education in the BSU and individual mortality, but only in the medium-sized and largest municipalities. The sharpest relationship was seen in the latter, where for example OR per year of education was 0.908 (95% CI 0.887-0.929) in the 1990-92 period. The findings were robust to various alternative specifications. Conclusion These results from a large data set are consistent with the idea that neighbourhood socio-economic resources may affect individual mortality, but suggest that distinctions according to population size or density be made in future research and that one should be careful, if focusing on cities, to generalize beyond that setting. With these data, one can only speculate about the reasons for the rural-urban difference. A stronger higher-level spatial segregation in urban areas may be one explanation.
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Affiliation(s)
- Oystein Kravdal
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
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Yen IH, Michael YL, Perdue L. Neighborhood environment in studies of health of older adults: a systematic review. Am J Prev Med 2009; 37:455-63. [PMID: 19840702 PMCID: PMC2785463 DOI: 10.1016/j.amepre.2009.06.022] [Citation(s) in RCA: 483] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 06/17/2009] [Accepted: 06/30/2009] [Indexed: 11/17/2022]
Abstract
CONTEXT Epidemiologists and public health researchers are studying neighborhood's effect on individual health. The health of older adults may be more influenced by their neighborhoods as a result of decreased mobility. However, research on neighborhood's influence on older adults' health, specifically, is limited. EVIDENCE ACQUISITION Recent studies on neighborhood and health for older adults were identified. Studies were identified through searches of databases including PsycINFO, CINAHL, PubMed, Academic Search Premier, Ageline, Social Science Citation Index, and Health Source. Criteria for inclusion were as follows: human studies; English language; study sample included adults aged > or =55 years; health outcomes, including mental health, health behaviors, morbidity, and mortality; neighborhood as the primary exposure variable of interest; empirical research; and studies that included > or =10 neighborhoods. Air pollution studies were excluded. Five hundred thirty-eight relevant articles were published during 1997-2007; a total of 33 of these articles met inclusion criteria. EVIDENCE SYNTHESIS The measures of objective and perceived aspects of neighborhood were summarized. Neighborhood was primarily operationalized using census-defined boundaries. Measures of neighborhood were principally derived from objective sources of data; eight studies assessed perceived neighborhood alone or in combination with objective measures. Six categories of neighborhood characteristics were socioeconomic composition, racial composition, demographics, perceived resources and/or problems, physical environment, and social environment. The studies are primarily cross-sectional and use administrative data to characterize neighborhood. CONCLUSIONS These studies suggest that neighborhood environment is important for older adults' health and functioning.
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Affiliation(s)
- Irene H Yen
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0856, USA.
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Abstract
CONTEXT Epidemiologists and public health researchers are studying neighborhood's effect on individual health. The health of older adults may be more influenced by their neighborhoods as a result of decreased mobility. However, research on neighborhood's influence on older adults' health, specifically, is limited. EVIDENCE ACQUISITION Recent studies on neighborhood and health for older adults were identified. Studies were identified through searches of databases including PsycINFO, CINAHL, PubMed, Academic Search Premier, Ageline, Social Science Citation Index, and Health Source. Criteria for inclusion were as follows: human studies; English language; study sample included adults aged > or =55 years; health outcomes, including mental health, health behaviors, morbidity, and mortality; neighborhood as the primary exposure variable of interest; empirical research; and studies that included > or =10 neighborhoods. Air pollution studies were excluded. Five hundred thirty-eight relevant articles were published during 1997-2007; a total of 33 of these articles met inclusion criteria. EVIDENCE SYNTHESIS The measures of objective and perceived aspects of neighborhood were summarized. Neighborhood was primarily operationalized using census-defined boundaries. Measures of neighborhood were principally derived from objective sources of data; eight studies assessed perceived neighborhood alone or in combination with objective measures. Six categories of neighborhood characteristics were socioeconomic composition, racial composition, demographics, perceived resources and/or problems, physical environment, and social environment. The studies are primarily cross-sectional and use administrative data to characterize neighborhood. CONCLUSIONS These studies suggest that neighborhood environment is important for older adults' health and functioning.
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Affiliation(s)
- Irene H Yen
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0856, USA.
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