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Brown R, Sillence E, Pepper G. Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:1339-1356. [PMID: 37871995 DOI: 10.1111/risa.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | | | - Gillian Pepper
- Psychology Department, Northumbria University, Newcastle, UK
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2
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Macassa G, McGrath C, Wijk K, Rashid M, Hiswåls AS, Soares J. The Association between Fear of Crime, Educational Attainment, and Health. EPIDEMIOLOGIA 2023; 4:148-162. [PMID: 37218875 DOI: 10.3390/epidemiologia4020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Fear of crime is an important public health problem that impacts people's quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18-84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40-4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90-3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14-2.53 and 1.73; CI 1.21-2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64-2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93-1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted-on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women's own perceptions regarding factors underlining their fear of crime (qualitative studies).
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Affiliation(s)
- Gloria Macassa
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Cormac McGrath
- Department of Education, Stockholm University, 10691 Stockholm, Sweden
| | - Katarina Wijk
- Centre for Research and Development, Uppsala University, 80187 Gävle, Sweden
- Department of Occupational Health Sciences and Psychology, University of Gävle, 80176 Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 75123 Uppsala, Sweden
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
| | - Anne-Sofie Hiswåls
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
| | - Joaquim Soares
- Department of Health Sciences, Mid-Sweden University, 85170 Sundsvall, Sweden
- Department of Psychology, Universidade Europeia, 1500-210 Lisbon, Portugal
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Parent's Health Locus of Control and Its Association with Parents and Infants Characteristics: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105804. [PMID: 35627339 PMCID: PMC9140620 DOI: 10.3390/ijerph19105804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
The Parent Health Locus of Control (PHLOC) investigates the individual’s beliefs about the factors that govern their state of health and that of their children. The direct association between PHLOC and preventive health behaviours compliance has already been demonstrated in the literature. However, it is still unclear how socio-demographic variables affect the PHLOC. We investigated the Parent Health Locus of Control of parents of full-term and preterm infants and evaluated whether there were any correlations between PHLOC and socio-demographic characteristics of both parents and infants. A single-centre transverse observational study was conducted in the Neonatology Operating Unit IRCCS Ca ‘Granda Foundation Ospedale Maggiore Policlinico of Milan. A self-administered questionnaire of the PHLOC scale was distributed to a sample of 370 parents of 320 full-term and 52 preterm infants attending the follow-up service. Parents under the age of 36 and with a higher level of education (bachelor’s degree or above) believe less in the influence of the media on their child’s health. Parents of preterm and first-child infants recognize the greater influence of health care workers, while parents of newborns that have experience complications in their clinical course, believe more in the influence of fate (Chance Health Locus of Control) and God. Younger parents with a higher level of education may be more prone to healthy preventative behaviours. Preterm birth is positively associated with an increased trust in health care professionals. The experience of disease can increase a “Chance Health Locus of Control” and risky behaviours. Assessment of PHLOC helps identify categories of parents prone to risky health behaviours and offer targeted health education interventions.
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Cross-sectional study of the effects of self-efficacy on fatigue and pain interference in black women with systemic lupus erythematosus: the role of depression, age and education. Lupus Sci Med 2022; 9:9/1/e000566. [PMID: 35149578 PMCID: PMC8845307 DOI: 10.1136/lupus-2021-000566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objective While fatigue and pain are pervasive symptoms in SLE, self-efficacy can mitigate their intensity and impact on patients’ daily activity. We examined the relationships of these domains and their interactions with demographics and depression in black women with SLE. Methods This is a cross-sectional analysis of data collected among 699 black women with SLE. We used validated, self-reported measures of fatigue, pain interference, symptom self-efficacy, treatment self-efficacy and depression. Linear regression analyses were conducted to examine the relationships between each outcome (fatigue and pain interference) and each predictor (symptom self-efficacy and treatment self-efficacy), and the interaction of demographics and depression. Results We found inverse associations between fatigue and each of symptom self-efficacy (slope −0.556, p<0.001) and treatment self-efficacy (slope −0.282, p<0.001), as well as between pain interference and each of symptom self-efficacy (slope −0.394, p<0.001) and treatment self-efficacy (slope −0.152, p<0.001). After adjusting for confounders, symptom self-efficacy remained significantly associated with each outcome (adjusted slope −0.241 (p<0.001) and −0.103 (p=0.008) for fatigue and pain, respectively). The amount of decrease in fatigue and pain interference differed by depression severity (p<0.05 for the interaction of symptom self-efficacy and depression). The difference in fatigue by depression widened as symptom self-efficacy increased; the adjusted fatigue scores for moderate/severe depression compared with no depression were 6.8 and 8.7 points higher at mean and high symptom self-efficacy, respectively (p<0.001). Age and education significantly changed the relationship between outcomes and self-efficacy. Conclusions Symptom self-efficacy and treatment self-efficacy were inversely related to fatigue and pain interference in black women with SLE. Depression disproportionately increased the intensity of these outcomes. While older women with low symptom self-efficacy reported disproportionately higher pain interference, those with higher education and mean or high levels of symptom self-efficacy reported lower pain interference. These findings may help predict who might benefit most from self-efficacy-enhancing interventions.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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Kraft P, Kraft B, Hagen T, Espeseth T. Subjective Socioeconomic Status, Cognitive Abilities, and Personal Control: Associations With Health Behaviours. Front Psychol 2022; 12:784758. [PMID: 35153907 PMCID: PMC8831894 DOI: 10.3389/fpsyg.2021.784758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine subjective and objective socioeconomic status (SSES and OSES, respectively) as predictors, cognitive abilities as confounders, and personal control perceptions as mediators of health behaviours.DesignA cross-sectional study including 197 participants aged 30–50 years, recruited from the crowd-working platform, Prolific.Main Outcome MeasureThe Good Health Practices Scale, a 16-item inventory of health behaviours.ResultsSSES was the most important predictor of health behaviours (beta = 0.19, p < 0.01). Among the OSES indicators, education (beta = 0.16, p < 0.05), but not income, predicted health behaviours. Intelligence (r = −0.16, p < 0.05) and memory (r = −0.22, p < 0.01) were negatively correlated with health-promoting behaviours, and the effect of memory was upheld in the multivariate model (beta = −0.17, p < 0.05). Personal control perceptions (mastery and constraints) did not act as mediators.ConclusionSSES predicted health behaviours beyond OSES. The effect of socioeconomic indicators was not confounded by cognitive abilities. Surprisingly, cognitive abilities were negatively associated with health-promoting behaviours. Future research should emphasise SSES as a predictor of health behaviours. Delineating the psychological mechanisms linking SSES with health behaviours would be a valuable contribution toward improved understanding of socioeconomic disparities in health behaviours.
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Affiliation(s)
- Pål Kraft
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
- *Correspondence: Pål Kraft,
| | - Brage Kraft
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Thomas Hagen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Thomas Espeseth
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
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Shin S, Lee E. Relationships among the Internal Health Locus of Control, Mental Health Problems, and Subjective Well-Being of Adults in South Korea. Healthcare (Basel) 2021; 9:healthcare9111588. [PMID: 34828633 PMCID: PMC8620821 DOI: 10.3390/healthcare9111588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023] Open
Abstract
The purpose of this study was to confirm the relationship between internal health locus of control, mental health problems, and subjective well-being in adults during the prolonged COVID-19 pandemic. In particular, the mediating effect of mental health problems on the relationship between internal health locus of control and subjective well-being was examined. A cross-sectional descriptive design was conducted via online survey. The participants were 600 adults over 20 years of age living in South Korea. The collected data were analyzed using hierarchical regression analysis and SPSS Process Macro (Model 4). As a result of the study, the internal health locus of control had a significant negative effect on mental health problems. In addition, in the process of the internal health locus of control affecting subjective well-being, the mediating effect of mental health problems was significantly shown. In the period of an infectious disease pandemic such as COVID-19, it is necessary to establish a strong internal health locus of control of individuals and to promote monitoring and treatment introduction for those with a low internal health locus of control. In addition, it was discussed that controlling mental health problems can improve subjective well-being, which is life satisfaction and happiness.
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Kraft P, Kraft B. Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation. Neurosci Biobehav Rev 2021; 127:689-708. [PMID: 34048858 DOI: 10.1016/j.neubiorev.2021.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 01/29/2023]
Abstract
The purpose of this article was to explore how individuals' position in a socioeconomic hierarchy is related to health behaviours that are related to socioeconomic disparities in health. We identified research which shows that: (a) low socioeconomic status (SES) is associated with living in harsh environments, (b) harsh environments are related to increased levels of stress and inflammation, (c) stress and inflammation impact neural systems involved in self-control by sensitising the impulsive system and desensitising the reflective system, (d) the effects are inflated valuations of small immediate rewards and deflated valuations of larger delayed rewards, (e) these effects are observed as increased delay discounting, and (f) delay discounting is positively associated with practicing more unhealthy behaviours. The results are discussed within an adaptive evolutionary framework which lays out how the stress response system, and its interaction with the immune system and brain systems for decision-making and behaviours, provides the biopsychological mechanisms and regulatory shifts that make widespread conditional adaptability possible. Consequences for policy work, interventions, and future research are discussed.
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Affiliation(s)
- Pål Kraft
- Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway; Department of Psychology, Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway.
| | - Brage Kraft
- Division of Psychiatry, Diakonhjemmet Hospital, P. O. Box 23 Vinderen, 0319, Oslo, Norway.
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Craveiro D, Marques S, Zvěřinová I, Máca V, Ščasný M, Chiabai A, Suarez C, Martinez-Juarez P, García de Jalón S, Quiroga S, Taylor T. Explaining inequalities in fruit and vegetable intake in Europe: The role of capabilities, opportunities and motivations. Appetite 2021; 165:105283. [PMID: 33991644 DOI: 10.1016/j.appet.2021.105283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
People who do not eat enough fruit and vegetables (F&V) have incremental health risks. Most Europeans do not comply with health recommendations relating to F&V consumption and this is especially true for those with lower-level education, which reinforces structural inequalities in health and wellbeing among Europeans. This study investigated the role of key behavioural triggers - capabilities, opportunities and motivation (in the COM-B model) - as pathways for educational differentials in F&V intake in Europe. A cross-sectional survey-based study was conducted in five European countries differing widely in their consumption habits, wealth, and climatic conditions. A structural equation model was designed to study how capabilities (diet perceived knowledge, health purchase criteria), opportunities (financial availability, social norms), and motivations (health value, habits strength) affect educational inequalities in the intake of F&V (5 portions a day) as mediators. Multi-group comparisons assessed country differences. People with higher levels of education were more likely to eat the recommended diet, i.e., at least 5 portions of F&V a day. Countries in the sample vary significantly in the percentage of people complying with the recommendation, but not significantly in terms of relative education differentials. The educational gap in the intake of F&V is mainly explained by education differentials in financial availability, diet knowledge, and habits in inserting F&V in main meals. Policies targeting dietary inequalities should address behavioural triggers affecting dietary intake, for example by subsidising F&V, developing targeted dietary awareness campaigns, or by intervening in mass catering contexts to facilitate the implementation of healthy habits.
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Affiliation(s)
- Daniela Craveiro
- Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL, Lisbon, Portugal; Lisbon School of Economics and Management, CSG/SOCIUS-ISEG, Universidade de Lisboa, Lisbon, Portugal.
| | - Sibila Marques
- Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL, Lisbon, Portugal
| | - Iva Zvěřinová
- Environment Centre, Charles University, Prague, Czech Republic
| | - Vojtěch Máca
- Environment Centre, Charles University, Prague, Czech Republic
| | - Milan Ščasný
- Environment Centre, Charles University, Prague, Czech Republic
| | | | - Cristina Suarez
- Department of Economics, Universidad de Alcalá, Alcalá, Spain
| | - Pablo Martinez-Juarez
- Department of Economics, Universidad de Alcalá, Alcalá, Spain; Department of Communication and Media Studies, University Carlos III of Madrid, Madrid, Spain
| | - Silvestre García de Jalón
- Basque Centre for Climate Change, BC3, Leioa, Spain; Department of Agricultural Economics, Statistics and Business Management, Universidad Politécnica de Madrid, Madrid, Spain
| | - Sonia Quiroga
- Department of Economics, Universidad de Alcalá, Alcalá, Spain
| | - Timothy Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, United Kingdom
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Trends and Dietary Assessment According to Fruit and Vegetable Intake in Korean Elderly People: Analysis Based on the Korea National Health and Nutrition Examination Survey 1998, 2008, and 2018. Foods 2020; 9:foods9111712. [PMID: 33266368 PMCID: PMC7700258 DOI: 10.3390/foods9111712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
The study aimed to examine the 20-year trends in fruit and non-starch/unsalted vegetable intake among the Korean elderly aged 65 years or older based on the Korea National Health and Nutrition Examination Survey (KNHANES) data. A total of 3722 elderly citizens aged 65 years or older who participated in the dietary survey (24-h recall of dietary intake) of the 1998, 2008, and 2018 NHANES were selected as the subjects of this study. Fruit and non-starchy/unsalted vegetable intake increased by approximately 86.53 g over the past 20 years, from 268.27 g in 1998 to 355.8 g in 2018. In particular, 65-74-year-olds had an increased intake by approximately 130.38 g over the past 20 years, from 277.34 g in 1998 to 407.72 g in 2018. In addition, snacks intake significantly increased over the past 20 years (p for trend < 0.001). Intake according to daily meal cooking location increased by approximately 130 g over the past 20 years, from 64.50 g in 1998 to 123.39 g in 2008, and to 198.01 g in 2018. The annual proportion of the total elderly population who meet the amount of vegetable food intake recommended by the World Health Organization (WHO)/World Cancer Research Fund (WCRF) (400 g or more fruits and non-starchy vegetables) increased by approximately 11.28%p (percentage points) over the past 20 years, from 21.78% in 1998 to 24.63% in 2008, and to 33.06% in 2018. The results of this study suggest that more fundamental measures are required to increase the fruit and non-starchy vegetable intake among the elderly. Furthermore, it is thought that the results of this study can be used as basic data in establishing dietary policy. In addition, it is thought that it can be used in developing nutrition education and dietary guidelines for enhancing fruit and vegetable intake.
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Kwon YS, Yang YY, Park Y, Park YK, Kim S. Dietary Assessment and Factors According to Fruits and Vegetables Intake in Korean Elderly People: Analysis of Data from the Korea National Health and Nutrition Examination Survey, 2013-2018. Nutrients 2020; 12:nu12113492. [PMID: 33203012 PMCID: PMC7698264 DOI: 10.3390/nu12113492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
This study analyzed dietary assessment and factors according to fruits and vegetables intake in Korean elderly people. We enrolled 8336 Korean elderly people aged ≥65 who participated in the dietary intake survey (24-h recall methods) of the 2013-2018 Korea National Health and Nutrition Examination (KNHANES). The intake of fruits and unsalted/non-starchy vegetables was 372.06 g/day. According to age group, the intake in the age group 65-74 years as 422.47 g/day, and the intake in the age group 75 years + was 301.12 g/day. Based on the intake of daily meals and snacks, the intake of fruits and unsalted/non-starchy vegetables was the highest in snack-eating individuals (480.96 g/day). The subjects who consumed more than the World Health Organization (WHO)/World Cancer Research Fund (WCRF)'s plant food intake standards (over 400 g/day of intake of fruits and unsalted/non-starchy vegetables) were 35.47% of the elderly people. These results suggest that it is necessary to develop more fundamental strategies to increase fruits and vegetables intake among elderly people. Furthermore, the study outcomes are expected to provide basic information for developing education programs to improve the dietary life of Korean elderly people.
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Affiliation(s)
- Yong-Suk Kwon
- Food and Nutrition Division, Department of Agrofood Resources, National Institute of Agricultural Sciences, Jeollabuk-do 55365, Korea; (Y.-S.K.); (Y.-Y.Y.); (Y.P.)
| | - Yu-Yeong Yang
- Food and Nutrition Division, Department of Agrofood Resources, National Institute of Agricultural Sciences, Jeollabuk-do 55365, Korea; (Y.-S.K.); (Y.-Y.Y.); (Y.P.)
| | - Younghee Park
- Food and Nutrition Division, Department of Agrofood Resources, National Institute of Agricultural Sciences, Jeollabuk-do 55365, Korea; (Y.-S.K.); (Y.-Y.Y.); (Y.P.)
| | - Yoo-Kyoung Park
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
| | - Sohye Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
- Nutrition Care Services, Seoul National University of Bundang Hospital, Seongnam 13620, Korea
- Correspondence:
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Miao JH, Wang HS, Liu N. The evaluation of a nurse-led hypertension management model in an urban community healthcare: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e20967. [PMID: 32629706 PMCID: PMC7337544 DOI: 10.1097/md.0000000000020967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.
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Affiliation(s)
| | | | - Na Liu
- TangShan Chinese Medicine Hospital, Heibei, P.R. China
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12
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Omodior O, Luetke M, Kianersi S, Colón A. Predictors of Tick Exposure Risk-Reduction Behavior in Indiana. J Community Health 2020; 45:862-870. [DOI: 10.1007/s10900-020-00803-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Sugisawa H, Harada K, Sugihara Y, Yanagisawa S, Shimmei M. Time perspectives as mediators of the associations between socio-economic status and health behaviours in older Japanese adults. Psychol Health 2019; 35:1000-1016. [PMID: 31698958 DOI: 10.1080/08870446.2019.1686505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Few studies have used time perspective (TP) theory to examine the factors mediating the association between socio-economic status (SES) and health behaviours (i.e. the psychological mechanisms that underlie SES differences in health behaviours). The purpose of this study was to examine the mediating effects of TPs on the relationship between SES and health behaviours in older Japanese adults. Design: In total, 761 participants living in the Tokyo metropolitan area participated in face-to-face interviews in 2016. Outcome measures: Health behaviours were measured using three indicators: participation in exercise, healthy dietary habits and smoking status. SES was composed of educational attainment and annual income. TPs were measured using the Zimbardo Time Perspective Inventory, which consisted of five subcategories: the past-negative, past-positive, present-hedonistic, present-fatalistic and future perspectives. Results: Among these five subcategories, none mediated both SES and health behaviours. Conclusion: TPs might not contribute to the appearance of SES differences in health behaviours in older adults.
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Affiliation(s)
| | - Ken Harada
- Department of Humanities and Social Sciences, Jissen Women's University, Tokyo, Japan
| | - Yoko Sugihara
- Department of Urban Science and Policy, Tokyo Metropolitan University, Tokyo, Japan
| | - Shizuko Yanagisawa
- Department of Oral Health Science and Social Welfare, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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14
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Allen K, McFarland M. How Are Income and Education Related to the Prevention and Management of Diabetes? J Aging Health 2019; 32:1063-1074. [PMID: 31609162 DOI: 10.1177/0898264319879608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To understand whether income and education have unique contributions in the prevention and management of diabetes, as measured by Hba1c levels among diagnosed and undiagnosed individuals. Method: Data were obtained from the Nashville Stress and Health Study (N = 1,189). Ordinary least squares regression analyses were used to examine the associations among education, annual household income, diabetes onset, and diabetes management (Hba1c). Results: Education, but not income, was inversely associated with Hba1c in undiagnosed participants. Income, but not education, was inversely associated with Hba1c among diagnosed participants. Discussion: These results support the idea that education and income provide non-fungible social and economic resources that vary in their consequences for Hba1c level depending on whether someone has been diagnosed with diabetes. The social resources provided by education may be more important in delaying the onset of disease, whereas resources provided by income may be more important for disease management.
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15
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Spitaels D, Vankrunkelsven P, Grypdonck L, Dusar FR, Aertgeerts B, Luyten FP, Hermens RPMG. Quality of Care for Knee Osteoarthritis in Primary Care: A Patient's Perspective. Arthritis Care Res (Hoboken) 2019; 72:1358-1366. [PMID: 31325228 DOI: 10.1002/acr.24034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/16/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the quality of osteoarthritis care in general practice from a patient's perspective and to identify novel associations between process quality indicators and patient-reported outcome and experience measures. METHODS For this study, 235 individuals with knee osteoarthritis completed a survey based on both process and outcome indicators. Process indicators were extracted from international guidelines and included the domains: diagnosis, self-management, treatment, and follow-up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and RAND 36-item Short Form health survey (SF-36) were used to assess patient-reported outcomes. Patient-reported experience with care was evaluated with the European Task Force on Patient Evaluations of General Practice Care (EUROPEP) instrument. A series of multilevel regression analyses were then performed to analyze determinants at the patient level (i.e., age, sex, body mass index, and education) and associations between process and outcome indicators. RESULTS Overall, low adherence to the process indicators was observed (38%), particularly on informing patients about the importance of weight loss (24% [95% confidence interval (95% CI) 19-31]) or referring them for physical therapy (41% [95% CI 33-49]). Patients described their quality of life as moderate, with an overall score of 63% and 35% on the SF-36 and WOMAC surveys, respectively. Regarding the determinants, patients with a higher education level were better informed (odds ratio [OR] 3.4; P = 0.0003). Associations between process and outcome indicators were scarce, with the exception of patient satisfaction with care and use of nonsteroidal antiinflammatory drugs (NSAIDs) (OR 2.9; P = 0.0014). CONCLUSION Patients with knee osteoarthritis receive suboptimal conservative management. They report a moderate quality of life. This study confirms the evidence suggesting that NSAIDs are the backbone of osteoarthritis pain management but also adds evidence from a patient's perspective.
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Affiliation(s)
- David Spitaels
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Lies Grypdonck
- Former Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Bert Aertgeerts
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Rosella P M G Hermens
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium, and Radboud Institute for Health Sciences, IQ Healthcare, and Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Schüz B, Brick C, Wilding S, Conner M. Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies. Ann Behav Med 2019; 54:36-48. [DOI: 10.1093/abm/kaz023] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.
Purpose
Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models.
Methods
Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES.
Results
Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES.
Conclusions
Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.
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Affiliation(s)
- Benjamin Schüz
- Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Cameron Brick
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, UK
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Olsson CB, Ekelund J, Degerstedt Å, Thorstensson CA. Change in self-efficacy after participation in a supported self-management program for osteoarthritis – an observational study of 11 906 patients. Disabil Rehabil 2019; 42:2133-2140. [DOI: 10.1080/09638288.2018.1555616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Christina B. Olsson
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Healthcare Centre, Stockholm County Council, Stockholm, Sweden
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Gothenburg, Sweden
| | | | - Carina A. Thorstensson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden
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18
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Park CL, Cho D, Moore PJ. How does education lead to healthier behaviours? Testing the mediational roles of perceived control, health literacy and social support. Psychol Health 2018; 33:1416-1429. [DOI: 10.1080/08870446.2018.1510932] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Dalnim Cho
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Health Disparities, MD Anderson Cancer Center, Unit 1440, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip J. Moore
- Department of Psychology, George Washington University, Washington, DC, USA
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19
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Local fast-food environment, diet and blood pressure: the moderating role of mastery. Eur J Nutr 2018; 58:3129-3134. [PMID: 30426195 PMCID: PMC6842338 DOI: 10.1007/s00394-018-1857-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/02/2018] [Indexed: 01/10/2023]
Abstract
Purpose To examine the moderating role of mastery in the association of local fast-food restaurants (FFR) with diet quality and systolic blood pressure (SBP). Methods We used cross-sectional data from 1543 adults participating in wave six of the Netherlands Study of Depression and Anxiety (NESDA). Data were collected between 2013 and 2016. Diet quality was defined by adherence with the dietary approaches to stop hypertension (DASH) diet. Individuals reported on their food consumption through a food frequency questionnaire and SBP was measured. Density of FFR in 1600 m, 800 m and 400 m circular buffers around the home postal code was calculated using Geographic Information Systems. We assessed the association between density of FFR, diet and SBP using linear regression analyses, testing for moderation by mastery. Results Mean age was 52 years and 32.2% of the sample were men. Exposure to FFR ranged from 0 to 35 FFR per km2. Density of FFR was not significantly associated with DASH adherence or SBP. Only one out of the six interaction terms was significant, suggesting that for individuals with lower levels of mastery, higher density of FFR in an 800-m buffer was negatively associated with DASH adherence, while for individuals with higher levels of mastery, this association was positive. Conclusions Exposure to FFR was not associated with diet quality and SBP, and we observed little evidence for moderation by level of mastery. This research question should be further explored in a large sample of healthy adults.
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20
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Chan SHW, Tse S. Coping with amplified emotionality among people with bipolar disorder: A longitudinal study. J Affect Disord 2018; 239:303-312. [PMID: 30031250 DOI: 10.1016/j.jad.2018.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/20/2018] [Accepted: 07/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The amplified emotionality characteristics of bipolar disorder (BD) may interfere with goal pursuit in the recovery process. This is the first study to test the coping flexibility model empirically among people with BD. Finding ways to cope with goal-striving life events should shed light on managing elevated mood states. METHODS Using a 12-month longitudinal follow-up design, this study examined the stability in coping flexibility with experimentally-devised Behavioral Approach System (BAS) activating life events and mood states at 6- and 12-month time points for individuals with BD (n = 83) and healthy controls (n = 89). Hierarchical linear modeling tested the individual growth model by studying the longitudinal data. RESULTS The findings showed fluctuations in different components of coping flexibility and mood states across time. They confirmed the amplified emotionality characteristics of BD. Moreover, coping flexibility took precedence over BAS sensitivity and psychosocial functioning levels in predicting mood states. LIMITATIONS Measurements of BAS sensitivity may focus on trait nature only and prone to subjective bias. The assessment of mood or coping flexibility may not accurately capture actual experience in daily life. Lack of respective data on bipolar subtypes and significant differences in some dimensions between the BD and control groups are further limitations of the study. CONCLUSIONS The study's findings have implications for coping with amplified emotionality within the personal recovery process for people with BD. Judicious application of coping strategies and adjustment of perceived controllability are crucial for individuals to reach goals pertinent to personal recovery and manage potential manic mood symptoms.
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Affiliation(s)
- Sunny H W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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21
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The general self-efficacy scale: New evidence of structural validity, measurement invariance, and predictive properties in relationship to subjective well-being in Serbian samples. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9992-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Amit Aharon A, Nehama H, Rishpon S, Baron-Epel O. A path analysis model suggesting the association between health locus of control and compliance with childhood vaccinations. Hum Vaccin Immunother 2018; 14:1618-1625. [PMID: 29771633 DOI: 10.1080/21645515.2018.1471305] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Despite vaccines benefits, parent's vaccine hesitancy is growing. Health locus of control (HLOC) may affect decision making regarding child vaccinations. The aim of this study was to investigate the relationship between parents' HLOC and compliance with routine childhood immunization programs. A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Internal HLOC, powerful others and chance HLOC (dimensions of external HLOC), reliability of information sources, and attitudes towards vaccines were measured. Path analysis was conducted to explore direct and indirect associations between HLOC and vaccination's compliance. The results show that High powerful others HLOC has a direct association with vaccination compliance (ß = 0.23, p < 0.001). High internal and chance HLOC have indirect associations through parents' attitudes regarding vaccines. Perceived reliability of information sources was associated with not complying with vaccines (ß = -0.07, p < 0.05). For conclusions, Interaction between internal and external HLOC may explain vaccination compliance. Decreasing levels of chance HLOC and increasing powerful others HLOC may increase levels of compliance with childhood vaccinations.
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Affiliation(s)
- Anat Amit Aharon
- a Sackler Faculty of Medicine, Nursing Department , Tel-Aviv University , Israel
| | - Haim Nehama
- b Public Health Department , Tel Aviv-Yafo Municipality , Israel
| | - Shmuel Rishpon
- c Ministry of Health and School of Public Health, Faculty of Welfare and Health Studies, Haifa University , Israel
| | - Orna Baron-Epel
- d School of Public Health, Faculty of Welfare and Health Studies, Haifa University , Israel
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23
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The Transplant Evaluation Rating Scale (TERS): A Tool for the Psychosocial Evaluation of Lung Transplant Candidates. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2018; 64:172-185. [PMID: 29862926 DOI: 10.13109/zptm.2018.64.2.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES An evaluation of psychosocial functioning prior to lung transplantation is advisable for anticipating behavioral difficulties and for screening for any psychological distress that might be harmful to posttransplantation outcomes and adjustment. METHODS In this cross-sectional, single-center study, the level of psychosocial functioning of N = 75 patients before lung transplantation was rated using the Transplant Evaluation Rating Scale (TERS). RESULTS he reliability of the TERS total score was satisfactory at α = 0.75. A two-factorial solution (emotional sensitivity; defiance) was found. Higher TERS scores were significantly associated with higher depressive and anxiety symptoms (r = .38/r = .42), lower quality of life (r = -.26), and fewer years abstinent from smoking (r = -.35). No associations were found with lung disease and symptom severity. CONCLUSIONS The TERS appears to be a reliable and valid measure with clinical utility for specifying behavioral concerns prior to lung transplantation.
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24
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McKenzie B, Santos JA, Trieu K, Thout SR, Johnson C, Arcand J, Webster J, McLean R. The Science of Salt: A focused review on salt-related knowledge, attitudes and behaviors, and gender differences. J Clin Hypertens (Greenwich) 2018; 20:850-866. [PMID: 29722131 PMCID: PMC8031068 DOI: 10.1111/jch.13289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
The aim of the current review was to examine the scope of studies published in the Science of Salt Weekly that contained a measure of self-reported knowledge, attitudes, and behavior (KAB) concerning salt. Specific objectives were to examine how KAB measures are used to evaluate salt reduction intervention studies, the questionnaires used, and whether any gender differences exist in self-reported KAB. Studies were reviewed from the commencement of Science of Salt Weekly, June 2013 to the end of August 2017. Seventy-five studies had relevant measures of KAB and were included in this review, 13 of these were salt-reduction intervention-evaluation studies, with the remainder (62) being descriptive KAB studies. The KAB questionnaires used were specific to the populations studied, without evidence of a best practice measure. 40% of studies used KAB alone as the primary outcome measure; the remaining studies used more quantitative measures of salt intake such as 24-hour urine. Only half of the descriptive studies showed KAB outcomes disaggregated by gender, and of those, 73% showed women had more favorable KAB related to salt. None of the salt intervention-evaluation studies showed disaggregated KAB data. Therefore, it is likely important that evaluation studies disaggregate, and are appropriately powered to disaggregate all outcomes by gender to address potential disparities.
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Affiliation(s)
- Briar McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Sudhir Raj Thout
- The George Institute for Global Health India, Unit No. 301, Hyderabad, Telangana, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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25
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Jang K, Baek YM. How to effectively design public health interventions: Implications from the interaction effects between socioeconomic status and health locus of control beliefs on healthy dietary behaviours among US adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:664-674. [PMID: 29659076 DOI: 10.1111/hsc.12577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
This study investigated whether individuals with different socioeconomic status (SES) should be provided differently tailored health messages to promote healthy dietary behaviour (HDB). Prior research has suggested that people with different SESs tend to exhibit different types of beliefs about health, but it remains unclear how SES interacts with these beliefs to influence health outcomes. To better understand the differences in HDB between high- and low-SES populations and propose effective intervention strategies, we examined (i) how SES is associated with HDB, (ii) how internal health locus of control (HLC) and powerful others HLC are associated with HDB, and (iii) how SES interacts with internal and powerful others HLC to influence HDB. Using data from the Annenberg National Health Communication Survey, collected from 2005 to 2012 (N = 6,262) in the United States, hierarchical multiple regression analyses were conducted. Education level was found to be positively associated with HDB, while income level was not. Both internal and powerful others HLC beliefs were positively associated with HDB. The positive relationship between internal HLC and HDB strengthened as the level of education and income increased, whereas the positive relationship between powerful others HLC and HDB weakened as respondents' education level increased. These results suggest that the design and delivery of communication messages should be tailored to populations' specific SES and HLC beliefs for effective public health interventions. For example, messages enhancing internal HLC (e.g. providing specific skills and knowledge about health behaviours) might be more helpful for the richer and more-educated, while messages appealing to one's powerful others HLC beliefs (e.g. advice on health lifestyles given by well-known health professionals) might be more effective for less-educated people.
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Affiliation(s)
- Kyungeun Jang
- Graduate School of Communication and Arts, Yonsei University, Seoul, South Korea
| | - Young Min Baek
- College of Communication, Yonsei University, Seoul, South Korea
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26
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Gazdzinska AP, Gazdzinski SP, Jagielski P, Wylezol M. Health Behaviors of Patients Qualified for Bariatric Surgery: The Role of Excess Body Weight, Age, and Depressive Symptoms. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Agata P. Gazdzinska
- Department of Nutrition and Obesity, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Stefan P. Gazdzinski
- Department of Magnetic Resonance, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Pawel Jagielski
- Human Nutrition Department, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Wylezol
- Department of Surgery, Military Institute of Aviation Medicine, Warsaw, Poland
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27
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Bonsaksen T, Lerdal A, Heir T, Ekeberg Ø, Skogstad L, Grimholt TK, Schou-Bredal I. General self-efficacy in the Norwegian population: Differences and similarities between sociodemographic groups. Scand J Public Health 2018; 47:695-704. [PMID: 29417880 DOI: 10.1177/1403494818756701] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: General self-efficacy (GSE) refers to optimistic self-beliefs of being able to perform and control behaviors, and is linked with various physical and mental health outcomes. Measures of self-efficacy are commonly used in health research with clinical populations, but are less explored in relationship to sociodemographic characteristics in general populations. This study investigated GSE in relation to sociodemographic characteristics in the general population in Norway. Methods: As part of a larger national survey, the GSE scale was administered to a general population sample, and 1787 out of 4961 eligible participants (response rate 36%) completed the scale. Group comparisons were conducted using independent t-tests and one-way analyses of variance. Linear regression analysis was used to examine factors independently associated with GSE. Results: GSE was lower for older compared to younger participants (p < 0.001). It was higher for men compared to women (p < 0.001), higher for those with higher levels of education compared to those with lower levels (p < 0.001) and higher for those in work compared to their counterparts (p < 0.001). Controlling for all variables, male gender and employment were independently associated with higher GSE. Age moderated the associations between gender and employment on one hand, and GSE on the other. The association between being male and having higher GSE was more pronounced in younger age, as was the association between being employed and having higher GSE. Conclusions: Male gender and being employed were related to higher GSE among persons in the general population in Norway, and these associations were stronger among persons of younger age. The findings are considered fairly representative for the Norwegian population.
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Affiliation(s)
- Tore Bonsaksen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Sandnes, Norway
| | - Anners Lerdal
- Department for Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trond Heir
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Laila Skogstad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Tine K Grimholt
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Inger Schou-Bredal
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department for Cancer, Oslo University Hospital, Oslo, Norway
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Davies H, Marcu A, Vedsted P, Whitaker KL. Is lower symptom recognition associated with socioeconomic inequalities in help-seeking for potential breast cancer symptoms? Psychooncology 2018; 27:626-632. [PMID: 28940942 DOI: 10.1002/pon.4557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Socioeconomic inequalities in recognising signs and symptoms of cancer may result in inequalities in timely help-seeking and subsequent prognosis of breast cancer. We explored the mediating role of symptom attribution and concern on the relationship between level of education and help-seeking for potential breast cancer symptoms. METHODS Women aged ≥47 years (n = 961) were purposively recruited (by education) to complete an online vignette-based survey that included nipple rash and axillary lump (in separate vignettes) as potential symptoms of breast cancer. Women completed questions relating to medical help-seeking (yes/no), cancer attribution, symptom concern, cancer avoidance, family history, and demographics. RESULTS Women with low education and mid education attributed nipple rash less often to cancer (26% and 27% mentioned cancer) than women with a degree or higher (40%). However, women with a degree or higher (63%) or mid education (64%) were less likely to anticipate seeking help for the nipple rash than women with no formal qualifications (73%). This association was statistically significant in the 60- to 69-year-old age group. There was no significant association between education and help-seeking for axillary lump. Mediation analysis adjusting for potential confounders confirmed that the association between education and help-seeking for nipple rash was fully mediated by symptom concern. CONCLUSIONS Socioeconomic inequalities in stage at diagnosis and survival of breast cancer may not always be explained by lower likelihood of suspecting cancer and subsequent impact on help-seeking. Reducing inequalities in stage at diagnosis will involve understanding a broader range of bio-psycho-social factors (eg, comorbidities and healthcare system factors).
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Affiliation(s)
- Hilary Davies
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Faculty of Health, Aarhus University, Aarhus, Denmark
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29
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Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial. Int J Nurs Stud 2018; 77:171-178. [DOI: 10.1016/j.ijnurstu.2017.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 02/03/2023]
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30
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India. Nutrients 2017; 9:E144. [PMID: 28212309 PMCID: PMC5331575 DOI: 10.3390/nu9020144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110070, India.
| | - Kris Rogers
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi 110070, India.
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Jacqui Webster
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad 500034, India.
- George Institute for Global Health, University of Oxford, Oxford OX1 3PA, UK.
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | - Bruce Neal
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
- Charles Perkins Centre, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Imperial College, London SW7 2AZ, UK.
- Royal Prince Alfred Hospital, Sydney 2050, Australia.
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Barker M, D'Angelo S, Ntani G, Lawrence W, Baird J, Jarman M, Vogel C, Inskip H, Cooper C, Harvey NC. The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy. Osteoporos Int 2017; 28:77-84. [PMID: 27549309 PMCID: PMC5404713 DOI: 10.1007/s00198-016-3721-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED In a randomised controlled trial of vitamin D during pregnancy, we demonstrated that women with lower self-efficacy were more likely to experience practical problems with taking the trial medication and that this was associated with lower compliance and achieved 25(OH)-vitamin D concentrations. INTRODUCTION The relationship between self-efficacy (the belief that one can carry out a behaviour), compliance with study protocol and outcome was explored within a randomised, double-blind, placebo-controlled trial of vitamin D supplementation in pregnancy. METHODS In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, women with circulating plasma 25(OH)-vitamin D of 25-100 nmol/l in early pregnancy were randomised to either 1000 IU cholecalciferol/day or matched placebo from 14 weeks until delivery. Circulating 25(OH)-vitamin D concentrations were assessed at 14 and 34 weeks' gestation. A sequential sub-sample completed Schwarzer's General Self-Efficacy Scale at 14 and 34 weeks and the Problematic Experiences of Therapy Scale at 34 weeks. Women were interviewed about their experiences of the trial and interview transcripts analysed thematically. RESULTS In 203 women, those with higher self-efficacy were less likely to experience practical problems taking the study medication (odds ratio (OR) 0.81 (95 % confidence interval (CI) 0.69-0.95), p = 0.01). Over half reported practical problems associated with poorer compliance with the protocol requiring women to take the medication daily. Compliance in women who experienced practical problems was 94 % compared with 98 % for those with no problems (p < 0.001). Poorer compliance was also associated with lower concentrations of 25(OH)-D in late pregnancy in the treatment group (β = 0.54 nmol/l (95 % CI 0.18-0.89), p = 0.003). Thematic analysis suggested common difficulties were remembering to take the medication every day and swallowing the large capsules. CONCLUSIONS These findings suggest that differences in self-efficacy influence trial outcomes. Such information may help clinicians anticipate responses to routine vitamin D supplementation in pregnancy and identify those who may need more support to comply. TRIAL REGISTRATION ISRCTN82927713, registered 11/04/2008.
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Affiliation(s)
- M Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - G Ntani
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - W Lawrence
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - J Baird
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - M Jarman
- Li Ka Shing Centre for Health Research Innovation, Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - C Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
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Rok Simon M, Korošec A, Bilban M. The influence of parental education and other socio-economic factors on child car seat use. Zdr Varst 2016; 56:55-64. [PMID: 28289464 PMCID: PMC5329786 DOI: 10.1515/sjph-2017-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 07/07/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The behaviour of parents in ensuring car passenger safety for their children is associated with socio-economic (SE) status of the family; however, the influence of parental education has rarely been researched and the findings are contradictory. The aim of the study was to clarify whether parental education influences the use of a child car seat during short rides. METHODS A cross-sectional survey was carried out in outpatient clinics for children's healthcare across Slovenia. 904 parents of 3-year-old children participated in the study; the response rate was 95.9%. A self-administered questionnaire was used. A binary multiple logistic regression was applied to assess the association between parental unsafe behaviour as dependent variable, and education and other SE factors as independent variables. RESULTS 14.6% of parents did not use a child car seat during short rides. Families where mother had low or college education had higher odds of the non-use of a child car seat than families where mother had a university education. Single-parent families and those who lived in areas with low or medium SE status also had higher odds of the non-use of a child car seat. CONCLUSIONS Low educational attainment influences parents' behaviour regarding the non-use of a child car seat. Low parental education is not the only risk factor since some highly educated parents also have high odds of unsafe behaviour. All parents should therefore be included in individually tailored safety counselling programmes. SE inequalities could be further reduced with provision of free child car seats for eligible families.
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Affiliation(s)
- Mateja Rok Simon
- National Institute of Public Health, Centre for Health Research and Development, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Aleš Korošec
- National Institute of Public Health, Centre for Health Research and Development, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Marjan Bilban
- Institute of Occupational Safety, Chengdujska c. 25, 1260 Ljubljana-Polje, Slovenia
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Park S, Song YM, Ko GN, Jhung K, Ha K, Lee YR, Kim Y. The Relationship between Personality, Sense of Efficacy, and Stress in Korean Teachers. Psychiatry Investig 2016; 13:566-570. [PMID: 27757136 PMCID: PMC5067352 DOI: 10.4306/pi.2016.13.5.566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/12/2016] [Accepted: 02/05/2016] [Indexed: 11/19/2022] Open
Abstract
Several studies have linked teachers' personality characteristics and sense of efficacy to stress. However, investigating the relationship between these three constructs in this context was limited. This study aims to investigate the relationship between personality, sense of efficacy and perceived stress among Korean teachers. A total of 137 teachers working in elementary, middle, and high schools located in Seoul, South Korea were recruited for the study. The participants were administered Temperament and Character Inventory, Teacher's Sense of Efficacy Scale (TSES), and Perceived Stress Scale. The TSES was negatively correlated with harm avoidance and positively correlated with persistence, self-directedness, cooperativeness, and self-transcendence. Perceived stress was positively correlated with harm avoidance and negatively correlated with persistence and self-directedness. The path analysis showed that harm avoidance directly predicted perceived stress (β=0.37, 95% CI=0.21-0.53, p=0.002), and self-directedness and persistence predicted one's sense of efficacy (β=0.18, 95% CI=0.01-0.39 and β=0.31, 95% CI=0.10-0.47), which predicted perceived stress (β=-0.21, 95% CI=-0.39 to -0.02). The results of the present study indicate that harm avoidance might be associated with stress-proneness, while persistence, self-directedness, and sense of efficacy might act as protective resources against stress in Korean teachers.
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Affiliation(s)
- Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Guy-Nueo Ko
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Kyungun Jhung
- Department of Psychiatry and Behavioral Neurosciences, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Ryeol Lee
- Department of Psychiatry, Bugok National Hospital, Changyeong, Republic of Korea
| | - Yeni Kim
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
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Abstract
In this article I consider the changing context and constitution of food in contemporary society, and the variety of ways it is bound up in health, identity and social relations. In particular, I briefly discuss the position of food in health, illness, embodiment, and the ways that food is becoming increasingly medicalized and politicized. I suggest that the treatment of food in health psychology research has frequently been overly simplistic, and argue that we need to take greater account of the complexity of food and its intricate relations to health and illness in our research if we are to investigate this topic comprehensively, and seek to contribute to better understandings and outcomes for people.
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Vasiljevic M, Ng YL, Griffin SJ, Sutton S, Marteau TM. Is the intention-behaviour gap greater amongst the more deprived? A meta-analysis of five studies on physical activity, diet, and medication adherence in smoking cessation. Br J Health Psychol 2015; 21:11-30. [PMID: 26264673 PMCID: PMC5014219 DOI: 10.1111/bjhp.12152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Indexed: 11/29/2022]
Abstract
Objectives Unhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self‐report measures of three behaviours, both individual‐ and area‐level indices of socio‐economic status, and pooling data from five studies. Design Secondary data analysis. Methods Multiple linear regressions and meta‐analyses of data on physical activity, diet, and medication adherence in smoking cessation from 2,511 participants. Results Across five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self‐report measures of behaviour. Using objectively measured behaviour and area‐level deprivation, meta‐analyses suggested that the gap between self‐efficacy and behaviour was greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]). Conclusions We find no compelling evidence to support the hypothesis that the intention–behaviour gap is greater amongst the more deprived. Statement of contribution What is already known on this subject? Unhealthy behaviour is more common in those who are more deprived. This may reflect a larger gap between intentions and behaviour amongst the more deprived. The limited evidence to date testing this hypothesis is mixed.
What does this study add? In the most robust study to date, combining results from five trials, we found no evidence for this explanation. The gap between intentions and behaviour did not vary with deprivation for the following: diet, physical activity, or medication adherence in smoking cessation. We did, however, find a larger gap between perceived control over behaviour (self‐efficacy) and behaviour in those more deprived. These findings add to existing evidence to suggest that higher rates of unhealthier behaviour in more deprived groups may be reduced by the following:
Strengthening behavioural control mechanisms (such as executive function and non‐conscious processes) or Behaviour change interventions that bypass behavioural control mechanisms.
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Affiliation(s)
| | - Yin-Lam Ng
- Behaviour and Health Research Unit, University of Cambridge, UK
| | - Simon J Griffin
- Behaviour and Health Research Unit, University of Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Stephen Sutton
- Behaviour and Health Research Unit, University of Cambridge, UK.,Behavioural Science Group, University of Cambridge, UK
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Haught HM, Rose JP, Brown JA. Social-class indicators differentially predict engagement in prevention vs. detection behaviours. Psychol Health 2015; 31:21-39. [PMID: 26244780 DOI: 10.1080/08870446.2015.1068313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Few systematic studies have examined the contexts in which social-class variables will predict engagement in health-relevant behaviours. The current research examined whether the impact of social-class on health behaviours depends upon how social-class is assessed and the category of health behaviour under consideration. METHOD Our sample was drawn from the Health Information National Trends Survey in 2012 (N = 3959). Participants reported their income and education as well as their engagement in a variety of prevention and detection behaviours. RESULTS Consistent with our hypothesised framework, we found that income predicted engagement in a variety of detection behaviours above and beyond education, whereas education predicted engagement in a variety of prevention behaviours above and beyond income. CONCLUSIONS Our findings suggest that income and education operate on health behaviours via different pathways and have implications for public health policy and intervention.
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Affiliation(s)
- Heather M Haught
- a Department of Psychology , The University of Toledo , Toledo , OH , USA
| | - Jason P Rose
- a Department of Psychology , The University of Toledo , Toledo , OH , USA
| | - Jill A Brown
- a Department of Psychology , The University of Toledo , Toledo , OH , USA
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Abstract
Previous studies showed that control beliefs are more strongly related to global cognition and mortality among adults with low education, providing preliminary evidence that self-efficacy buffers against the negative impact of educational disadvantage on physical and cognitive health. The current study extends these findings to a nationally representative sample of men and women aged 30 to 85 and explores which cognitive domains are most strongly associated with self-efficacy, educational attainment, and their interaction. Data were obtained from 1032 adult (30-85) participants in the United States norming study for the NIH Toolbox. Self-efficacy, executive functioning, working memory, processing speed, episodic memory, and vocabulary were assessed with the NIH Toolbox. Multivariate analysis of covariance and follow-up regressions tested the hypothesis that self-efficacy would be more strongly related to cognitive performance among individuals with lower education, controlling for age, sex, race, ethnicity, education, reading level, testing language, and depressive symptoms. Higher education was associated with higher self-efficacy and better performance on all cognitive tests. Higher self-efficacy was associated with better set-switching and attention/inhibition. Significant self-efficacy by education interactions indicated that associations between self-efficacy and executive abilities were stronger for individuals with lower education. Specifically, individuals with low education but high self-efficacy performed similarly to individuals with high education. This study provides evidence that self-efficacy beliefs buffer against the negative effects of low educational attainment on executive functioning. These results have implications for future policy and/or intervention work aimed at reducing the deleterious effects of educational disadvantage on later cognitive health.
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Sugisawa H, Nomura T, Tomonaga M. Psychosocial mediators between socioeconomic status and dietary habits among Japanese older adults. J Nutr Health Aging 2015; 19:130-6. [PMID: 25651437 DOI: 10.1007/s12603-014-0521-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION OBJECTIVES The purpose of this study was to examine psychosocial mediators between socioeconomic status (SES) and eating habits in older Japanese adults. SUBJECTS AND METHODS A questionnaire was mailed to a representative sample of people who were 60 years and older (N=1,000) living in a suburban area within the Tokyo city metropolitan limits, in Japan. There were 552 effective participants in the study. DESIGN Dietary habits were evaluated by assessing the diversity of food that was consumed. SES was evaluated by educational attainment and household income. Four dimensions of psychosocial mediators were assessed: control expectancy, self-efficacy, social influence, and social support. Indirect effects of SES through the mediators were evaluated by using a multiple mediator model. RESULTS The relationship between education and dietary habits was mediated by three variables excluding social support. Especially, social influence had the strongest mediating effect. These three significant variables explained the majority of differences in dietary habits resulting from education. The effects of household income were also similarly mediated by the identical variables. CONCLUSIONS Control expectancy, self-efficacy, and social influence mediate the relationship between SES and dietary habits.
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Affiliation(s)
- H Sugisawa
- Hidehiro Sugisawa, Graduate School of Gerontology, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, Japan, TEL: +81 (0) 42-797-9847,FAX: +81 (0) 42-797-9847, E-mail:
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Influences on the diet quality of pre-school children: importance of maternal psychological characteristics. Public Health Nutr 2014; 18:2001-10. [PMID: 25409750 DOI: 10.1017/s136898001400250x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To test the hypothesis that maternal psychological profiles relate to children's quality of diet. DESIGN Cross-sectional study. Mothers provided information on their health-related psychological factors and aspects of their child's mealtime environment. Children's diet quality was assessed using an FFQ from which weekly intakes of foods and a diet Z-score were calculated. A high score described children with a better quality diet. Cluster analysis was performed to assess grouping of mothers based on psychological factors. Mealtime characteristics, describing how often children ate while sitting at a table or in front of the television, their frequency of takeaway food consumption, maternal covert control and food security, and children's quality of diet were examined, according to mothers' cluster membership. SUBJECTS Mother-child pairs (n 324) in the Southampton Initiative for Health. Children were aged 2-5 years. SETTING Hampshire, UK. RESULTS Two main clusters were identified. Mothers in cluster 1 had significantly higher scores for all psychological factors than mothers in cluster 2 (all P < 0.001). Clusters were termed 'more resilient' and 'less resilient', respectively. Children of mothers in the less resilient cluster ate meals sitting at a table less often (P = 0.03) and watched more television (P = 0.01). These children had significantly poorer-quality diets (β = -0.61, 95% CI -0.82, -0.40, P ≤ 0.001). This association was attenuated, but remained significant after controlling for confounding factors that included maternal education and home/mealtime characteristics (P = 0.006). CONCLUSIONS The study suggests that mothers should be offered psychological support as part of interventions to improve children's quality of diet.
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Tsai TI, Lee SYD, Tsai YW. Explaining selected health behaviors in a national sample of Taiwanese adults. Health Promot Int 2013; 30:563-72. [PMID: 24342796 DOI: 10.1093/heapro/dat085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extant research provides little evidence about how health literacy, self-efficacy and health locus of control are related to each other in affecting health behaviors. The purposes of this study were to examine the associations among health literacy, self-efficacy and health locus of control and how the three factors are related to health behaviors using data from a national survey of Taiwanese adults. The analysis showed moderate correlations among health literacy, self-efficacy and locus of control, suggesting that they were independent, albeit correlated, factors. Moreover, we found in most cases that health literacy, self-efficacy and locus of control had independent associations with health behaviors. Of the three factors, self-efficacy had the most consistent and positive associations with health behaviors. Our findings suggest that efforts to promote and sustain health behaviors need to focus on improving individuals' emotional states and correcting their faulty self-beliefs and habits of thinking. Health education campaigns and enhancement of literacy skills alone may not achieve the desirable goal of behavioral change.
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Affiliation(s)
- Tzu-I Tsai
- School of Nursing, National Yang Ming University, Taipei, Taiwan
| | - Shoou-Yih Daniel Lee
- Department of Health Management and Policy, School of Public Health, The University of Michigan, Ann Arbor, MI, USA
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang Ming University, Taipei, Taiwan
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Education as a social determinant of health: issues facing indigenous and visible minority students in postsecondary education in Western Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3908-29. [PMID: 23989527 PMCID: PMC3799536 DOI: 10.3390/ijerph10093908] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/11/2013] [Accepted: 08/19/2013] [Indexed: 11/20/2022]
Abstract
The level of educational attainment is increasingly being recognized as an important social determinant of health. While higher educational attainment can play a significant role in shaping employment opportunities, it can also increase the capacity for better decision making regarding one’s health, and provide scope for increasing social and personal resources that are vital for physical and mental health. In today’s highly globalized knowledge based society postsecondary education (PSE) is fast becoming a minimum requirement for securing employment that can afford young adults the economic, social and personal resources needed for better health. Canada ranks high among OECD countries in terms of advanced education, with 66% of Canadians having completed some form of postsecondary education. Yet youth from low income indigenous and visible minority (LIIVM) backgrounds continue to be poorly represented at PSE levels. The current study aimed to understand the reasons for this poor representation by examining the experiences of LIIVM students enrolled in a postsecondary program. Findings show that the challenges they faced during the course of their study had an adverse impact on their health and that improving representation of these students in PSE will require changes at many levels.
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Healthier lives for European minority groups: school and health care, lessons from the Roma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3089-111. [PMID: 23887619 PMCID: PMC3774426 DOI: 10.3390/ijerph10083089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
Abstract
On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms of educational participation which have a direct impact on improving their health status, regardless of their educational level. The findings from this research, unanimously endorsed by the European Parliament, have been included in several European Union recommendations and resolutions as part of the EU strategy on Roma inclusion. To analyze these SA, as well as the conditions that promote them and their impact on reducing health inequalities, communicative fieldwork has been conducted with Roma people from a deprived neighbourhood in the South of Spain, who are participating in the previously identified SA. The analysis reveals that these SA enable Roma people to reinforce and enrich specific strategies like improving family cohesion and strengthening their identity, which allow them to improve their overall health. These findings may inform public policies to improve the health condition of the Roma and other vulnerable groups, one goal of the Europe 2020 strategy for a healthier Europe.
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Sarmugam R, Worsley A, Wang W. An examination of the mediating role of salt knowledge and beliefs on the relationship between socio-demographic factors and discretionary salt use: a cross-sectional study. Int J Behav Nutr Phys Act 2013; 10:25. [PMID: 23418906 PMCID: PMC3610230 DOI: 10.1186/1479-5868-10-25] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discretionary salt use varies according to socio-demographic factors. However, it is unknown whether salt knowledge and beliefs mediate this relationship. This study examined the direct and indirect effect of socio-demographic factors on salt knowledge and discretionary salt use in a sample of 530 Australian adults. METHODS An internet based cross-sectional survey was used to collect data for this study. Participants completed an online questionnaire which assessed their salt knowledge, beliefs and salt use behaviour. Mplus was used to conduct structural equation modelling to estimate direct and indirect effects. RESULTS The mean age of the participants was 49.2 years, and about a third had tertiary education. Discretionary salt use was inversely related to age (r=-0.11; p<0.05), and declarative salt knowledge (knowledge of factual information) scores (r = -0.17; p<0.01), but was positively correlated with misconceptions about salt (r = 0.09; p<0.05) and beliefs about the taste of salt (r = 0.51; p<0.001). Structural equation modelling showed age, education and gender were indirectly associated with the use of discretionary salt through three mediating pathways; declarative salt knowledge, misconceptions about salt and salt taste beliefs. CONCLUSIONS Inequalities observed between socio-demographic groups in their use of discretionary salt use can potentially be reduced through targeted salt knowledge and awareness campaigns.
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Affiliation(s)
- Rani Sarmugam
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Anthony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Wei Wang
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Coetzee M, Oosthuizen RM. Examining the Mediating Effect of Open Distance Learning Students' Study Engagement in Relation to Their Life Orientation and Self-Efficacy. JOURNAL OF PSYCHOLOGY IN AFRICA 2013. [DOI: 10.1080/14330237.2013.10820619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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45
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Hong SA, Kim K, Kim MK. Educational attainment and differences in fruit and vegetable consumption among middle-aged adults in the Korean National Health and Nutrition Examination Survey IV. Nutr Res Pract 2012; 6:263-9. [PMID: 22808352 PMCID: PMC3395793 DOI: 10.4162/nrp.2012.6.3.263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/20/2012] [Accepted: 05/20/2012] [Indexed: 11/26/2022] Open
Abstract
We investigated whether socioeconomic differences affect fruit and vegetable (FV) consumption with respect to total intake and intake of various FV subgroups. Our study included 6667 adults aged 40-64 years who completed a dietary survey in the fourth Korean NHANES (2007-2009). FV intake was estimated from 24-hour recalls and food frequency questionnaires. Differences in FV consumption related to educational attainment were analyzed according to different nutritional categories of FV. Both men and women in the low-education group had the lowest intake of total FV and total fruits, and women also had the lowest intake of total vegetables. Also lowest in this group was consumption of mushrooms and vegetables (excluding kimchi) among men, and cruciferous and allium vegetables (excluding Chinese cabbage and radish) among women, while kimchi consumption was the highest in this group. Additionally, an association between educational level and intake of citrus fruits was evident among men. Adults in the low-education group consumed less carotene-rich FV, red fruit and/or vegetables, and dark-green leafy vegetables, fewer total vegetable dishes, and fewer types of fruit than in other groups. Men in this group had the lowest intake of yellow/orange fruit and/or vegetables, and women consumed the least folate-rich FV. There is a clear association between educational attainment and FV intake with regard to total intake, and to specific nutrients, bioactive compounds, colors, and variety.
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Affiliation(s)
- Seo Ah Hong
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul 137-791, Korea
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Non AL, Gravlee CC, Mulligan CJ. Education, genetic ancestry, and blood pressure in African Americans and Whites. Am J Public Health 2012; 102:1559-65. [PMID: 22698014 DOI: 10.2105/ajph.2011.300448] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We assessed the relative roles of education and genetic ancestry in predicting blood pressure (BP) within African Americans and explored the association between education and BP across racial groups. METHODS We used t tests and linear regressions to examine the associations of genetic ancestry, estimated from a genomewide set of autosomal markers, and education with BP variation among African Americans in the Family Blood Pressure Program. We also performed linear regressions in self-identified African Americans and Whites to explore the association of education with BP across racial groups. RESULTS Education, but not genetic ancestry, significantly predicted BP variation in the African American subsample (b=-0.51 mm Hg per year additional education; P=.001). Although education was inversely associated with BP in the total population, within-group analyses showed that education remained a significant predictor of BP only among the African Americans. We found a significant interaction (b=3.20; P=.006) between education and self-identified race in predicting BP. CONCLUSIONS Racial disparities in BP may be better explained by differences in education than by genetic ancestry. Future studies of ancestry and disease should include measures of the social environment.
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Affiliation(s)
- Amy L Non
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA.
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47
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Trends in the inequality of fruit and vegetable consumption between education levels indicated by the Korea National Health and Nutrition Examination Surveys. Eur J Clin Nutr 2012; 66:942-9. [DOI: 10.1038/ejcn.2012.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Grimholt TK, Bjornaas MA, Jacobsen D, Dieserud G, Ekeberg O. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning. Ann Gen Psychiatry 2012; 11:10. [PMID: 22520705 PMCID: PMC3347980 DOI: 10.1186/1744-859x-11-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. METHODS A cohort of patients who self-poisoned (n = 867) over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Generalized Self-Efficacy Scale (GSE) were used. The participation rate was 28% (n = 242); mean age, 41 years; 66% females. RESULTS Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe). The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. CONCLUSIONS Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.
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Affiliation(s)
- Tine K Grimholt
- Department of Acute Medicine, Oslo University Hospital Ulleval HF, Oslo, Norway.
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Burker EJ, Phillips KM, Giza M. Factors related to health locus of control among lung transplant candidates. Clin Transplant 2012; 26:748-54. [PMID: 22515175 DOI: 10.1111/j.1399-0012.2012.01614.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 12/01/2022]
Abstract
As the number of individuals pursuing lung transplantation to treat lung disease increases, transplant team members have an opportunity to maximize patients' chances for post-transplant success through identifying and addressing psychosocial factors that have been previously associated with patients' post-transplant survival, such as health locus of control (HLC). The purpose of this cross-sectional study was to understand the factors associated with HLC in lung transplant candidates. The aims were to (i) identify the demographic factors associated with internal (IHLC), chance (CHLC), and powerful others (PHLC) HLC; (ii) examine the associations between HLC and anxiety, depression, and optimism; and (iii) determine whether these factors explain a significant proportion of variance in HLC. Hierarchical regression analyses indicated that age, education, trait anxiety, and optimism explained 20% of the variance in CHLC; gender, trait anxiety, and depression accounted for 9% of the variance in IHLC; and lower education accounted for 5% of the variance in PHLC. Helping transplant team members understand the factors that influence patients' perceptions that their own behaviors impact their health status is important for maximizing post-transplant success.
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Affiliation(s)
- Eileen J Burker
- Division of Rehabilitation Counseling & Psychology, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA.
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50
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Mulder BC, de Bruin M, Schreurs H, van Ameijden EJC, van Woerkum CMJ. Stressors and resources mediate the association of socioeconomic position with health behaviours. BMC Public Health 2011; 11:798. [PMID: 21991933 PMCID: PMC3205066 DOI: 10.1186/1471-2458-11-798] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 10/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Variability in health behaviours is an important cause of socioeconomic health disparities. Socioeconomic differences in health behaviours are poorly understood. Previous studies have examined whether (single) stressors or psychosocial resources mediate the relationship between socioeconomic position and health or mortality. This study examined: 1) whether the presence of stressors and the absence of resources can be represented by a single underlying factor, and co-occur among those with lower education, 2) whether stressors and resources mediated the relation between education and health behaviours, and 3) addressed the question whether an aggregate measure of stressors and resources has an added effect over the use of individual measures. METHODS Questionnaire data on sociodemographic variables, stressors, resources, and health behaviours were collected cross-sectionally among inhabitants (n = 3050) of a medium-sized Dutch city (Utrecht). Descriptive statistics and bootstrap analyses for multiple-mediator effects were used to examine the role of stressors and resources in mediating educational associations with health behaviours. RESULTS Higher levels of stressors and lower levels of resources could be represented by a single underlying factor, and co-occurred among those with lower educational levels. Stressors and resources partially mediated the relationship between education and four health- behaviours (exercise, breakfast frequency, vegetable consumption and smoking). Financial stress and poor perceived health status were mediating stressors, and social support a strong mediating resource. An aggregate measure of the stressors and resources showed similar associations with health behaviours compared to the summed individual measures. CONCLUSIONS Lower educated groups are simultaneously affected by the presence of various stressors and absence of multiple resources, which partially explain socioeconomic differences in health behaviours. Compared to the direct associations of stressors and resources with health behaviours, the association with socioeconomic status was modest. Therefore, besides addressing structural inequalities, interventions promoting financial management, coping with chronic disease, and social skills training have the potential to benefit large parts of the population, most notably the lower educated. Further research is needed to clarify how stressors and resources impact health behaviours, why this differs between behaviours and how these disparities could be alleviated.
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Affiliation(s)
- Bob C Mulder
- Communication Science, Wageningen University, Hollandseweg 1, 6706 KN, Wageningen, The Netherlands.
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