1
|
Andrees V, Bei der Kellen R, Augustin M, Gallinat J, Harth V, Hoven H, Kühn S, Lautenbach A, Magnussen C, Mohr N, Twerenbold R, Schäfer I, Waschki B, Zyriax BC, Augustin J. Spatial characteristics of non-communicable diseases and their associations to social conditions in a large urban cohort in Germany-Results from the Hamburg City Health Study. PLoS One 2024; 19:e0301475. [PMID: 38593150 PMCID: PMC11003678 DOI: 10.1371/journal.pone.0301475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city. METHODS This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values. RESULTS The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01). CONCLUSIONS The study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.
Collapse
Affiliation(s)
- Valerie Andrees
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ramona Bei der Kellen
- Epidemiological Study Center, Hamburg City Health Study, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Anne Lautenbach
- Department Endocrinology, Diabetology, Obesity and Lipids, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Magnussen
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg, Kiel, Luebeck, Germany
| | - Nicole Mohr
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Raphael Twerenbold
- Epidemiological Study Center, Hamburg City Health Study, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ines Schäfer
- Epidemiological Study Center, Hamburg City Health Study, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Benjamin Waschki
- Department of Pneumology, Hospital Itzehoe, Itzehoe, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science – Health Service Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jobst Augustin
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
2
|
Weber S, Mascherek A, Augustin J, Cheng B, Thomalla G, Hoven H, Harth V, Augustin M, Gallinat J, Kühn S. My home-my castle? Self-reported anxiety varies in relation to the subjective evaluation of home environment. Front Psychol 2024; 14:1267900. [PMID: 38268813 PMCID: PMC10806144 DOI: 10.3389/fpsyg.2023.1267900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Although people spend most of the day in their home environment, the focus of research in environmental psychology to date has been on factors outside the home. However, it stands to reason that indoor quality likewise has an impact on psychological well-being. Therefore, the present study addresses the question of whether the subjective evaluation of home environmental parameters are related to self-reported anxiety and whether they can additionally explain variance beyond the usual sociodemographic and general lifestyle variables. Methods Data from the Hamburg City Health Study (first 10,000 participants) was analyzed. A subsample of N = 8,886 with available GAD-7 anxiety data was selected, and hierarchical regression models were computed, with demographic data entered first, followed by variables concerning lifestyle/habits and finally variables of the subjective evaluation of home environment. Results Using the integrated model, we were able to explain about 13% of the variance in self-reported anxiety scores. This included both the demographic, lifestyle, and subjective evaluation of home environment variables. Protection from disturbing night lights, a greater sense of security, less disturbing noises, brighter accommodations, and a satisfactory window view explained almost 6% of the variance and was significantly associated with lower anxiety scores. Conclusion The home as a place of refuge plays an increasingly important role as home office hours rise. It is therefore crucial to identify domestic factors contributing to people's mental well-being. The subjective evaluation of one's home environment has proven influential over and above modifiable lifestyle variables.
Collapse
Affiliation(s)
- Sandra Weber
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Mascherek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jobst Augustin
- Institute of Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Augustin
- Institute of Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| |
Collapse
|
3
|
Hoven H, Backhaus I, Gerő K, Kawachi I. Characteristics of employment history and self-perceived barriers to healthcare access. Eur J Public Health 2023; 33:1080-1087. [PMID: 37857366 PMCID: PMC10710348 DOI: 10.1093/eurpub/ckad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators. METHODS We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics. RESULTS Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators. CONCLUSION Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.
Collapse
Affiliation(s)
- Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Insa Backhaus
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Krisztina Gerő
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
4
|
Reißmann DR, Lamprecht R, Koch-Gromus U, Borof K, Kofahl C, Härter M, Büschel J, Harth V, Hoven H, Kahl-Nieke B, Beikler T, Heydecke G, Aarabi G. [Association of oral health literacy and behaviour with physical oral health. What role can dental education play?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1320-1327. [PMID: 37947842 PMCID: PMC10667136 DOI: 10.1007/s00103-023-03793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Oral health is an essential component of a person's general health and well-being. It is influenced by many factors. These include individual aspects such as oral health literacy and oral health behaviour. The aim of this study was to investigate the association between oral health literacy and behaviour with physical oral health. METHODS In this population-based cross-sectional study, data of 5510 subjects enrolled in the Hamburg City Health Study (HCHS) from 2016 to 2018 with a mean age of 62.1 years and 50.7% women were evaluated. Physical oral health was assessed using the 14-item Physical Oral Health Index (PhOX). A newly developed 10-item questionnaire based on the Oral Health Literacy Adult Questionnaire and the 5th German Oral Health Study were used to determine oral health literacy and behaviour. RESULTS The sum score of the 10 questions related to oral health literacy and behaviour significantly correlated with the PhOX sum score (r = 0.23; p < 0.001). An increase of one point in the total score of oral health literacy and behaviour was associated with an increase in the PhOX sum score of 1.45 points on average. This association decreased only marginally after integrating potential confounders such as age and education. CONCLUSION Higher oral health literacy and better oral health behaviour are associated with better physical oral health. Oral health literacy and behaviour should be important targets in dental education to efficiently and sustainably improve the oral health of the general population.
Collapse
Affiliation(s)
- Daniel R Reißmann
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Klinik für Zahnärztliche Prothetik, Department für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Poliklinik für Zahnärztliche Prothetik und Werkstoffkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Ragna Lamprecht
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Uwe Koch-Gromus
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Katrin Borof
- Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Christopher Kofahl
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Julie Büschel
- Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Volker Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hanno Hoven
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bärbel Kahl-Nieke
- Poliklinik für Kieferorthopädie, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Beikler
- Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Guido Heydecke
- Poliklinik für Zahnärztliche Prothetik, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ghazal Aarabi
- Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| |
Collapse
|
5
|
Shi Y, Strobl R, Apfelbacher C, Bahmer T, Geisler R, Heuschmann P, Horn A, Hoven H, Keil T, Krawczak M, Krist L, Lemhöfer C, Lieb W, Lorenz-Depiereux B, Mikolajczyk R, Montellano FA, Reese JP, Schreiber S, Skoetz N, Störk S, Vehreschild JJ, Witzenrath M, Grill E. Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort. Infection 2023; 51:1679-1694. [PMID: 37231313 PMCID: PMC10212223 DOI: 10.1007/s15010-023-02043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. METHODS COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. RESULTS Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection. CONCLUSION In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.
Collapse
Affiliation(s)
- Yanyan Shi
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
| | - Peter Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Anna Horn
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, University Hospital Jena, Jena, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Lorenz-Depiereux
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Centre for Mental Health, Site Jena-Magdeburg-Halle, Halle, Germany
| | - Felipe A Montellano
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn‑Cologne, Cologne, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.
| |
Collapse
|
6
|
Kopasker D, Katikireddi SV, Santos JV, Richiardi M, Bronka P, Rostila M, Cecchini M, Ali S, Emmert-Fees K, Bambra C, Hoven H, Backhaus I, Balaj M, Eikemo TA. Microsimulation as a flexible tool to evaluate policies and their impact on socioeconomic inequalities in health. Lancet Reg Health Eur 2023; 34:100758. [PMID: 37876527 PMCID: PMC10590730 DOI: 10.1016/j.lanepe.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | | | - João Vasco Santos
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Portugal
- MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Matteo Richiardi
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Patryk Bronka
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Sweden
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, Canada
- Department of Health Sciences, University of York, UK
- WHO Collaborating Centre for Knowledge Translation and HTA in Health Equity, Canada
| | - Karl Emmert-Fees
- School of Medicine and Health, Technical University of Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Germany
| | - Clare Bambra
- Population Health Sciences Institute, University of Newcastle, UK
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Insa Backhaus
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| |
Collapse
|
7
|
Backhaus I, Hoven H, Kawachi I. Far-right political ideology and COVID-19 vaccine hesitancy: Multilevel analysis of 21 European countries. Soc Sci Med 2023; 335:116227. [PMID: 37722145 DOI: 10.1016/j.socscimed.2023.116227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Far-right political parties across the EU have downplayed the risk of COVID-19 and have expressed skepticism toward the safety of the COVID-19 vaccine. This may affect the risk perception of people who support far-right parties and may be associated with an elevated risk of vaccine hesitancy. We aimed to explore if voting far-right is associated with COVID-19 vaccine hesitancy and if the association varies by individual and country-level factors. METHODS We used cross-sectional data from 28,057 individuals nested in 21 countries who participated in the tenth round of the European Social Survey (ESS). COVID-19 vaccine hesitancy was assessed by asking respondents whether they will get vaccinated against COVID-19. Voting behavior was measured by asking respondents which party they voted for in the last election. To test the association between far-right voting and COVID-19 hesitancy, we applied a series of multilevel regression models. We additionally ran models including interaction terms to test if the association differs by sociodemographic characteristics (e.g., institutional trust) or contextual factors (e.g., income inequality). RESULTS We found that far-right voters were 2.7 times more likely to be COVID-19 vaccine hesitant compared to center voters (PR: 2.69, 95% CI: 1.46-4.94). The association persisted even after controlling for institutional trust and social participation (adjusted PR: 2.15, 95% CI: 1.35-3.42). None of the tested interaction terms were significant suggesting that the association between political ideology and COVID-19 vaccine hesitancy does not differ by sociodemographic characteristics or contextual factors. CONCLUSION Voting for far-right parties is associated with COVID-19 vaccine hesitancy. The association is similar among European countries, regardless of how stringent the public health measures were and magnitude of income inequality in each country. Our findings call for a more in-depth investigation of why, how and under which conditions political ideology affects vaccination behavior.
Collapse
Affiliation(s)
- Insa Backhaus
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Hanno Hoven
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ichiro Kawachi
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Backhaus I, Hoven H, Bambra C, Oksanen T, Rigó M, di Tecco C, Iavicoli S, Dragano N. Changes in work-related stressors before and during the COVID-19 pandemic: differences by gender and parental status. Int Arch Occup Environ Health 2023; 96:421-431. [PMID: 36367561 PMCID: PMC9651091 DOI: 10.1007/s00420-022-01933-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The COVID-19 pandemic changed people's working conditions worldwide and research suggests increases in work stressors. However, it is not known to what extent these changes differ by gender or parental status. In the present study, we investigate trends in work stressors and whether these differ by gender and parental status. METHODS We used cross-sectional time series data of the European Working Conditions Survey of 2015 and Living, Working and COVID-19 survey of spring 2020 to examine trends in work stressors by gender and parental status. Work stressors were working in leisure time, lack of psychological detachment and work-life conflict. We applied three-way multilevel regressions reporting prevalence ratios and reported predicted probabilities and average marginal effects to show trends and differences in changes in work stressors. RESULTS Our multilevel regression results showed elevated prevalence ratios during the pandemic for working leisure time (PR: 1.43, 95% CI 1.34-1.53), psychological detachment (PR: 1.70, 95% CI 1.45-1.99) and work-life conflict (PR: 1.29, 95% CI 1.17-1.43) compared to before the pandemic. Except for working in leisure time, the increase was more significant among women and mothers. The proportion of work-life conflict in 2020 was 20.7% (95% CI 18.7-22.9) for men and 25.8% (95% CI 24.0-27.6) for women, equalling a difference of 5.1% (p < 0.001). CONCLUSIONS There is evidence that work stressors increased disproportionately for women and mothers. This needs to be monitored and addressed to prevent widening gender inequalities in the quality of work.
Collapse
Affiliation(s)
- Insa Backhaus
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mariann Rigó
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Cristina di Tecco
- Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Rome, Italy
| | - Sergio Iavicoli
- Directorate for Communication and International Affairs, Ministry of Health, Rome, Italy
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
| |
Collapse
|
9
|
Hoven H, Dragano N, Angerer P, Apfelbacher C, Backhaus I, Hoffmann B, Icks A, Wilm S, Fangerau H, Söhner F. Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning. Int J Public Health 2022; 67:1604542. [PMID: 35450128 PMCID: PMC9017774 DOI: 10.3389/ijph.2022.1604542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Since the WHO's "Influenza Pandemic Preparedness Plan" in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning-factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.
Collapse
Affiliation(s)
- Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational and Social Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Insa Backhaus
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Hoffmann
- Institute of Occupational and Social Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Heiner Fangerau
- Department of the History, Philosophy, and Ethics of Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felicitas Söhner
- Department of the History, Philosophy, and Ethics of Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
10
|
Abstract
OBJECTIVES Worldwide, the COVID-19 pandemic triggered the sharpest economic downturn since the Great Recession. To prepare for future crises and to preserve public health, we conduct an overview of systematic reviews to examine the evidence on the effect of the Great Recession on population health. METHODS We searched PubMed and Scopus for systematic reviews and/or meta-analyses focusing specifically on the impact of the Great Recession on population health (eg, mental health). Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed throughout this review and critical appraisal of included systematic reviews was performed using Assessing the Methodological Quality of Systematic Reviews. RESULTS Twenty-one studies were identified and consistently showed that the Great Recession was most risky to health, the more a country's economy was affected and the longer strict austerity policies were in place. Consequently, a deterioration of health was highest in countries that had implemented strict austerity measures (eg, Greece), but not in countries that rejected austerity measures (eg, Germany). Moreover, the impact of the Great Recession fell disproportionately on the most vulnerable groups such as people in unemployment, at risk of unemployment and those living in poverty. CONCLUSIONS The experiences of the last economic crisis show that it is possible to limit the consequences for health. Prioritising mental healthcare and prevention, foregoing austerity measures in the healthcare system and protecting vulnerable groups are the most important lessons learnt. Moreover, given the further aggravating social inequalities, a health in all policies approach, based on a comprehensive Health Impact Assessment, is advised.
Collapse
Affiliation(s)
- Insa Backhaus
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Cristina Di Tecco
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Sergio Iavicoli
- Directorate for Communication and International Affairs, Ministry of Health, Rome, Italy
| | - Arne Conte
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
11
|
Persson RM, Tellnes K, Hoven H, Haaverstad R, Svendsen ØS. Harlequin syndrome associated with thoracic epidural anaesthesia. Anaesth Rep 2022; 10:ANR312144. [PMID: 35118419 PMCID: PMC8790003 DOI: 10.1002/anr3.12144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- R. M. Persson
- Department of RadiologyHaukeland University HospitalBergenNorway
| | - K. Tellnes
- Department of RadiologyHaukeland University HospitalBergenNorway
| | - H. Hoven
- Department of RadiologyHaukeland University HospitalBergenNorway
| | - R. Haaverstad
- Section of Cardiothoracic SurgeryDepartment for Heart DiseaseHaukeland University HospitalBergenNorway
| | - Ø. S. Svendsen
- Department of Anesthesia and Intensive CareHaukeland University HospitalBergenNorway
| |
Collapse
|
12
|
Hoven H, Wahrendorf M, Goldberg M, Zins M, Siegrist J. Adverse employment histories, work stress and self-reported depression in the French CONSTANCES study. Eur J Public Health 2021; 31:1230-1236. [PMID: 34643687 PMCID: PMC8995100 DOI: 10.1093/eurpub/ckab181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Job instability and disadvantaged work were shown to be associated with poor mental health, but few studies analyzed these conditions in a life course perspective. In this study, adverse employment histories are retrospectively assessed and linked to self-reported depression. Furthermore, indirect effects of later stressful psychosocial work in terms of effort-reward imbalance are investigated. METHODS With data from the French CONSTANCES cohort study of 13 716 male and 12 767 female employees aged 45 and older, we identify adverse employment histories between age 25 and 45, focussing on job discontinuity, job instability and cumulative disadvantage. Direct effects of these conditions on self-reported depression over a period of up to 5 years are analyzed, using discrete-time logistic regression. Indirect effects of stressful work at baseline are examined. RESULTS Moderately elevated odds ratios of self-reported depression are observed among participants with discontinued employment histories (number of unemployment periods; years out of work for men). Effort-reward imbalance at work is consistently related to elevated risk of self-reported depression and explains parts of the association between discontinuous employment and depression. CONCLUSIONS Applying a life course perspective to occupational health research extends current knowledge. Specifically, adverse employment histories in terms of recurrent job discontinuity are related to the risk of self-reported depression. This association is partly explained by exposure to a stressful psychosocial work environment. These results can instruct labour market policies and the development of targeted worksite interventions that address disadvantage throughout entire employment trajectories.
Collapse
Affiliation(s)
- Hanno Hoven
- Centre for Health and Society, Medical Faculty, Institute of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany
| | - Morten Wahrendorf
- Centre for Health and Society, Medical Faculty, Institute of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France.,Université de Paris, France
| | - Marie Zins
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France.,Université de Paris, France
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
13
|
Wahrendorf M, Chandola T, Goldberg M, Zins M, Hoven H, Siegrist J. Adverse employment histories and allostatic load: associations over the working life. J Epidemiol Community Health 2021; 76:374-381. [PMID: 34625518 PMCID: PMC8921582 DOI: 10.1136/jech-2021-217607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022]
Abstract
Background Most studies on the health impact of occupational stress use single-point measures of stress at work. This study analyses the associations of properties of entire employment trajectories over an extended time period with a composite score of allostatic load (AL). Methods Data come from the French CONSTANCES cohort, with information on adverse employment histories between ages 25 and 45 and a composite score of AL (based on 10 biomarkers, range 0–10) among people aged 45 or older (47 680 women and 45 035 men). Data were collected by questionnaires (including retrospective employment histories) or by health examinations (including blood-based biomarkers). We distinguish six career characteristics: number of temporary jobs, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion. Results For both men and women, results of negative binomial regressions indicate that adverse employment histories are related to higher levels of AL, particularly histories that are characterised by a continued disadvantaged occupational position, repeated periods of unemployment or years out of work. Findings are adjusted for partnership, age and education, and respondents with a health-related career interruption or early retirement are excluded. Conclusions Our study highlights physiological responses as a mechanism through which chronic stress during working life is linked to poor health and calls for intervention efforts among more disadvantaged groups at early stages of labour market participation.
Collapse
Affiliation(s)
- Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Heinrich-Heine-University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Tarani Chandola
- Department of Social Statistics, University of Manchester, Manchester, UK
| | - Marcel Goldberg
- Population-Based Epidemiologic Cohorts Unit, INSERM, UMS 011, Villejuif, France.,Faculté de Médecine, Paris University, Paris, France
| | - Marie Zins
- Population-Based Epidemiologic Cohorts Unit, INSERM, UMS 011, Villejuif, France.,Faculté de Médecine, Paris University, Paris, France
| | - Hanno Hoven
- Centre for Health and Society, Institute of Medical Sociology, Heinrich-Heine-University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Johannes Siegrist
- Senior Professorship Work Stress Research, Heinrich-Heine-University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| |
Collapse
|
14
|
Wahrendorf M, Hoven H, Deindl C, Lunau T, Zaninotto P. Adverse Employment Histories, Later Health Functioning and National Labor Market Policies: European Findings Based on Life-History Data From SHARE and ELSA. J Gerontol B Psychol Sci Soc Sci 2021; 76:S27-S40. [PMID: 32322883 DOI: 10.1093/geronb/gbaa049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We investigate associations between adverse employment histories over an extended time period and health functioning in later life, and explore whether national labor market policies moderate the association. METHODS We use harmonized life-history data from the Gateway to Global Aging Data on two European studies (SHARE and ELSA) linked to health beyond age 50 (men = 11,621; women = 10,999). Adverse employment histories consist of precarious, discontinued, and disadvantaged careers between age 25 and 50, and we use depressive symptoms, grip strength, and verbal memory as outcomes. RESULTS Adverse employment histories between age 25 and 50 are associated with poor health functioning later in life, particularly repeated periods of unemployment, involuntary job losses, weak labor market ties, and disadvantaged occupational positions. Associations remain consistent after adjusting for age, partnership history, education and employment situation, and after excluding those with poor health prior to or during working life. We find no variations of the associations by national labor market policies. DISCUSSION Our study calls for increased intervention efforts to improve working conditions at early career stages. Despite the importance in shaping employment histories, the role of national policies in modifying the impact of employment on health is less clear.
Collapse
Affiliation(s)
- Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Medical Faculty, Germany
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Medical Faculty, Germany
| | - Christian Deindl
- Institute of Medical Sociology, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Medical Faculty, Germany
| | - Thorsten Lunau
- Institute of Medical Sociology, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Medical Faculty, Germany
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, UK
| |
Collapse
|
15
|
Hoven H, Wahrendorf M, Goldberg M, Zins M, Siegrist J. Cumulative disadvantage during employment careers - The link between employment histories and stressful working conditions. Adv Life Course Res 2020; 46:100358. [PMID: 36721343 DOI: 10.1016/j.alcr.2020.100358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/06/2020] [Accepted: 06/24/2020] [Indexed: 06/18/2023]
Abstract
Accumulated evidence on health-adverse effects of stressful psychosocial and physical work environments is considered a major breakthrough in recent social epidemiological research. However, research on adverse health effects of repeated exposure over time is lacking. In this contribution we analyse associations of characteristics of adverse employment histories with stressful psychosocial and physical current working conditions. We use data from the French CONSTANCES study and restrict the sample to employed men and women aged 45-60 (n = 23652). Current working conditions are assessed by effort-reward imbalance as well as stressful physical working tasks and positions. Previous employment histories (between age 25 and 45) are retrospectively assessed and measured by indicators of precarious, discontinuous and disadvantaged working careers. We found consistent associations of precarious, discontinuous or disadvantaged careers with strenuous physical working conditions and with low occupational rewards. However, low effort rather than high effort was associated with adverse employment histories. Therefore, associations with the effort-reward ratio turned out to be inconsistent. By extending the scope of analysis beyond single time-point measures, we identified three types of adverse employment histories among employees between age 25 and 45 in a stress-theoretical framework, and we demonstrated their associations with employees' current adversity at work between the age of 45-60.
Collapse
Affiliation(s)
- Hanno Hoven
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany.
| | - Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France; Paris Descartes University, France
| | - Marie Zins
- INSERM, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France; Paris Descartes University, France
| | | |
Collapse
|
16
|
Hoven H, Dragano N, Lunau T, Deindl C, Wahrendorf M. The role of pension contributions in explaining inequalities in depressive symptoms. Results from SHARE. Scand J Public Health 2020; 49:581-588. [PMID: 32103706 PMCID: PMC8512261 DOI: 10.1177/1403494820909011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aims: Research has established solid evidence that
socioeconomic position impacts health. It is, however, still debated to what
extent characteristics of entire employment histories are associated with health
inequalities later on. This study investigates associations between contributing
to pension schemes throughout entire employment histories and depressive
symptoms in older men and women. Methods: We use
retrospective life history data from the Survey of Health, Ageing and Retirement
in Europe (SHARE), collected in 2008–2009 from retired men and women. Data
include detailed information on previous employment histories (between age 25
and 60 years) that allows us to measure labour market involvements and pension
contributions during past working lives. In addition, we measure elevated
depressive symptoms using EURO-D. Results: We
observe that employed work without contributing to pension schemes is associated
with elevated depressive symptoms for women, even when taking the current
household income into consideration. For men (but not for women), self-employed
work without pension contributions is linked to elevated depressive symptoms.
Conclusions: Our results indicate that studies
linking previous employment participation to health after labour market exit
should not only consider whether a person worked, but also whether he or she
contributed to a pension scheme. In addition, our study points to
interesting gender differences, where pension contributions matter most for
women in employed work and for men in self-employed work.
Collapse
Affiliation(s)
- Hanno Hoven
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Nico Dragano
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Thorsten Lunau
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Christian Deindl
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| |
Collapse
|
17
|
Hoven H, Wahrendorf M, Siegrist J. Cumulative Disadvantage during Employment Careers – the Link between Employment Histories and Stressful Working Conditions. ACTA ACUST UNITED AC 2019. [DOI: 10.1055/s-0039-1694430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H Hoven
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - M Wahrendorf
- Institut für Medizinische SoziologieUniversitätsklinikum – Centre for Health and Society (CHS) Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - J Siegrist
- Medizinische Fakultät, Life-Science Center, Universität Düsseldorf, Düsseldorf
| |
Collapse
|
18
|
Wahrendorf M, Zaninotto P, Hoven H, Head J, Carr E. Late Life Employment Histories and Their Association With Work and Family Formation During Adulthood: A Sequence Analysis Based on ELSA. J Gerontol B Psychol Sci Soc Sci 2019; 73:1263-1277. [PMID: 28575487 PMCID: PMC6146763 DOI: 10.1093/geronb/gbx066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/05/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives To extend research on workforce participation beyond age 50 by describing entire employment histories in later life and testing their links to prior life course conditions. Methods We use data from the English Longitudinal Study of Ageing, with retrospective information on employment histories between age 50 and 70 for 1,103 men and 1,195 women (n = 2,298). We apply sequence analysis and group respondents into eight clusters with similar histories. Using multinomial regressions, we then test their links to labor market participation, partnership, and parenthood histories during early (age 20–34) and mid-adulthood (age 35–49). Results Three clusters include histories dominated by full-time employees but with varying age of retirement (before, at, and after age 60). One cluster is dominated by self-employment with comparatively later retirement. Remaining clusters include part-time work (retirement around age 60 or no retirement), continuous domestic work (mostly women), or other forms of nonemployment. Those who had strong attachments to the labor market during adulthood are more likely to have histories of full-time work up until and beyond age 60, especially men. Parenthood in early adulthood is related to later retirement (for men only). Continued domestic work was not linked to parenthood. Partnered women tend to work part-time or do domestic work. The findings remain consistent after adjusting for birth cohort, childhood adversity, life course health, and occupational position. Discussion Policies aimed at increasing the proportion of older workers not only need to address later stages of the life course but also early and mid-adulthood.
Collapse
Affiliation(s)
- Morten Wahrendorf
- Centre for Health and Society, Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, UK
| | - Hanno Hoven
- Centre for Health and Society, Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Germany
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, UK
| | - Ewan Carr
- Department of Epidemiology and Public Health, University College London, UK
| |
Collapse
|
19
|
Hoven H, Siegrist J, Goldberg M, Ribet C, Zins M, Wahrendorf M. Intragenerational social mobility and depressive symptoms. Results from the French CONSTANCES cohort study. SSM Popul Health 2019; 7:100351. [PMID: 30705934 PMCID: PMC6349560 DOI: 10.1016/j.ssmph.2019.100351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To further explain the association between low socioeconomic position and increased risk of poor health, research started to consider life course conditions, including previous occupational positions and patterns of social mobility in the analysis. We describe patterns of intragenerational social mobility and investigate their associations with depressive symptoms. METHODS We use data from the French CONSTANCES study, a population-based cohort and restrict the sample to people aged 45 to 60. Based on detailed retrospective data with annual information on respondents' occupational position, we assess the modal social class for two time periods - early adulthood (age 25-34) and mid-adulthood (age 35-44). Depressive symptoms are measured by the Centre for Epidemiologic Studies Depression Scale (CES-D), using sex-specific cut-points. RESULTS Our study reveals that most respondents remained in stable working careers, but these careers were less frequent amongst participants with lower socioeconomic positions compared with higher ones. In contrast to several earlier findings we observe no independent associations of intragenerational social mobility processes and health once the social positions of origin and destination are considered. However, our findings confirm a social gradient in the prevalence of depressive symptoms for stable working careers. CONCLUSIONS Our findings underline the importance of integrating data into analysis on starting and ending points of social mobility processes within entire histories of labor market participation.
Collapse
Affiliation(s)
- Hanno Hoven
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Johannes Siegrist
- Senior professorship on work stress research, Medical Faculty, University of Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Paris Descartes University, France
| | - Céline Ribet
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Paris Descartes University, France
| | - Marie Zins
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Paris Descartes University, France
| | - Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| |
Collapse
|
20
|
Abstract
BACKGROUND With changing employment histories in European labour markets, occupational health research needs to be supplemented by an approach that integrates adverse characteristics of entire employment histories, in terms of precarious, discontinued and disadvantaged employment careers. We analyse associations of adverse employment histories and six measures of health functioning, including affective, physical and cognitive functioning. METHODS We use baseline data from the CONSTANCES study with detailed retrospective data on previous employment histories that are linked to current health functioning among people aged 45-60 years (men = 15 134; women = 16 584). The following career characteristics are assessed (all referring to careers between ages 25 and 45 years): number of jobs with temporary contracts, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion. The measures of health functioning range from depressive symptoms, standing balance, walking speed, lung function, to verbal memory and semantic fluency. RESULTS For both men and women, multilevel regressions (participant nested in health-examination centre) revealed that adverse employment histories are associated with poor health functioning later on, in particular persistent disadvantage in terms of low occupational position, repeated periods of unemployment and weak labour-market ties (years out of work). Findings remain consistent after excluding respondents who had a health-related career interruption or already retired before age 45 years and, additionally, after adjusting for age, partnership and education. CONCLUSION Findings call for increased intervention efforts among more disadvantaged groups of the labour market at early-career stages.
Collapse
Affiliation(s)
- Morten Wahrendorf
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Hanno Hoven
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Paris Descartes University, Paris, France
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
21
|
Siegrist J, Wahrendorf M, Goldberg M, Zins M, Hoven H. Is effort-reward imbalance at work associated with different domains of health functioning? Baseline results from the French CONSTANCES study. Int Arch Occup Environ Health 2018; 92:467-480. [PMID: 30406331 DOI: 10.1007/s00420-018-1374-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/28/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite its importance a comprehensive assessment of health functioning has rarely been included in epidemiological investigations of work-related health outcomes. In this study, we analyzed associations of a health-adverse psychosocial work environment with a comprehensive set of subjective and objective measures of health functioning that cover the three domains of affective, cognitive, and physical functioning. METHODS Baseline data from the French CONSTANCES cohort study were used with a sample of 24,327 employed men and women aged 45-60. Psychosocial work environment was measured by the short version of the effort-reward imbalance (ERI) questionnaire. Measures of health functioning were depressive symptoms, semantic fluency, verbal memory, walking speed, standing balance and lung function. RESULTS First, we replicated main psychometric properties of the ERI questionnaire in the French cohort. Second, ERI scales revealed consistent associations with depressive symptoms, but less consistent links to cognitive and physical function. Among men, we observed an association of stressful work with reduced lung function. CONCLUSIONS This study demonstrated consistent associations of stressful work in terms of effort-reward imbalance with affective functioning in a large sample of male and female employees. Relationships with physical functioning were less consistent and restricted to men, and cognitive functioning was only marginally associated with stressful work. We also established the psychometric properties of the French short version of the ERI questionnaire, thus offering a tool for guiding and harmonizing further research in this field.
Collapse
Affiliation(s)
- Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
| |
Collapse
|
22
|
Götz S, Hoven H, Müller A, Dragano N, Wahrendorf M. Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel. Int Arch Occup Environ Health 2018; 91:479-496. [PMID: 29487994 PMCID: PMC5908813 DOI: 10.1007/s00420-018-1298-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
Abstract
Purpose We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age. Methods We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components (“high effort” and “low reward”). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress. Results Each of the three indicators of stressful work is related to higher number of sickness days, with except of “high effort” in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance. Conclusion Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers. Electronic supplementary material The online version of this article (10.1007/s00420-018-1298-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Simon Götz
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitaetsstrasse 1, 40225, Duesseldorf, Germany.
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitaetsstrasse 1, 40225, Duesseldorf, Germany
| | - Andreas Müller
- Institute of Psychology, Work and Organizational Psychology, University of Duisburg-Essen, Universitätsstrasse 2, 45141, Essen, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitaetsstrasse 1, 40225, Duesseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitaetsstrasse 1, 40225, Duesseldorf, Germany
| |
Collapse
|
23
|
Hoven H, Dragano N, Wahrendorf M. Kritische Erwerbsbiografien und psychische Gesundheit nach dem Arbeitsmarktaustritt – Ergebnisse aus SHARE. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H Hoven
- Universität Düsseldorf, Medizinische Fakultät, Centre for Health and Society, Institut für Medizinische Soziologie, Düsseldorf
| | - N Dragano
- Universität Düsseldorf, Medizinische Fakultät, Centre for Health and Society, Institut für Medizinische Soziologie, Düsseldorf
| | - M Wahrendorf
- Universität Düsseldorf, Medizinische Fakultät, Centre for Health and Society, Institut für Medizinische Soziologie, Düsseldorf
| |
Collapse
|
24
|
Hoven H, Ford R, Willmot A, Hagan S, Siegrist J. Job Coaching and Success in Gaining and Sustaining Employment Among Homeless People. Res Soc Work Pract 2016; 26:668-674. [PMID: 27630516 PMCID: PMC5019281 DOI: 10.1177/1049731514562285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE People who are homeless experience many barriers that affect their ability to gain and sustain work. In this study, we investigate whether personal job coaching support contributes toward employment success. METHODS The short- and long-term employment outcomes of 2,480 clients participating in a labor market program were analyzed. RESULTS Clients being supported by a job coach have significantly higher chances of gaining employment than those not being supported. This holds particularly true for the youngest age-group. Furthermore, results also indicate that job coaching improves clients' chances of successfully sustaining employment. CONCLUSIONS Personal approaches and individual coaching seem to be promising strategies in social work practice and specifically in return to work programs for people who have experienced homelessness.
Collapse
Affiliation(s)
- Hanno Hoven
- Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
- Centre for Health and Society, Institute for Medical Sociology, University of Düsseldorf, Düsseldorf, Germany
| | | | | | | | | |
Collapse
|
25
|
Hoven H, Wahrendorf M, Siegrist J. Occupational position, work stress and depressive symptoms: a pathway analysis of longitudinal SHARE data. J Epidemiol Community Health 2015; 69:447-52. [PMID: 25648992 PMCID: PMC4413688 DOI: 10.1136/jech-2014-205206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
Abstract
Background Several studies tested whether stressful work mediates the association between socioeconomic position (SEP) and health. Although providing moderate support, evidence is still inconclusive, partly due to a lack of theory-based measures of SEP and work stress, and because of methodological limitations. This contribution aims at overcoming these limitations. Methods We conduct pathway analysis and investigate indirect effects of SEP on mental health via stressful work. Data are derived from the first two waves of the ‘Survey of Health, Ageing and Retirement in Europe’ (SHARE) with information from employed men and women aged 50–64 across 11 European countries (N=2798). SEP is measured according to two alternative measures of occupational position: occupational class (focus on employment relations) and occupational status (focus on prestige). We assess work stress according to the effort-reward imbalance and the demand-control model (wave 1), and we use newly occurring depressive symptoms as health outcome (wave 2). Results Effort-reward imbalance and, less consistently, low control mediate the effect of occupational class and occupational status on depressive symptoms. Conclusions Our findings point to two important aspects of work stress (effort-reward imbalance and low control) in explaining socioeconomic differences in health. Further, we illustrate the significance of two alternative dimensions of occupational position, occupational class and occupational status.
Collapse
Affiliation(s)
- H Hoven
- Faculty of Medicine, Senior Professorship on Work Stress Research, University of Duesseldorf, Duesseldorf, Germany Centre for Health and Society, Institute for Medical Sociology, University of Duesseldorf, Duesseldorf, Germany
| | - M Wahrendorf
- Centre for Health and Society, Institute for Medical Sociology, University of Duesseldorf, Duesseldorf, Germany
| | - J Siegrist
- Faculty of Medicine, Senior Professorship on Work Stress Research, University of Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
26
|
Montano D, Hoven H, Siegrist J. A meta-analysis of health effects of randomized controlled worksite interventions: does social stratification matter? Scand J Work Environ Health 2014; 40:230-4. [PMID: 24788850 DOI: 10.5271/sjweh.3412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of this review was to assess what types of socioeconomic positions (SEP) are being considered in randomized controlled intervention studies and estimate the moderation of SEP in workplace intervention effects on body mass index (BMI), fruit and vegetable consumption, musculoskeletal symptoms, and job stress. METHODS A meta-analysis of randomized controlled workplace interventions was undertaken. Studies were classified by participants' SEP. The overall standardized mean difference (SMD) for each outcome was estimated with random-effects models. Additionally, a random-effects model with SEP as moderating variable was calculated in order to assess intervention effect modification (EM). RESULTS This review covers 36 studies. Altogether 40 reports of intervention effects were considered. The overall mean differences in the models, without SEP as moderating variable, were significant for all outcomes. BMI, self-reported musculoskeletal symptoms, and self-reported job stress decreased [SMD -0.16, 95% confidence interval (95% CI) -0.29- -0.02, SMD -0.32, 95% CI -0.51- -0.14, and SMD -0.37, 95% CI -0.71- -0.04, respectively], whereas daily consumption of fruit and vegetables increased (SMD 0.12, 95% CI 0.01-0.22). There were no statistically significant differences between occupational classes for the health outcomes considered (SMD -0.102, 95% CI -0.264-0.060, EM -0.141, 95% CI -0.406-0.125; SMD 0.117, 95% CI -0.049-0.282, EM 0.000, 95% CI -0.230-0.231; SMD -0.301, 95% CI -0.494- -0.107, EM -0.369, 95% CI -1.169-0.430; and SMD -0.200, 95% CI -0.524-0.124, EM -0.598, 95% CI -1.208-0.012, respectively). CONCLUSIONS Workplace interventions can achieve small positive effects on major health outcomes. We could not confirm whether these effects are moderated by occupational class.
Collapse
Affiliation(s)
- Diego Montano
- "Work Stress Research", Life-Science-Center, Faculty of Medicine, Düsseldorf University, Merowingerplatz 1a, D-40225 Düsseldorf, Germany.
| | | | | |
Collapse
|
27
|
Låftman SB, Modin B, Östberg V, Hoven H, Plenty S. Effort-reward imbalance in the school setting: associations with somatic pain and self-rated health. Scand J Public Health 2014; 43:123-9. [PMID: 25504584 DOI: 10.1177/1403494814561818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS According to the workplace theory of effort-reward imbalance (ERI), individuals who perceive a lack of reciprocity between their effort spent at work and the rewards received in turn are at an increased risk of stress-related ill-health. It is also assumed that being overcommitted to work is linked to an increased risk of stress-related ill-health. This study applies the effort-reward imbalance model to the school setting. It aims to analyse the associations that effort-reward imbalance and overcommitment share with somatic pain and self-rated health among adolescents. METHODS Data are from the School Stress and Support Study (TriSSS), involving students in grades 8 and 9 (ages 14-16 years) in two schools in Stockholm, Sweden, during 2010 (n=403). Information on effort-reward imbalance and health outcomes was gathered from self-report questionnaires. An adjusted short version of ERI was used. Factor analysis showed that extrinsic effort, reward and overcommitment constitute three distinct dimensions. The designed measures demonstrated sound psychometric properties both for the full sample and for subgroups. Ordered logistic regressions were conducted. RESULTS The analyses showed that low reward and higher overcommitment were associated with greater somatic pain and poorer self-rated health. Furthermore, effort-reward imbalance was linked with an elevated risk of somatic pain and poorer self-rated health. CONCLUSIONS Students are more likely to experience stress-related ill-health when they perceive an imbalance between their effort and rewards. In addition, high overcommitment is associated with an increased risk of ill-health among students.
Collapse
Affiliation(s)
- Sara Brolin Låftman
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Bitte Modin
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Viveca Östberg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Hanno Hoven
- Centre for Health and Society, Institute for Medical Sociology, University of Duesseldorf, Germany
| | - Stephanie Plenty
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| |
Collapse
|
28
|
Montano D, Hoven H, Siegrist J. Effects of organisational-level interventions at work on employees' health: a systematic review. BMC Public Health 2014; 14:135. [PMID: 24507447 PMCID: PMC3929163 DOI: 10.1186/1471-2458-14-135] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/06/2014] [Indexed: 11/21/2022] Open
Abstract
Background Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Methods Systematic review. Organisational-level workplace interventions aiming at improving employees’ health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. Results 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Conclusions Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.
Collapse
Affiliation(s)
- Diego Montano
- Senior Professorship "Work Stress Research", Faculty of Medicine, Duesseldorf University, Duesseldorf, Germany.
| | | | | |
Collapse
|
29
|
Hoven H, Montano D, Siegrist J. Social inequalities, working conditions, and health: evidence from cohort and intervention studies. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Hoven H, Siegrist J. Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies. Occup Environ Med 2013; 70:663-9. [PMID: 23739492 PMCID: PMC3756612 DOI: 10.1136/oemed-2012-101331] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.
Collapse
Affiliation(s)
- Hanno Hoven
- Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Life-Science Center, Düsseldorf, Germany
| | | |
Collapse
|