Health Beliefs in a Population: The Michigan Blood Pressure Survey

In a general population sample, we examined relationships between sociodemographic characteristics and health beliefs. Individual questionnaire measures for components of the health belief model were combined to form six scales. In analyses which adjusted for perceived levels of health, sociodemographic markers of social disadvantage (e.g., black race, or low socioeconomic status) appeared to associate with favorable health beliefs, that is, with health beliefs often associated with health promoting behaviors. Specifically, we found that blacks expressed greater concern about health. Women believed they tended to get sick more often and to suffer more severely from illness. Female and older respondents placed greater value on the kinds of services provided by members of the health professions. Female, black, older, and lower socioeconomic status respondents placed greater value on such healthful personal habits as exercise, alcohol avoidance, and proper diet. These results suggested that the poor health suffered by relatively disadvantaged members of society are not, in some manner, a consequence of funda mental beliefs about health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66619/2/10.1177_109019819001700202.pd

Alcohol and fatal life trajectories in Russia: understanding narrative accounts of premature male death in the family

Background: In the post-Soviet period, Russian working-age men have suffered unusually high mortality rates. Earlier quantitative work found that part of this is attributable to hazardous and harmful patterns of alcohol consumption, which increased in the period of transition at a time of massive social and economic disruption and uncertainty. However, there has been very little work done to document and understand in detail the downward life trajectories of individual men who died prematurely from alcohol-related conditions. Building on an earlier case-control study, this unique qualitative study investigates the perceived interplay between men's drinking careers, their employment and family history, health and eventual death.Methods: In-depth interviews were conducted with close relatives (most often the widow) of 19 men who died between 2003 and 2005 aged 25-54 years whose close relatives reported that alcohol contributed to their death. The study was conducted in a typical medium-sized Russian city. The relative's accounts were analysed using thematic content analysis.Results: The accounts describe how hazardous drinking both contributed to serious employment, family and health problems, and was simultaneously used as a coping mechanism to deal with life crises and a decline in social status. The interviews highlighted the importance of the workplace and employment status for shaping men's drinking patterns. Common themes emerged around a culture of drinking in the workplace, peer pressure from colleagues to drink, use of alcohol as remuneration, consuming non-beverage alcohols,Russian-specific drinking patterns, attitudes to treatment, and passive attitudes towards health and drinking.Conclusions: The study provides a unique insight into the personal decline that lies behind the extremely high working-age mortality due to heavy drinking in Russia, and highlights how health status and hazardous drinking are often closely intertwined with economic and social functioning. Descriptions of the development of drinking careers, hazardous drinking patterns and treatment experiences can be used to plan effective interventions relevant in the Russian context

Psychosocial primary care – what patients expect from their General Practitioners A cross-sectional trial

BACKGROUND: Psychosocial Primary Care (PPC) is a model of service delivery for patients with mental disorders and psychosocial problems which was established in Germany in 1987. This study was performed as part of the evaluation of a PPC training program. We investigated patients' expectations of the psychosocial treatment offered by GPs trained in PPC. METHODS: Ten general practitioners trained in PPC were randomly selected. Two hundred and twenty patients were surveyed in the waiting room regarding their expectations concerning psychological treatment. RESULTS: Eighty-five per cent of patients could envisage making use of psychosocial treatments. Counselling by the GP was considered most important (65%). Fifty-four per cent of patients indicated that there was sufficient counselling, but further distinctions revealed dissatisfaction with both the extent and content of the counselling. Lack of time was the most frequent reason (53%) cited for insufficient counselling. A willingness to discuss the psychological aspects of illness was exhibited by between 55% (current illness) and 79% of patients. Two-thirds of patients believed that discussing psychological aspects and counselling by the doctor could exert a healing effect or contribute to symptomatic improvement in physical illnesses. Younger patients and patients with experience in psychotherapy expected referral to mental health services. CONCLUSIONS: Primary care patients desire and accept psychological treatment from their GP. Training in psychosocial competence in primary care should be offered more frequently

The State Socialist Mortality Syndrome

Death rates for working-age men in European state socialist countries deviated from general improvements in survival observed in the rest of Europe during the 20th century. The magnitude of structural labor force changes across countries correlates with lagged increases in death rates for men in the working ages. This pattern is consistent with a hypothesis that hyper-development of heavy industry and stagnation (even contraction) of the service sector created anomic conditions leading to unhealthy lifestyles and self-destructive behavior among men moving from primary-sector to secondary-sector occupations. Occupational contrasts within countries similarly show concentration of rising male death rates among blue collar workers. Collapse of state socialist systems produced rapid corrections in labor force structure after 1990, again correlated with a fading of the state socialist mortality syndrome in following decades

Labor force participation in later life: Evidence from a cross-sectional study in Thailand

<p>Abstract</p> <p>Background</p> <p>The labor force participation rate is an important indicator of the state of the labor market and a major input into the economy's potential for creating goods and services. The objectives of this paper are to examine the prevalence of labor force participation among older people in Thailand and to investigate the factors affecting this participation.</p> <p>Methods</p> <p>The data for this study were drawn from the '2007 Survey of Older Persons' in Thailand. Bivariate analysis was used to identify the factors associated with labor force participation. The variables were further examined using multivariate analysis in order to identify the significant predictors of the likelihood of older people participating in the labor force, after controlling for other variables.</p> <p>Results</p> <p>Overall, 30,427 elderly people aged 60 or above were interviewed. More than a third (35%) of all respondents had participated in the labor force during the seven days preceding the survey. Respondents who were female (OR = 0.56), those who were older (OR = 0.47 for 70-79 and 0.21 for 80+ years), those who were widowed/divorced (OR = 0.85), those who were living with their children (OR = 0.69), those whose family income was relatively low, and those who worked in government sectors (OR = 0.33) were less likely to participate in the labor force than were their counterparts. On the other hand, those who lived in urban areas (OR = 1.2), those who had a low level of education (OR, secondary level 1.8, primary 2.4, and no schooling 2.5), those who were the head of the household (OR = 1.9), and those who were in debt (OR = 2.3) were more likely be involved in the labor force than their comparison groups. Furthermore, respondents who experienced greater difficulty in daily living, those who suffered from more chronic diseases, and those who assessed their health as poor were less likely to participate in the labor force than their counterparts.</p> <p>Conclusion</p> <p>Labor force participation in their advanced years is not uncommon among the Thai elderly. The results suggest that improving the health status of the elderly is necessary in order to encourage their employment. By doing so, the country can fulfill the labor shortage and further improve the economic condition of the nation. The results of this study also suggest that for policies encouraging employment among older persons to succeed, special focus on the rural elderly is necessary.</p

Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Russian society has faced dramatic changes in terms of social stratification since the collapse of the Soviet Union. During this time, extensive reforms have taken place in the organisation of health services, including the development of the private sector. Previous studies in Russia have shown a wide gap in mortality between socioeconomic groups. There are just a few studies on health service utilisation in post-Soviet Russia and data on inequality of health service use are limited. The aim of the present study was to analyse health (self-rated health and self-reported chronic diseases) and health care utilisation patterns by socioeconomic status (SES) among reproductive age women in St. Petersburg.</p> <p>Methods</p> <p>The questionnaire survey was conducted in 2004 (n = 1147), with a response rate of 67%. Education and income were used as dimensions of SES. The association between SES and health and use of health services was assessed by logistic regression, adjusting for age.</p> <p>Results</p> <p>As expected low SES was associated with poor self-rated health (education: OR = 1.48; personal income: OR = 1.42: family income: OR = 2.31). University education was associated with use of a wider range of outpatient medical services and increased use of the following examinations: Pap smear (age-adjusted OR = 2.06), gynaecological examinations (age-adjusted OR = 1.62) and mammography among older (more than 40 years) women (age-adjusted OR = 1.98). Personal income had similar correlations, but family income was related only to the use of mammography among older women.</p> <p>Conclusions</p> <p>Our study suggests a considerable inequality in health and utilisation of preventive health service among reproductive age women. Therefore, further studies are needed to identify barriers to health promotion resources.</p

Qualitative differences in psychiatric symptoms between high risk groups assessed on a screening test (GHQ-30)

Scores on five subscales derived from the GHQ-30 have been examined in various groups at risk for psychiatric disorder, to determine whether different patterns of symptoms are found. The subscales are based on a factor analysis of a population sample of over 6,000 adults (Huppert et al. 1989) which identified five robust factors corresponding to symptoms of anxiety, feelings of incompetence, depression, difficulty in coping and social dysfunction. Previous studies have identified certain groups of people who are vulnerable to mental illness and are therefore likely to obtain a high score on the GHQ. These include unemployed men, single women with dependent children, and elderly people in poor health. The results show marked differences in symptom patterns among these three at-risk groups. For example, while scores on anxiety and depression subscales were significantly raised in most at-risk groups, young unemployed men did not show significant anxiety whereas elderly men in poor health did not show significant depressive symptoms. However both these groups showed difficulty in coping, unlike older unemployed men or elderly women in poor health. Single women with dependent children reported the highest rate of psychiatric symptoms, particularly anxiety and depression, but had difficulty in coping only if they were also employed. These findings suggest that this method of analysing data from the GHQ-30 has potential value in yielding qualitative as well as quantitative information about psychiatric symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41738/1/127_2004_Article_BF00789216.pd

‘Fish out of water’: a cross-sectional study on the interaction between social and neighbourhood effects on weight management behaviours

Objective: To analyse whether an individual’s neighbourhood influences the uptake of weight management strategies and whether there is an interaction between individual socio-economic status and neighbourhood deprivation. Methodology: Data were collected from the Yorkshire Health Study (2010–2012) for 27 806 individuals on the use of the following weight management strategies: ‘slimming clubs’, ‘healthy eating’, ‘increasing exercise’ and ‘controlling portion size’. A multi-level logistic regression was fit to analyse the use of these strategies, controlling for age, sex, body mass index, education, neighbourhood deprivation and neighbourhood population turnover (a proxy for neighbourhood social capital). A cross-level interaction term was included for education and neighbourhood deprivation. Lower Super Output Area was used as the geographical scale for the areal unit of analysis. Results: Significant neighbourhood effects were observed for use of ‘slimming clubs’, ‘healthy eating’ and ‘increasing exercise’ as weight management strategies, independent of individual- and area-level covariates. A significant interaction between education and neighbourhood deprivation was observed across all strategies, suggesting that as an area becomes more deprived, individuals of the lowest education are more likely not to use any strategy compared with those of the highest education. Conclusions: Neighbourhoods modify/amplify individual disadvantage and social inequalities, with individuals of low education disproportionally affected by deprivation. It is important to include neighbourhood-based explanations in the development of community-based policy interventions to help tackle obesit