60 research outputs found
The creation of a smoking class: how prevention efforts can deepen social inequalities in health
"Die Verminderung sozialer Ungleichheit gehört in vielen LĂ€ndern zu den Kernzielen der Politik. Einzelne Elemente der Gesundheitspolitik können aber Folgen haben, die diesem allgemeinen Ziel entgegenwirken. Das zeigt das Beispiel der NichtraucherschutzPolitik. Das Rauchen wird sozial stigmatisiert, und den Rauchern, die in zunehmendem MaĂe aus den Ă€rmeren Schichten kommen, wird abweichendes Sozialverhalten vorgeworfen. Dies fĂŒhrt zu einer VerschĂ€rfung gesellschaftlicher Trennungen, die eigentlich aufgehoben werden sollen."[Autorenreferat]"In many countries the reduction of social inequalities in health is an important policy goal. Some populationbased public health interventions, however, may have effects that in practise conflict with these objectives. Current antismoking policies, for instance, are framing smoking as a deviant, undesirable, and morally repugnant behaviour. The discourse embraced by tobacco control and public health may be contributing to the stigmatization of smokers, thus adding to the process of âlumpenizationâ of smoking and ultimately the social exclusion of economically disadvantaged smokers."[authorÂŽs abstract
The collective lifestyles framework : a contextual analysis of social practices, social structure and disease
ThÚse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur
Cultural capital and smoking in young adults: applying new indicators to explore social inequalities in health behaviour
Background: Associations between social status and health behaviours are well documented, but the mechanisms involved are less understood. Cultural capital theory may contribute to a better understanding by expanding the scope of inequality indicators to include individuals' knowledge, skills, beliefs and material goods to examine how these indicators impact individuals' health lifestyles. We explore the structure and applicability of a set of cultural capital indicators in the empirical exploration of smoking behaviour among young male adults. Methods: We analysed data from the Swiss Federal Survey of Adolescents (CH-X) 2010-11 panel of young Swiss males (n = 10 736). A set of nine theoretically relevant variables (including incorporated, institutionalized and objectified cultural capital) were investigated using exploratory factor analysis. Regression models were run to observe the association between factor scores and smoking outcomes. Outcome measures consisted of daily smoking status and the number of cigarettes smoked by daily smokers. Results: Cultural capital indicators aggregated in a three-factor solution representing âhealth values', âeducation and knowledge' and âfamily resources'. Each factor score predicted the smoking outcomes. In young males, scoring low on health values, education and knowledge and family resources was associated with a higher risk of being a daily smoker and of smoking more cigarettes daily. Conclusion: Cultural capital measures that include, but go beyond, educational attainment can improve prediction models of smoking in young male adults. New measures of cultural capital may thus contribute to our understanding of the social status-based resources that individuals can use towards health behaviour
Moving beyond the residential neighbourhood to explore social inequalities in exposure to area-level disadvantage: Results from the Interdisciplinary Study on Inequalities in Smoking
The focus, in place and health research, on a single, residential, context overlooks the fact that
individuals are mobile and experience other settings in the course of their daily activities. Socioeconomic
characteristics are associated with activity patterns, as well as with the quality of places
where certain groups conduct activities, i.e. their non-residential activity space. Examining how
measures of exposure to resources, and inequalities thereof, compare between residential and nonresidential
contexts is required. Baseline data from 1,890 young adults (18 to 25 years-old)
participating in the Interdisciplinary Study of Inequalities in Smoking, Montreal, Canada (2011-
2012), were analyzed. Socio-demographic and activity location data were collected using a
validated, self-administered questionnaire. Area-level material deprivation was measured within
500-meter road-network buffer zones around participantsâ residential and activity locations.
Deprivation scores in the residential area and non-residential activity space were compared
between social groups. Multivariate linear regression was used to estimate associations between
individual- and area-level characteristics and non-residential activity space deprivation, and to
explore whether these characteristics attenuated the education-deprivation association. Participants
in low educational categories lived and conducted activities in more disadvantaged areas than
university students/graduates. Educational inequalities in exposure to area-level deprivation were
larger in the non-residential activity space than in the residential area for the least educated, but
smaller for the intermediate group. Adjusting for selected covariates such as transportation
resources and residential deprivation did not significantly attenuate the education-deprivation
associations. Results support the existence of social isolation in residential areas and activity
locations, whereby less educated individuals tend to be confined to more disadvantaged areas than
their more educated counterparts. They also highlight the relevance of investigating both residential
and non-residential contexts when studying inequalities in health-relevant exposures
Social inequalities in health information seeking among young adults in Montreal
Over their lifecourse, young adults develop different skills and preferences in relationship to the information sources they seek when having questions about health. Health information seeking behaviour (HISB) includes multiple, unequally accessed sources; yet most studies have focused on single sources and did not examine HISBâs association with social inequalities. This study explores âmultiple-sourceâ profiles and their association with socioeconomic characteristics. We analyzed cross-sectional data from the Interdisciplinary Study of Inequalities in Smoking involving 2093 young adults recruited in Montreal, Canada, in 2011â2012. We used latent class analysis to create profiles based on responses to questions regarding whether participants sought health professionals, family, friends or the Internet when having questions about health. Using multinomial logistic regression, we examined the associations between profiles and economic, social and cultural capital indicators: financial difficulties and transportation means, friend satisfaction and network size, and individual, motherâs, and fatherâs education. Five profiles were found: âall sourcesâ (42%), âhealth professional centredâ (29%), âfamily onlyâ (14%), âInternet centredâ (14%) and âno sourcesâ (2%). Participants with a larger social network and higher friend satisfaction were more likely to be in the âall sourcesâ group. Participants who experienced financial difficulties and completed college/university were less likely to be in the âfamily onlyâ group; those whose mother had completed college/university were more likely to be in this group. Our findings point to the importance of considering multiple sources to study HISB, especially when the capacity to seek multiple sources is unequally distributed. Scholars should acknowledge HISBâs implications for health inequalities
Expected or completed? Comparing two measures of education and their relationship with social inequalities in health among young adults
Background. Similarly to other age groups, there are significant social inequalities in health among
young adults (YA). Education is thought to be the most appropriate indicator of YA socioeconomic
status (SES), yet it is often in progress at that age and may not be representative of future achievement.
Therefore, scholars have explored YA âexpectedâ education as a proxy of SES. However, no study has
examined how it compares to the more common SES indicator, âcompletedâ education.
Methods. Using data from 1,457 YA surveyed twice over a two year period, we describe associations
between participantsâ completed and expected education at baseline and completed education at followup.
We then compare associations between these two measures and three health outcomes â smoking
status, self-rated mental health, and participation in physical activity and sports â at baseline and
follow-up using regression models.
Results. At baseline, half of the participants were imputed a higher âexpectedâ level than that
âcompletedâ at that time. In regression models, âexpectedâ and âcompletedâ education were strongly
associated with all outcomes and performed slightly differently in terms of effect size, statistical
significance, and model fit.
Conclusions. âExpectedâ education offers a good approximation of future achievement. More
importantly, âexpectedâ and âcompletedâ education variables can be conceptualized as complementary
indicators associated with inequalities in health in YA. Using both may help better understand social
inequalities in health in YA
The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults
Background: Despite a declining prevalence in many countries, smoking rates remain consistently
high among young adults. Targeting contextual influences on smoking, such as the availability of
tobacco retailers, is one promising avenue of intervention. Most studies have focused on residential
or school neighbourhoods without accounting for other settings where individuals spend time, i.e.,
their activity space. We investigated the association between tobacco retailer availability in the
residential neighbourhood and in the activity space and smoking status. Methods: Cross-sectional
baseline data from 1,994 young adults (age 18-25) participating in the Interdisciplinary Study of
Inequalities in Smoking (Montreal, Canada, 2011-2012) were analyzed. Residential and activity
locations served to derive two measures of tobacco retailer availability: counts within 500-meter
buffers and proximity to the nearest retailer. Prevalence ratios for the association between each
tobacco retailer measure and smoking status were estimated using log-binomial regression. Results:
Participants encountering high numbers of tobacco retailers in their residential neighbourhood, and
both medium and high retailer counts in their activity space, were more likely to smoke compared to
those exposed to fewer retailers. While residential proximity was not associated with smoking, we
found 36% and 42% higher smoking prevalences among participants conducting activities within
medium and high proximity to tobacco retailers compared to those conducting activities further
from such outlets. Conclusion: This study adds to the sparse literature on contextual correlates of
smoking among young adults, and illustrates the added value of considering individualsâ activity
space in contextual studies of smoking
Taking account of context in population health intervention research: guidance for producers, users and funders of research
Population health intervention research (PHIR) seeks to develop and evaluate policies, programmes and
other types of interventions that may affect population health and health equity. Such interventions are
strongly influenced by context â taken to refer to any feature of the circumstances in which an intervention
is conceived, developed, implemented and evaluated. Understanding how interventions relate to context is
critical to understanding how they work; why they sometimes fail; whether they can be successfully
adapted, scaled up or translated from one context to another; why their impacts vary; and how far effects
observed in one context can be generalised to others.
Concerns that context has been neglected in research to develop and evaluate population health
interventions have been expressed for at least 20 years. Over this period, an increasingly comprehensive
body of guidance has been developed to help with the design, conduct, reporting and appraisal of PHIR.
References to context have become more frequent in recent years, as interest has grown in complex and
upstream interventions, systems thinking and realist approaches to evaluation, but there remains a lack of
systematic guidance for producers, users and funders of PHIR on how context should be taken into account.
This document draws together recent thinking and practical experience of addressing context within
PHIR. It provides a broad, working definition of context and explains why and how context is important to
PHIR. It identifies the dimensions of context that are likely to shape how interventions are conceptualised,
the impacts that they have and how they can be implemented, translated and scaled up. It suggests how
context should be taken into account throughout the PHIR process, from priority setting and intervention
development to the design and conduct of evaluations and reporting, synthesis and knowledge exchange.
It concludes by summarising the key messages for producers, users and funders of PHIR and suggesting
priorities for future research. The document is meant to be used alongside existing guidance for the
development, evaluation and reporting of population health interventions. We expect the guidance to
evolve over time, as practice changes in the light of the guidance and experience accumulates on useful
approaches.
The work was funded by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) â Institute of
Population and Public Health (CIHR-IPPH) and the UK National Institute for Health Research (NIHR)
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