Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki

Study objective: Mortality and morbidity vary across neighbourhoods and larger residential areas. Effects of area deprivation on health may vary across countries, because of greater spatial separation of people occupying high and low socioeconomic positions and differences in the provision of local services and facilities. Neighbourhood variations in health and the contribution of residents' characteristics and neighbourhood indicators were compared in London and Helsinki, two settings where inequality and welfare policies differ.Design: Data from two cohorts were used to investigate associations between self rated health and neighbourhood indicators using a multilevel approach.Setting: London and Helsinki.Participants: From the Whitehall II study (London, aged 39-63) and the Helsinki health study (aged 40-60).Main results: Socioeconomic segregation was higher in London than in Helsinki. Age and sex adjusted differences in self rated health between neighbourhoods were also greater in London. Independent of individual socioeconomic position, neighbourhood unemployment, proportion of residents in manual occupations, and proportion of single households were associated with health. In pooled data, residence in a neighbourhood with highest unemployment was associated with an odds ratio of less than good self rated health of 1.51 (95% CI 1.30 to 1.75). High rates of single parenthood were associated with health in London but not in Helsinki.Conclusions: Neighbourhood socioeconomic context was associated with health in both countries, with some evidence of greater neighbourhood effects in London. Greater socioeconomic segregation in London may have emergent effects at the neighbourhood level. Local and national social policies may reduce, or restrict, inequality and segregation between areas

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Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan

INTRODUCTION: Socioeconomic differences in smoking over time and across national contexts are poorly understood. We assessed the magnitude of relative and absolute social class differences in smoking in cohorts from Britain, Finland and Japan over 5-7 years. METHODS: The British Whitehall II study (n=4350), Finnish Helsinki Health Study (n=6328), and Japanese Civil Servants Study (n=1993) all included employed men and women aged 35-68 at baseline in 1997-2002. Follow-up was in 2003-2007 (mean follow-up 5.1, 6.5 and 3.6 years, respectively). Occupational social class (managers, professionals and clerical employees) was measured at baseline. Current smoking and covariates (age, marital status, body mass index and self-rated health) were measured at baseline and follow-up. We assessed relative social class differences using the Relative Index of Inequality (RII) and absolute differences using the Slope Index of Inequality (SII). RESULTS: Social class differences in smoking were found in Britain and Finland, but not in Japan. Age-adjusted relative differences at baseline ranged from RII 3.08 (95% confidence interval 1.99-4.78) among Finnish men to 2.32 (1.24-4.32) among British women, with differences at follow-up greater by 8-58%. Absolute differences remained stable and varied from SII 0.27 (0.15-0.40) among Finnish men to 0.10 (0.03-0.16) among British women. Further adjustment for covariates had modest effects on inequality indices. CONCLUSIONS: Large social class differences in smoking persisted among British and Finnish men and women, with widening tendencies in relative differences over time. No differences could be confirmed among Japanese men or women

Monitoring trends in socioeconomic health inequalities: it matters how you measure

<p>Abstract</p> <p>Background</p> <p>Odds ratio (OR), a relative measure for health inequality, has frequently been used in prior studies for presenting inequality trends in health and health behaviors. Since OR is not a good approximation of prevalence ratio (PR) when the outcome prevalence is quite high, an important problem may arise when OR trends are used in data in which the outcome variable (e.g., smoking or ill-health) is of relatively high prevalence and varies significantly over time. This study is to compare time trends of odds ratio (OR) and prevalence ratio (PR) for examining time trends in socioeconomic inequality in smoking.</p> <p>Methods</p> <p>A total of 147,805 subjects (71,793 men and 76,017 women) aged 25–64 from three Social Statistics Surveys of Korea from 1999 to 2006 were analyzed. Socioeconomic position indicators were occupational class and education.</p> <p>Results</p> <p>While there were no significant p values for trend in ORs of occupational class among men, trends for PRs were significant. In women, p values for OR trends were similar to those for PR trends. In males, RII by log-binomial regression showed a significant increasing tendency while RII by logistic regression was stable between years. In females, trends of RIIs by logistic regression and log-binomial regression produced a similar level of p values.</p> <p>Conclusion</p> <p>Different methods of measuring trends in socioeconomic health inequalities may lead to different conclusions about whether relative inequalities are increasing or decreasing. Trends in ORs may overstate or understate trends in relative inequality in health when the outcome is of relatively high prevalence and that prevalence varies significantly with time.</p

A participatory physical and psychosocial intervention for balancing the demands and resources among industrial workers (PIPPI): study protocol of a cluster-randomized controlled trial

Background: Need for recovery and work ability are strongly associated with high employee turnover, well-being and sickness absence. However, scientific knowledge on effective interventions to improve work ability and decrease need for recovery is scarce. Thus, the present study aims to describe the background, design and protocol of a cluster randomized controlled trial evaluating the effectiveness of an intervention to reduce need for recovery and improve work ability among industrial workers. Methods/Design: A two-year cluster randomized controlled design will be utilized, in which controls will also receive the intervention in year two. More than 400 workers from three companies in Denmark will be aimed to be cluster randomized into intervention and control groups with at least 200 workers (at least 9 work teams) in each group. An organizational resources audit and subsequent action planning workshop will be carried out to map the existing resources and act upon initiatives not functioning as intended. Workshops will be conducted to train leaders and health and safety representatives in supporting and facilitating the intervention activities. Group and individual level participatory visual mapping sessions will be carried out allowing team members to discuss current physical and psychosocial work demands and resources, and develop action plans to minimize strain and if possible, optimize the resources. At all levels, the intervention will be integrated into the existing organization of work schedules. An extensive process and effect evaluation on need for recovery and work ability will be carried out via questionnaires, observations, interviews and organizational data assessed at several time points throughout the intervention period. Discussion: This study primarily aims to develop, implement and evaluate an intervention based on the abovementioned features which may improve the work environment, available resources and health of industrial workers, and hence their need for recovery and work ability

Gender differences in health and health care utilisation in various ethnic groups in the Netherlands: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>To determine gender differences in health and health care utilisation within and between various ethnic groups in the Netherlands.</p> <p>Methods</p> <p>Data from the second Dutch National Survey of General Practice (2000–2002) were used. A total of 7,789 persons from the indigenous population and 1,512 persons from the four largest migrant groups in the Netherlands – Morocco, Netherlands Antilles, Turkey and Surinam – aged 18 years and older were interviewed. Self-reported health outcomes studied were general health status and the presence of acute (past 14 days) and chronic conditions (past 12 months). And self-reported utilisation of the following health care services was analysed: having contacted a general practitioner (past 2 months), a medical specialist, physiotherapist or ambulatory mental health service (past 12 months), hospitalisation (past 12 months) and use of medication (past 14 days). Gender differences in these outcomes were examined within and between the ethnic groups, using logistic regression analyses.</p> <p>Results</p> <p>In general, women showed poorer health than men; the largest differences were found for the Turkish respondents, followed by Moroccans, and Surinamese. Furthermore, women from Morocco and the Netherlands Antilles more often contacted a general practitioner than men from these countries. Women from Turkey were more hospitalised than Turkish men. Women from Morocco more often contacted ambulatory mental health care than men from this country, and women with an indigenous background more often used over the counter medication than men with an indigenous background.</p> <p>Conclusion</p> <p>In general the self-reported health of women is worse compared to that of men, although the size of the gender differences may vary according to the particular health outcome and among the ethnic groups. This information might be helpful to develop policy to improve the health status of specific groups according to gender and ethnicity. In addition, in some ethnic groups, and for some types of health care services, the use by women is higher compared to that by men. More research is needed to explain these differences.</p

Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study

Background Previous studies have found generally better health among those who combine employment and family responsibilities; however, most research excludes men, and relies on subjective measures of health and information on work and family activities from only 1 or 2 time points in the life course. This study investigated associations between work-family life course types (LCTs) and markers of metabolic risk in a British birth cohort study. Methods Multichannel sequence analysis was used to generate work-family LCTs, combining annual information on work, partnership and parenthood between 16 and 42 years for men and women in the British National Child Development Study (NCDS, followed since their birth in 1958). Associations between work-family LCTs and metabolic risk factors in mid-life (age 44-45) were tested using multivariate linear regression in multiply imputed data. Results Life courses characterised by earlier transitions into parenthood were associated with significantly increased metabolic risk, regardless of attachment to paid work or marital stability over the life course. These associations were only partially attenuated by educational qualifications, early life circumstances and adult mediators. The positive association between weak labour markets ties and metabolic risk was weaker than might be expected from previous studies. Associations between work-family LCTs and metabolic risk factors did not differ significantly by gender. Conclusions Earlier transitions to parenthood are linked to metabolic risk in mid-life

Socioeconomic differences in cancer survival: The Norwegian Women and Cancer Study

<p>Abstract</p> <p>Background</p> <p>Cancer survival has been observed to be poorer in low socioeconomic groups, but the knowledge about the underlying causal factors is limited. The purpose of this study was to examine how cancer survival varies by socioeconomic status (SES) among women in Norway, and to identify factors that explain this variation. SES was measured by years of education and gross household income, respectively.</p> <p>Methods</p> <p>We used data from The Norwegian Women and Cancer Study, a prospective cohort study including 91 814 women who responded to an extensive questionnaire between 1996 and 1998. A total of 3 899 incident cancer cases were diagnosed during follow-up, of whom 1 089 women died, 919 of them from cancer. Cox Proportional Hazards Model was used to calculate relative risks (RR) of mortality and 95% confidence intervals.</p> <p>Results</p> <p>We observed an overall negative socioeconomic gradient in cancer survival, which was most evident in the site specific analyses for survival of ovarian cancer by years of education. For colorectal cancer, mortality increased with years of education, but not with income. After adjustment for household size, marital status, disease stage, and smoking status the SES variation in cancer survival became non-significant. We found that the unequal socioeconomic distribution of smoking status prior to diagnosis contributed considerably to the poorer survival in low SES groups.</p> <p>Conclusion</p> <p>We found an overall negative socioeconomic gradient in cancer survival when SES is measured as years of education or gross household income. Smoking status prior to diagnosis was an important predictive factor for socioeconomic variation in survival.</p