Income and economic exclusion: do they measure the same concept?

<p>Abstract</p> <p>Introduction</p> <p>In this paper, we create an index of economic exclusion based on validated questionnaires of economic hardship and material deprivation, and examine its association with health in Canada. The main study objective is to determine the extent to which income and this index of economic exclusion index are overlapping measurements of the same concept.</p> <p>Methods</p> <p>We used the Canadian Household Panel Survey Pilot and performed multilevel analysis using a sample of 1588 individuals aged 25 to 64, nested within 975 households.</p> <p>Results</p> <p>While economic exclusion is inversely correlated with both individual and household income, these are not perfectly overlapping constructs. Indeed, not only these indicators weakly correlated, but they also point to slightly different sociodemographic groups at risk of low income and economic exclusion. Furthermore, the respective associations with health are of comparable magnitude, but when these income and economic exclusion indicators are included together in the same model, they point to independent and cumulative, not redundant effects.</p> <p>Conclusions</p> <p>We explicitly distinguish, both conceptually and empirically, between income and economic exclusion, one of the main dimensions of social exclusion. Our results suggest that the economic exclusion index we use measures additional aspects of material deprivation that are not captured by income, such as the effective hardship or level of economic 'well-being'.</p

Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France, 2005–2006

<p>Abstract</p> <p>Background</p> <p>The Internet is a major source of information for professionals and the general public, especially in the field of health. However, despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in: 1) having or not having Internet access; and 2) using or not using the Internet to obtain health information.</p> <p>Methods</p> <p>A cross-sectional survey of a representative random sample was conducted in the Paris metropolitan area, France, in the fall of 2005 (n = 3023).</p> <p>Results</p> <p>Close to 70% of the adult population had Internet access, and 49% of Internet users had previously searched for medical information. Economic and social disparities observed in online health information seeking are reinforced by the economic and social disparities in Internet access, hence a double divide. While individuals who reported having a recent health problem were less likely to have Internet access (odds ratio (OR): 0.72, 95% confidence interval (CI): 0.53–0.98), it is they who, when they have Internet access, are the most likely to search for health information (OR = 1.44, 95% CI = 1.11–1.87).</p> <p>Conclusion</p> <p>In the French context of universal health insurance, access to the Internet varies according to social and socioeconomic status and health status, and its use for health information seeking varies also with health beliefs, but not to health insurance coverage or health-care utilisation. Certain economic and social inequalities seem to impact cumulatively on Internet access and on the use of the Internet for health information seeking. It is not obvious that the Internet is a special information tool for primary prevention in people who are the furthest removed from health concerns. However, the Internet appears to be a useful complement for secondary prevention, especially for better understanding health problems or enhancing therapeutic compliance.</p

Family social environment in childhood and self-rated health in young adulthood

<p>Abstract</p> <p>Background</p> <p>Family social support, as a form of social capital, contributes to social health disparities at different age of life. In a life-course epidemiological perspective, the aims of our study were to examine the association between self-reported family social environment during childhood and self-reported health in young adulthood and to assess the role of family functioning during childhood as a potential mediating factor in explaining the association between family breakup in childhood and self-reported health in young adulthood.</p> <p>Methods</p> <p>We analyzed data from the first wave of the Health, Inequalities and Social Ruptures Survey (SIRS), a longitudinal health and socio-epidemiological survey of a random sample of 3000 households initiated in the Paris metropolitan area in 2005. Sample-weighted logistic regression analyses were performed to determine the association between the quality of family social environment in childhood and self-rated health (overall health, physical health and psychological well-being) in young adults (n = 1006). We used structural equation model to explore the mediating role of the quality of family functioning in childhood in the association between family breakup in childhood and self-rated health in young adulthood.</p> <p>Results</p> <p>The multivariate results support an association between a negative family social environment in childhood and poor self-perceived health in adulthood. The association found between parental separation or divorce in childhood and poor self-perceived health in adulthood was mediated by parent-child relationships and by having witnessed interparental violence during childhood.</p> <p>Conclusion</p> <p>These results argue for interventions that enhance family cohesion, particularly after family disruptions during childhood, to promote health in young adulthood.</p

Recherche d'information en matière de santé sur Internet (déterminants, pratiques et impact sur la santé et le recours aux soins)

Si Internet est une source d information considérable dans le domaine de la santé, une fracture numérique persiste dans les pays industrialisés. Parallèlement, des inégalités sociales existent en lien avec l état de santé, les représentations, le recours aux soins et la relation avec les soignants. L objectif de cette thèse est de décrire la stratification sociale de l utilisation d Internet pour s informer en matière de santé et ses conséquences sur la gestion de la santé et des soins. Des enquêtes quantitatives en population générale ont été conduites. Dans une perspective de santé publique, Internet apparaît comme une source d information privilégiée pour les personnes malades mais plus discutable en population générale. Internet semble susceptible d accroître au moins temporairement les inégalités sociales de santé. A contrario, Internet pourrait contribuer à réduire les disparités observées (prévention primaire, promotion de la santé) à condition de promouvoir activement sa diffusion ainsi que la formation à son utilisation, parallèlement au développement de systèmes d information de qualité et adaptés aux différents publics.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Internet uses for health information seeking: Internet uses and healthcare information

Background: With the widespread dissemination of the Internet throughout the world of health, it would be relevant to report on current knowledge about health information search on the Internet from the consumers' standpoint. Methods: We conducted a bibliographical research over the past five years and distinguished between international and French studies. Results: For a long time, the (mostly US) studies have been merely descriptive. The studies highlight that the factors associated with health searches on the Internet are similar to the factors underlying the digital divide. Consumer searches are deemed efficient although search skills are comparatively below standard. Attempts are underway to set up tools, circulate them widely, and ensure better quality information on the Internet. However, comprehension and literacy are still issues in some social groups. Regarding the impact on consumer health per se, a (positive) effect of the Internet seems to emerge but research should be continued. Conclusion: Many of the behaviors, uses or limits addressed in this paper pertain to any information search on the Internet but other problems or differences also occur in the specific area of health. Longitudinal investigations are needed, specifically to gain deeper insight into the impacts we have addressed, while rolling out a comprehensive approach to the temporal evolution of user practices and experiences. Specifically, the central issue is still to determine how (and for whom) the Internet alters information search behaviors and, in fine, to what extent this affects health behaviors and the recourse to healthcare

Unequal Health, Health Care Needs and SES over the Life Course: The Role of Health Insurance in a National Health System

The association between health and income has been extensively described in the literature. However, accounts of the time dynamics of this relationship are scant, as are studies examining the modifying effect of public policies on this relationship, measured here through health insurance (HI). We used the National Population Health Survey, a cohort study of the general Canadian population spanning almost 10 years, from 1996 to 2004. We considered middle-aged participants (25-56, n=6116) by groups of 10 years. Structural equation models were employed to assess the impact of HI on the pathway between socioeconomic status, health needs and health status. Regarding the 45-55 year old sub-sample, income inadequacy increased the probability of suffering from unmet health care needs, the later increasing the probability of later poor self-rated health (SRH). Years spent with HI do not seem to have an impact on this relationship. However, different results were found when people did not receive health care because of financial cost. In addition to the significant pathway from income adequacy to SRH, we observed a significant effect of income on HI, and a marginal one of HI on SRH. Our results indicate that health insurance coverage tends to increase health inequalities in Canada. Within an international context of a growing proportion of private health insurance coverage at the expense of public insurance, the surveillance of these trajectories could give evidence for future public health orientations and policies. Emilie Renahy is a postdoctoral fellow in the Department of Epidemiology, Biostatistics and Occupational Health - McGill University. She is the Data Specialist of the the International Research Infrastructure on Social inequalities in health (IRIS). She is a social epidemiologist with extensive experience in designing surveys, analysing longitudinal survey data and structural equation models. Within a health over the life course perspective, her work deals with the impact of health insurance on social health inequalities. Her research interests include: Social epidemiology, Social inequalities, Determinants of health, Longitudinal analysis, Lifecourse epidemiology, Survey design, Health insurance, Healthcare system, Health information and Internet use. Amélie Quesnel-Vallée, PhD, is Assistant Professor at McGill University, where she holds an Arts and Medicine cross-faculty appointment in the Departments of Sociology and of Epidemiology. She also heads the International Research Infrastructure on Social inequalities in health (IRIS), funded by the Canada Foundation for Innovation Leaders Opportunity Fund. In 2005, she received the American Sociological Association Dissertation Award for her Fulbright-funded doctoral research. She currently studies the impact of public policies on health inequalities in 21 OECD countries. Her work recently appeared in a book she co-edited, Le privé dans la santé : Les discours et les faits (Presses de l’Université de Montréal, 2008

Determinants of the frequency of online health information seeking: results of a web-based survey conducted in France in 2007.: Determinants of ehealth searches' frequency

International audienceIn the general population, social disparities in Internet practices have been less described than disparities in health information access. Aim is to determine whether there are differences in the frequency of Internet use for health information among health seekers. We conducted an Internet-based survey from November 2006 to March 2007. We considered the 3720 residents of France who had searched for health information during the previous 12 months. This study reveals different uses of the Internet for health information seeking (HIS) between men and women and between the general population and people who work in the health sector. Health status, taking care of somebody who is sick, and active Internet use were associated with higher frequencies of online HIS to varying degrees. The effects of age and level of education were not clear or were not significant. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use for HIS in the general population. Considering that this increasing use of online tools for HIS is consistent with current public health policies that promote the development of the 'informed patient', one should remain cautious about these social disparities in online HIS practices

[Internet and health: lessons learned from the French national survey on households living conditions in 2005].

International audienceBACKGROUND: The Internet is a major source of information for the general public in the field of health. However despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in Internet access and then in Internet use for health information seeking. METHODS: This study is based on a cross-sectional survey of a representative random sample of French inhabitants: the Enquête permanente sur les conditions de vie des ménages conducted by Insee in 2005, which included a specific investigation on information and communication technology. RESULTS: Fifty-two percent of the French adult population had Internet access, and 28.5% of the Internet users had previously searched for medical information during the month before the survey. A first level of socioeconomic divide has been shown in Internet access: poor socioeconomic status, health problems. In terms of health information seeking among Internet users, the divide was not socioeconomic but more related to gender, the health care system utilization, and the diversified use of the Internet. CONCLUSION: In a public health perspective, this study suggests that promoting Internet access and utilization is still necessary in order to make it a widely used tool for prevention and health promotion