Age differences in mammography screening reconsidered: life course trajectories in 13 European countries

Background: Breast cancer is the most common cause of cancer mortality among European women. To reduce mortality risk, early detection through mammography screening is recommended from the age of 50 years onwards. Although timely initiation is crucial for cancer prognosis, the temporal dimension has largely been ignored in research. In cross-sectional research designs, it is not clear whether reported age differences reflect ‘true’ age effects and/or presumed period effects resulting from evolving knowledge and screening programmes. Methods: We use longitudinal data from the survey of Health, Ageing and Retirement (SHARELIFE, 2008), which enables to cast light on age differences by providing retrospective information on the age at which women commenced regular mammography screening. Moreover, the cross-national dimension of the SHARE permits framing the results within the context of nationally implemented screening programmes. By means of the Kaplan–Meier procedure, we examine age trajectories for five 10-year birth cohorts in 13 European countries (n = 13 324). Results: Birth cohorts show very similar age trajectories for each country. Along with the observation that large country differences and country-specific deviations coincide with screening programme characteristics, this suggests strong period effects related to implemented national screening programmes. Conclusion: Age differences in mammography screening generally reflect the period effects of national screening policies. This leaves little room for economic theories about human health capital that leave out the institutional context of preventive health care provision

Depressive symptoms among immigrants and ethnic minorities: a population based study in 23 European countries

European studies about ethnic inequalities in depressive symptoms are scarce, show inconclusive results and are complicated by the discussion of what constitute (im)migrant and ethnic minority groups. Moreover, comparisons across countries are hampered by a lack of comparable measures of depressive symptoms. This study aims to assess the prevalence and determinants of depressive symptoms among immigrants, ethnic minorities and natives in 23 European countries. Multilevel analyses are performed using data from the third wave of the European Social Survey (ESS-3). This dataset comprises information about 36,970 respondents, aged 21 years or older, of whom 13.3% immigrants and 6.2% ethnic minorities. Depressive symptoms were assessed with an 8-item version of the Center for Epidemiologic Studies-Depression scale. Main determinants are immigrant status, socio-economic conditions and the experience of ethnic discrimination in the host country. The results show that immigrants and ethnic minorities do experience more depressive symptoms than natives in an essential part of the countries. Moreover, socio-economic conditions and the experience of ethnic discrimination are important risk factors. Immigrant status seems irrelevant, once the other risk factors are accounted for. Finally, immigrant and ethnic minority groups do not consist of the same individuals and therefore have different prevalence rates of depressive symptoms. The prevalence rates of depressive symptoms are higher for immigrant and ethnic minority groups in a substantial part of the European countries. A clear definition is indispensable for developing policies that address the right-targeted population

Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective

Whilst there are abundant descriptions of socio-economic inequalities in preventive health care, knowledge about the true mechanisms is still lacking. Recently, the role of cultural health capital in preventive health care inequalities has been discussed theoretically. Given substantial analogies, we explore how our understanding of cultural health capital and preventive health care inequalities can be advanced by applying the theoretical principles and methodology of the life course perspective. By means of event history analysis and retrospective data from the Survey of Health Ageing and Retirement (SHARELIFE), we examine the role of cultural capital and cultural health capital during childhood on the timely initiation of mammography screening in Belgium (N=1,348). In line with cumulative disadvantage theory, the results show that childhood cultural conditions are independently associated with mammography screening, even after childhood and adulthood SEP and health are controlled for. Lingering effects from childhood are suggested by the accumulation of cultural health capital that starts early in life. Inequalities in the take up of screening are manifested as a lower probability of ever having a mammogram, rather than in the late initiation of screening

The social gradient in preventive health care use: what can we learn from socially mobile individuals?

Little is known about the origins of the stratified nature of preventive health behaviour. In this paper, we introduce theory and methodology from the field of social mobility research. Intergenerational, socially mobile individuals can provide insights into the central discussion about how health lifestyles or cultural health capital develop over the life course, during which different contexts of socialisation are encountered, each with its own characteristic health-related practices. We study the use of regular mammography screening by Belgian women using data from the Survey of Health, Aging and Retirement and we operationalise social mobility as occupational mobility using the International Standard Classification of Occupations (ISCO-88). By means of diagonal reference models, we are able to discern the effects of the social position of origin, the social position of destination and social mobility itself, contrary to the less rigorous linear regression approach that prevails in health behaviour research. As expected, the take up of mammography screening is strongly influenced by social position. It seems that both upwardly and downwardly mobile women adapt to the mammography screening practices in their position of destination. This study shows the potential for social mobility research to enrich the debate on health lifestyles

Gender specific effects of financial and housework contributions on depression: a multi-actor study among three household types in Belgium

Studies that focus on the effects of both the division of household chores and of financial contributions on the mental health of couples are scarce. This paper expands on previous research by paying attention to the variation of this relationship among three types of households: male breadwinner, one-and-a-half-earner and dual-earner. Using paired data from the tenth wave of the Panel Study of Belgian Households, collected in 2001, we perform separate linear regressions for men (N = 1054) and women (N = 1054). The results suggest that in one-and-a-half-earner households, women’s employment has a negative effect on their partner’s depression level and that in dual-earner households, the effect of women’s employment is only negative if men are not the major breadwinner. Crossover effects of depression between partners seem to mediate part of the aforementioned associations