Ying Chih Chuang

Bio: Ying Chih Chuang is an academic researcher from Taipei Medical University. The author has contributed to research in topics: Socioeconomic status & Population. The author has an hindex of 13, co-authored 30 publications receiving 846 citations.

Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking

Abstract: Objectives: To assess the effects of neighbourhood level socioeconomic status (SES) and convenience store concentration on individual level smoking, after consideration of individual level characteristics. Design: Individual sociodemographic characteristics and smoking were obtained from five cross sectional surveys (1979–1990). Participants’ addresses were geocoded and linked with census data for measuring neighbourhood SES and with telephone yellow page listings for measuring convenience store concentration (density in a neighbourhood, distance between a participant’s home and the nearest convenience store, and number of convenience stores within a one mile radius of a participant’s home). The data were analysed with multilevel Poisson regression models. Setting: 82 neighbourhoods in four northern California cities. Participants: 8121 women and men aged 25–74 from the Stanford heart disease prevention programme. Main results: Lower neighbourhood SES and higher convenience store concentration, measured by density and distance, were both significantly associated with higher level of individual smoking after taking individual characteristics into account. The association between convenience store density and individual smoking was modified by individual SES and neighbourhood SES. Conclusions: These findings are consistent with a growing body of literature suggesting that the socioeconomic and physical environments of neighbourhoods are associated with individual level smoking.

Women’s autonomy and maternal healthcare service utilization in Ethiopia

Abstract: Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Social cohesion matters in health

Abstract: The concept of social cohesion has invoked debate due to the vagueness of its definition and the limitations of current measurements. This paper attempts to examine the concept of social cohesion, develop measurements, and investigate the relationship between social cohesion and individual health. This study used a multilevel study design. The individual-level samples from 29 high-income countries were obtained from the 2000 World Value Survey (WVS) and the 2002 European Value Survey. National-level social cohesion statistics were obtained from Organization of Economic Cooperation and Development datasets, World Development Indicators, and Asian Development Bank key indicators for the year 2000, and from aggregating responses from the WVS. In total 47,923 individuals were included in this study. The factor analysis was applied to identify dimensions of social cohesion, which were used as entities in the cluster analysis to generate a regime typology of social cohesion. Then, multilevel regression models were applied to assess the influences of social cohesion on an individual’s self-rated health. Factor analysis identified five dimensions of social cohesion: social equality, social inclusion, social development, social capital, and social diversity. Then, the cluster analysis revealed five regimes of social cohesion. A multi-level analysis showed that respondents in countries with higher social inclusion, social capital, and social diversity were more likely to report good health above and beyond individual-level characteristics. This study is an innovative effort to incorporate different aspects of social cohesion. This study suggests that social cohesion was associated with individual self-rated after controlling individual characteristics. To achieve further advancement in population health, developed countries should consider policies that would foster a society with a high level of social inclusion, social capital, and social diversity. Future research could focus on identifying possible pathways by which social cohesion influences various health outcomes.

Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking.

Abstract: To assess the effects of neighbourhood level socioeconomic status (SES) and convenience store concentration on individual level smoking, after consideration of individual level characteristics. Individual sociodemographic characteristics and smoking were obtained from five cross sectional surveys (1979–1990). Participants’ …

Bowling alone: The collapse and revival of American community

Abstract: The present historical moment may seem a particularly inopportune time to review Bowling Alone, Robert Putnam's latest exploration of civic decline in America. After all, the outpouring of volunteerism, solidarity, patriotism, and self-sacrifice displayed by Americans in the wake of the September 11 terrorist attacks appears to fly in the face of Putnam's central argument: that \"social capital\" -defined as \"social networks and the norms of reciprocity and trustworthiness that arise from them\" (p. 19)'has declined to dangerously low levels in America over the last three decades. However, Putnam is not fazed in the least by the recent effusion of solidarity. Quite the contrary, he sees in it the potential to \"reverse what has been a 30to 40-year steady decline in most measures of connectedness or community.\"' As an example of how the current \"war on terrorism\" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says \"permanently marked\" the generation that lived through it and had a \"terrific effect on American public life over the last half-century.\" 3 If Americans can follow this example and channel their current civic

The Social Determinants of Health: It's Time to Consider the Causes of the Causes:

Abstract: During the past two decades, the public health community’s attention has been drawn increasingly to the social determinants of health (SDH)—the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use “medical care” rather than “health care” to refer to clinical services, to avoid potential confusion between “health” and “health care.” The World Health Organization’s Commission on the Social Determinants of Health has defined SDH as “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions.” The term “social determinants” often evokes factors such as health-related features of neighborhoods (e.g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes. This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social—and particularly socioeconomic— factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.

The Social Determinants of Health: Coming of Age

Abstract: In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants—including economic resources, education, and racial discrimination—that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions. Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through kno...

Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association

Abstract: Background—Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results—For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change...