Showing papers in "International Journal of Public Health in 2018"
TL;DR: Web-based data collection present lower RRs compared to alternative methods, however, it is not recommended to interpret this as a meta-analytical evidence due to the high heterogeneity of the studies.
Abstract: To systematically review the literature and compare response rates (RRs) of web surveys to alternative data collection methods in the context of epidemiologic and public health studies. We reviewed the literature using PubMed, LILACS, SciELO, WebSM, and Google Scholar databases. We selected epidemiologic and public health studies that considered the general population and used two parallel data collection methods, being one web-based. RR differences were analyzed using two-sample test of proportions, and pooled using random effects. We investigated agreement using Bland-and-Altman, and correlation using Pearson’s coefficient. We selected 19 studies (nine randomized trials). The RR of the web-based data collection was 12.9 percentage points (p.p.) lower (95% CI = − 19.0, − 6.8) than the alternative methods, and 15.7 p.p. lower (95% CI = − 24.2, − 7.3) considering only randomized trials. Monetary incentives did not reduce the RR differences. A strong positive correlation (r = 0.83) between the RRs was observed. Web-based data collection present lower RRs compared to alternative methods. However, it is not recommended to interpret this as a meta-analytical evidence due to the high heterogeneity of the studies.
78 citations
TL;DR: Polices to reduce ethnic inequalities in health should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.
Abstract: Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004–2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087). Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57–2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53–0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.
60 citations
TL;DR: Cancer is responsible for a substantial disease burden in the EMR, which is increasing, and there is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as to improve diagnosis, treatment, and palliative care services.
Abstract: OBJECTIVES: To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015.METHODS: Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology.RESULTS: In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths.CONCLUSIONS: Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.
60 citations
TL;DR: This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015 and calls for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.
Abstract: We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). We estimated the prevalence of overweigh ...
57 citations
TL;DR: The age-standardized DALY rates in the EMR are considerably higher than the global average, and these findings call for a comprehensive approach to prevent and control the burden of CVD in the region.
Abstract: To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. We used the 2015 Global Burden of Disease study for estimates of mortality and disa ...
54 citations
TL;DR: This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality, and emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.
Abstract: To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga’s method to decompose life expectancy by age group and 24 causes of death. Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer’s disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.
53 citations
TL;DR: The burden of mental disorders in the EMR is higher than global levels, particularly for women, and governments should implement nationwide quality epidemiological surveillance ofmental disorders and provide adequate prevention and treatment services.
Abstract: Mental disorders are among the leading causes of nonfatal burden of disease globally. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.
53 citations
TL;DR: In this article, the authors used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015, and they used the Global Burden of Disease (GBD) study to measure intentional injury.
Abstract: Objectives: We used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015.Methods: The Global Burden of Disease (GBD) study ...
48 citations
TL;DR: A considerable proportion of the refugees in Sweden have limited CHL, and report less than good health and impaired well-being, or that they have refrained from seeking healthcare, and CHL is associated with the above-mentioned factors.
Abstract: The objectives of the study were to explore the distributions of comprehensive health literacy (CHL), general health, psychological well-being, and having refrained from seeking healthcare among refugees in Sweden. Further objectives were to examine associations between CHL and the above-mentioned factors. A cross-sectional study was conducted among 513 refugees speaking Arabic, Dari, and Somali. Participants in the civic orientation course in Sweden responded to a questionnaire. CHL was measured using the HLS-EU-Q16 questionnaire. Uni- and multivariate logistic regression was used to investigate potential associations. The majority of the respondents had limited CHL, and about four of ten had reported poor health and/or having refrained from seeking healthcare. Limited CHL was associated with having reported poor health and having refrained from seeking healthcare. A considerable proportion of the refugees in Sweden have limited CHL, and report less than good health and impaired well-being, or that they have refrained from seeking healthcare. Furthermore, CHL is associated with the above-mentioned factors. Efforts are needed to promote refugees’ CHL, optimal health-seeking behavior, and health.
47 citations
TL;DR: In this paper, the authors proposed a public health module for low-and middle-income countries (LMICs) to address the emerging challenges of aging and epidemiological change in LMICs.
Abstract: The growth rate of the population aged 60 years and over is about three times faster in less developed countries than in more developed countries (Chatterji et al. 2015). This is a remarkable success story, reflecting declines in mortality and improvements in longevity resulting from major health-care efforts in lowand middle-income countries (LMICs). However, this unprecedented growth of the older population increases prevalence rates of non-communicable diseases (NCDs) and of old-age disability (United Nations 2011), creating demands that many health systems are currently not equipped to meet. Responding to these demographic and health trends will be particularly challenging in LMICs, where many mature adults have been exposed to adverse economic and health environments for most of their lives. Cumulative exposure to poverty, infections, and other disease risks is likely to take a toll on the health of these older adults. Furthermore, the coexistence of infectious disease and NCD burdens in severely resource-constrained health systems makes it challenging to implement effective, yet economically feasible responses to population aging (United Nations 2011; Ebrahim et al. 2013). As a result, LMICs can be trapped in a vicious circle in which poor health, resource scarcity, and health system deficiencies aggravate the NCD burden, which, in turn, causes major barriers to economic and social development. The achievements of the Millennium Development Goals (MDGs) and the potential of the Sustainable Developments Goals (SDGs) are at risk if the unfolding NCD epidemics in LMICs are not addressed with some urgency (United Nations 2011). Faced with this critical confluence of aging and epidemiological transition (Murray et al. 2012; Lim et al. 2013), national health strategies in LMICs have started to rise to the challenges posed by NCDs, which presents a growing need to collect data and assemble evidence to guide policy responses (Ebrahim et al. 2013; Suzman et al. 2015). While the interplay between aging, NCDs, disability, and socioeconomic outcomes is relatively well documented in more developed countries—thanks to the availability of internationally comparable multi-disciplinary longitudinal health and retirement studies (Piggott and Woodland 2016), such as the US Health and Retirement Study (HRS), the Survey of Health, Aging and Retirement in Europe (SHARE), or the WHO Study on Global Ageing and Adult Health (SAGE)—corresponding data from less developed countries are still very sparse (Chatterji et al. 2015). Recognizing the pressing need for high-quality longitudinal data and for evidence of the impacts of NCDs and disability on socioeconomic outcomes in the developing world, the Swiss Programme for Research on Global Issues for Development (r4d) launched a public health module in 2014. The module aims to deliver research findings to guide policy makers toward sustaining health gains while addressing the emerging challenges of aging and epidemiological change in LMICs. One r4d project in this public health module has helped to implement high-quality HRS-style data collection in India, Sri Lanka, the Philippines, and Malawi, with a focus on mature adults and NCDs. This Editorial is part of the series ‘‘Young Researcher Editorial’’, a project of the Swiss School of Public Health (SSPH?).
44 citations
TL;DR: Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions.
Abstract: OBJECTIVES: Transport injuries (TI) are ranked as one of the leading causes of death, disability, and property loss worldwide. This paper provides an overview of the burden of TI in the Eastern Mediterranean Region (EMR) by age and sex from 1990 to 2015.METHODS: Transport injuries mortality in the EMR was estimated using the Global Burden of Disease mortality database, with corrections for ill-defined causes of death, using the cause of death ensemble modeling tool. Morbidity estimation was based on inpatient and outpatient datasets, 26 cause-of-injury and 47 nature-of-injury categories.RESULTS: In 2015, 152,855 (95% uncertainty interval: 137,900-168,100) people died from TI in the EMR countries. Between 1990 and 2015, the years of life lost (YLL) rate per 100,000 due to TI decreased by 15.5%, while the years lived with disability (YLD) rate decreased by 10%, and the age-standardized disability-adjusted life years (DALYs) rate decreased by 16%.CONCLUSIONS: Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions. (Less)
TL;DR: Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education, and countries can reduce educational inequalities by applying organised screening programmes.
Abstract: To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic. Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12 months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied. Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities were significantly smaller in countries with organised cervical cancer screening than they were in countries with opportunistic screening (OR = 0.716, 95% CI 0.549–0.935). The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance. This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.
TL;DR: The findings imply that although sticks and stones may break bones, it does seem that derogatory words and other forms of non-physical sexual harassment definitely harm high school students.
Abstract: The paper examines how strongly non-physical peer sexual harassment is associated with a wide range of well-being outcomes from symptoms of depression and anxiety to self-esteem and body image. Two large community samples of high school students were analyzed (n = 1384 and n = 1485). Students responded to questionnaires on being subject to non-physical sexual harassment, sexual coercion and forced intercourse, and to well-being indicators ranging from anxiety, depression, self-esteem, body image. Regression analyses suggest that being harassed by peers in a non-physical way was moderately associated with lower levels of well-being over and above the effect of other risk factors. This effect was present for all indicators of well-being. The effect of peer harassment on depressive symptoms was moderated by sex (affected women more) but not by sexual or ethnic minority status. The findings imply that although sticks and stones may break bones, it does seem that derogatory words and other forms of non-physical sexual harassment definitely harm high school students.
TL;DR: Low CSES and CA are associated with higher risk of chronic conditions in later life, and a minor proportion of these associations are driven by recall bias.
Abstract: The aim of this study was to (1) identify the influence of childhood socioeconomic status (CSES) on five chronic conditions: asthma, bronchitis, hypothyroid, migraine, and psychiatric disorders in later life; (2) determine the mediating role of childhood abuse (CA) in these associations, and (3) quantify recall bias due to respondent’s mental health in these associations. 10,325 men and women from the Tromso Study were followed for 13 years, and Poisson regression models were used. Low CSES was associated with a 16–23% higher risk of chronic conditions, and CA was associated with a 16–58% higher risk of chronic conditions (p < 0.05). A minor proportion of the association between CSES and CA (3.98%, p < 0.05); CSES and chronic conditions (5.54–8.71%, p < 0.05); and CA and chronic conditions (9.51–19.52%, p < 0.05), were driven by recall bias due to the respondent’s mental health. CA mediated the association between CSES and chronic conditions (9.58–25.06%, p < 0.05). Low CSES and CA are associated with higher risk of chronic conditions in later life. A minor proportion of these associations are driven by recall bias.
TL;DR: DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI) and there is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.
Abstract: We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990-2015. We e ...
TL;DR: There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries and future strategies should be externally evaluated.
Abstract: To appraise improvement strategies adopted by low- and middle-income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation. A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL, and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system. Of 3069 articles identified, 18 studied were included. These studies involved less than a tenth (n = 12, 8.6%) of all low- and middle-income countries. Most were case reports (58%), and the majority focused on palliative care (n = 11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure. There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, vaccines, and technologies; financing; and leadership and governance.
TL;DR: Employees with chronic disease leave paid work more often for unfavourable work outcomes and higher age, poor health, burnout, low co-worker support and chronic disease limitations were predictors for leaving paid employment.
Abstract: Objectives Objectives were to: (1) longitudinally assess transitions in employment status of employees with and without chronic disease; and (2) assess predictors of exit from paid employment. Methods Transitions in employment status at 1- and 2-year follow-up were assessed in a longitudinal cohort study of employees aged 15–63 years. Generalised estimating equations (GEE) and logistic regression analyses were performed to analyse differences in transitions and identify sociodemographic, health- and work-related predictors. Results At 1- and 2-year follow-up, 10,038 employees (37% with chronic disease) and 7636 employees responded. Employees with chronic disease had higher probability of leaving paid employment [OR 1.4 (1.1–1.6)] and unemployment, disability pension and early retirement. Employees without chronic disease had higher chance of moving into self-employment or study. At 2-year follow-up, employees with cardiovascular disease (15%), chronic mental disease (11%), diabetes (10%) and musculoskeletal disease (10%), had left paid employment most often. Higher age, poor health, burnout, low co-worker support and chronic disease limitations were predictors for leaving paid employment. Conclusions Employees with chronic disease leave paid work more often for unfavourable work outcomes.
TL;DR: Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region has been uneven and an overview of the EMR region is provided.
Abstract: Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview ...
TL;DR: A guideline on outdoor air pollution and its links to health makes recommendations on local interventions that can help improve air quality and prevent a range of adverse health outcomes associated with road-traffic-related air pollution.
Abstract: The National Institute for Health and Care Excellence, jointly with Public Health England, have developed a guideline on outdoor air pollution and its links to health. The guideline makes recommendations on local interventions that can help improve air quality and prevent a range of adverse health outcomes associated with road-traffic-related air pollution. The guideline was based on a rigorous assessment of the scientific evidence by an independent advisory committee, with input from public health professionals and other professional groups. The process included systematics reviews of the literature, expert testimonies and stakeholder consultation. The guideline includes recommendations for local planning, clean air zones, measures to reduce emissions from public sector transport services, smooth driving and speed reduction, active travel, and awareness raising. The guideline recommends taking a number of actions in combination, because multiple interventions, each producing a small benefit, are likely to act cumulatively to produce significant change. These actions are likely to bring multiple public health benefits, in addition to air quality improvements.
TL;DR: A systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus, calls for public health strategies to reduce the level of risk factors in each age group.
Abstract: OBJECTIVES: We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. METHODS: We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. RESULTS: In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. CONCLUSIONS: Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.
TL;DR: The selected UA are strongly associated with an increased occurrence of adolescents’ health-risk behaviours and low academic achievement, but adolescents engaged only in UA consistently report the least favourable outcomes.
Abstract: We aimed to assess the associations of involvement in selected unstructured activities (UA) with health-risk behaviours and academic achievement and the degree to which the participation in organized leisure-time activities (OLTA) changes these associations.
Using a sample of 6935 Czech adolescents aged 13 and 15 years, we investigated adolescents’ weekly involvement in hanging out, visiting shopping malls for fun and meeting friends after 8 p.m., OLTA and engagement in three health-risk behaviours and academic achievement.
Weekly involvement in the selected UA was associated with higher odds for regular smoking, being drunk, having early sexual intercourse and low academic achievement. Concurrent participation in OLTA did not buffer these negative outcomes, except for sexual experience. However, those highly engaged only in UA were more likely to participate in the health-risk behaviours and report worse academic achievement than those participating in any OLTA concurrently. The selected UA are strongly associated with an increased occurrence of adolescents’ health-risk behaviours and low academic achievement. Concurrent participation in OLTA does not buffer these negative outcomes significantly, but adolescents engaged only in UA consistently report the least favourable outcomes.
TL;DR: Detention, even for brief periods in relatively adequate conditions, was found to be detrimental to asylum seekers’ mental health and this adverse impact appears to be largely attributable to the combined effect of symbolic violence and disem power.
Abstract: The first objective of this qualitative component of a mixed-methods study is to provide a descriptive account of adult asylum seekers’ experience of detention in Canadian immigration detention centers. The second objective is to identify the main underlying factors accounting for their reported feelings of distress. Researchers interviewed 81 adult asylum seekers held in two Canadian immigration detention centers concerning their experience of detention. Participants were drawn from a sample of 122 detained asylum seekers who had completed structured questionnaires about mental health and detention conditions. Asylum seekers expressed shock and humiliation at being “treated like criminals.” Detainees felt disempowered by the experience of waiting for an indeterminate period for the outcome of a discretionary decision over which they have little control, but which will determine their freedom and their future. For trauma survivors, detention sometimes triggered retraumatization. Detention, even for brief periods in relatively adequate conditions, was found to be detrimental to asylum seekers’ mental health. This adverse impact appears to be largely attributable to the combined effect of two factors: symbolic violence and disempowerment.
TL;DR: Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities and the knowledge of referral reasons and the employment status were significantly associated with appointment show-ups.
Abstract: Assess the effect of selected low-cost eHealth tools on diabetes/hypertension detection and referrals rates in rural settings and refugee camps in Lebanon and explore the barriers to showing-up to scheduled appointments at Primary Healthcare Centers (PHC). Community-based screening for diabetes and hypertension was conducted in five rural and three refugee camp PHCs using an eHealth netbook application. Remote referrals were generated based on pre-set criteria. A phone survey was subsequently conducted to assess the rate and causes of no-shows to scheduled appointments. Associations between the independent variables and the outcome of referrals were then tested. Among 3481 screened individuals, diabetes, hypertension, and comorbidity were detected in 184,356 and 113 per 1000 individuals, respectively. 37.1% of referred individuals reported not showing-up to scheduled appointments, owing to feeling better/symptoms resolved (36.9%) and having another obligation (26.1%). The knowledge of referral reasons and the employment status were significantly associated with appointment show-ups. Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities.
TL;DR: Although the meso-level is explicitly mentioned in some of the integrative models to explain health inequalities, an explicit institutional approach including compositional and contextual characteristics of the major institutions of society has rarely been the focus of either theoretical reasoning or empirical research.
Abstract: Multilevel models that integrate associations between proximal and distant determinants of health have significantly improved our understanding of how health inequalities emerge. For example, it has been argued that the likelihood of being exposed to individual material, psychosocial and behavioural risk factors (micro-level) is strongly influenced by determinants at the macro-level (societal level) such as macroeconomic characteristics (income distribution, national wealth, and welfare), health care policy, or societal norms (CSDH 2008). Area-based measures of poverty and deprivation have also been found to be associated with health outcomes after adjustment for individual-level factors. The effects of these group-level variables on individual-level outcomes have been referred to as contextual effects (Sauzet and Leyland 2017). However, with regard to socioeconomic inequalities in health, surprisingly, little is known about contextual factors located at the (intermediate) meso-level. In general, mesolevel entities can be understood as smaller scale, lower level social arrangements or units with a different set of guidelines for societal organization. Key terms to define these arrangements are ‘‘institutions’’ or ‘‘institutional structures’’ which can be broadly described as systems of established and prevalent social rules that shape social interactions. Although the meso-level is explicitly mentioned in some of the integrative models to explain health inequalities, an explicit institutional approach including compositional and contextual characteristics of the major institutions of society has rarely been the focus of either theoretical reasoning or empirical research. Coming of age is a good example to illustrate how institutional contexts produce and reproduce health inequalities. Girls and boys participate in different institutional contexts and develop through involvement in institutionalized forms of practice that are characterized by institution-specific communication, activities, environments, and learning objectives. These forms of practice initiate but also restrict young people’s activities and thereby become important conditions for their development (Silverstein and Giarrusso 2011). Family/home, kindergarten, preschool, primary and secondary school, higher education, vocational schools, and training, the workplace and local health care system are such important institutional contexts, as they are relevant in most children’s and adolescents’ lives (Blum et al. 2012). Although these different institutional contexts have varying importance in childhood, adolescence, and young adulthood, they do have a strong reciprocal effect on each other. It is likely that characteristics of these institutions have an independent contextual effect on health above and beyond the individual level. Here, the meso-level generally includes group-level characteristics which can be separated into ‘‘compositional’’ factors (which people are found in an institution) and ‘‘contextual’’ ones (characteristics of an institution). For example, the school provides students with differential learning and developmental opportunities that are determined by group composition and schools’ contextual characteristics. Compositional features, for example, refer to student characteristics in classes and schools measured by aggregating information from students to the class or school level, such as the average level of the psychosocial learning environment or the proportion of students with specific socioeconomic background characteristics. Contextual factors, in contrast, focus on the shared organizational, cultural, social, and physical factors of the institution, meaning the built environment, quality of sanitary facilities, the number of teachers and their qualification, and even the availability of healthy food at school. & Matthias Richter m.richter@medizin.uni-halle.de
TL;DR: Tobacco control efforts must address the higher prevalence and co-occurrence of risk factors in higher SES contexts since these may render initiation highly probable in many lower SES youth.
Abstract: To investigate whether the prevalence or co-occurrence of risk factors for cigarette smoking initiation differ by socioeconomic status (SES) and whether SES interacts with risk factors to increase initiation. In 2005, 1451 5th grade never smokers (mean age 10.7 years) in Montreal, Canada, provided baseline data, with follow-up in 6th and/or 7th grade (2005–2007). Poisson regression analyses estimated the association between 13 risk factors and initiation. Excess risk of each risk factor in low vs. moderate–high SES participants was assessed. Cigarette smoking was initiated by 9.4% of participants (n = 137). Low SES was associated with a higher prevalence and co-occurrence of risk factors. The estimated association of most risk factors with initiation was similar across SES, although participants from low SES neighborhoods whose mothers had no university education had three times the risk of initiation [ARR = 3.10 (1.19, 8.08)] compared to more affluent peers. Tobacco control efforts must address the higher prevalence and co-occurrence of risk factors in lower SES contexts since these may render initiation highly probable in many lower SES youth.
TL;DR: The majority of the widening in the educational gap in mortality among women can be attributed to alcohol and smoking-related mortality, which contributes substantially to inequalities among men and women.
Abstract: To assess the level and changes in contribution of smoking and alcohol-related mortality to educational differences in life expectancy in Sweden. We used register data on the Swedish population at ages 30–74 during 1991–2008. Cause of death was used to identify alcohol-related deaths, while smoking-related mortality was estimated using lung cancer mortality to indirectly assess the impact of smoking on all-cause mortality. Alcohol consumption and smoking contributed to educational differences in life expectancy. Alcohol-related mortality was higher among men and contributed substantially to inequalities among men and made a small (but increasing) contribution to inequalities among women. Smoking-related mortality decreased among men but increased among women, primarily among the low educated. At the end of the follow-up, smoking-related mortality were at similar levels among men and women. The widening gap in life expectancy among women could largely be attributed to smoking. Smoking and alcohol consumption contribute to educational differences in life expectancy among men and women. The majority of the widening in the educational gap in mortality among women can be attributed to alcohol and smoking-related mortality.
TL;DR: Higher levels of perceptions of the importance of spiritual health, both overall and within the four domains, were associated with higher likelihoods of reporting each of the positive health outcomes.
Abstract: Spirituality has been proposed as a potential health asset a ‘developmental engine’ that works by fostering the search for connectedness, meaning and purpose. The aim is to examine to what extent spiritual health might be protective of young people’s overall health and well-being. In 2014, young people aged 11, 13, and 15 years in England, Scotland and Canada were surveyed as part of the HBSC study (n = 26,701). The perceived importance of spiritual health and domains (connections with self, others, nature, and the transcendent) was measured in these countries. Multi-level log-binomial models were used to explore relationships between spiritual health and three self-reported positive health outcomes: general health status, subjective life satisfaction and health complaints. Higher levels of perceptions of the importance of spiritual health, both overall and within the four domains, were associated with higher likelihoods of reporting each of the positive health outcomes. Spiritual health appears to operate as a protective health asset during adolescence and is significantly shaped by external relationships and connections.
TL;DR: Migrants and children with unemployed parents are at risk for excessive ST and all vulnerable groups have lower odds of being sports club members.
Abstract: To examine associations between social vulnerabilities and meeting physical activity (PA) and screen time (ST) recommendations during a 2-year follow-up. 13,891 children aged 2.0 to < 9.9 from eight European countries were assessed at baseline and 8482 children at follow-up. Children’s sports club membership, PA and ST were collected via parental questionnaires. Moderate-to-vigorous physical activity (MVPA) was objectively assessed with accelerometers. Performing at least 1 h of MVPA daily and spending less than 2 h of ST defined physically active and non-sedentary children, respectively. Vulnerable groups were defined at baseline as children whose parents had minimal social networks, from non-traditional families, with migrant origin or with unemployed parents. Logistic mixed-effects analyses were performed adjusting for classical socioeconomic indicators. Children whose parents had minimal social networks had a higher risk of non-compliance with PA recommendations (subjectively assessed) at baseline. Migrants and children with unemployed parents had longer ST. All vulnerable groups were less likely to be sports club members. Migrants and children with unemployed parents are at risk for excessive ST and all vulnerable groups have lower odds of being sports club members.
TL;DR: The burden of VL is high in the EMR; however, it shows a descending trend over the past 25 years and EMR countries need to establish comprehensive eye care programs in their health care systems.
Abstract: To report the estimated trend in prevalence and years lived with disability (YLDs) due to vision loss (VL) in the Eastern Mediterranean region (EMR) from 1990 to 2015. The estimated trends in age-standardized prevalence and the YLDs rate due to VL in 22 EMR countries were extracted from the Global Burden of Disease (GBD) 2015 study. The association of Socio-demographic Index (SDI) with changes in prevalence and YLDs of VL was evaluated using a multilevel mixed model. The age-standardized prevalence of VL in the EMR was 18.2 in 1990 and 15.5 in 2015. The total age-standardized YLDs rate attributed to all-cause VL in EMR was 536.9 per 100,000 population in 1990 and 482.3 per 100,000 population in 2015. For each 0.1 unit increase in SDI, the age-standardized prevalence and YLDs rate of VL showed a reduction of 1.5 (p < 0.001) and 23.9 per 100,000 population (p < 0.001), respectively. The burden of VL is high in the EMR; however, it shows a descending trend over the past 25 years. EMR countries need to establish comprehensive eye care programs in their health care systems.
TL;DR: The goal of this project was to modify the ACE-IQ for cultural context in a low-resource, underserved community in South Africa (SA).
Abstract: Adverse childhood experiences (ACEs) research based in the United States demonstrated that traumatic stress in childhood can cause negative physical and mental health outcomes (Stumbo et al. 2015; Normal et al. 2012; Waldman et al. 2011). Many developing countries lack extensive research on ACEs and comprehensive data on exposure to childhood trauma (Anda 2009). The World Health Organization (WHO) ACE international questionnaire (ACEIQ) highlights multiple types of abuse, neglect, and violence while broadening the definition of traumatic stress to include more globally relevant concerns (WHO 2017). The ACE-IQ requires modifications to match the cultural context of the population. This is of high importance due to the need to develop and implement culturally relevant survey mechanisms specific to communities and interventions aligned with community needs. Cultural relevancy is formulated by addressing cultural and contextual differences between the priority population and other populations (Alegria et al. 2004; Kumas-Tan et al. 2007) and is depicted by a specific location, cultural mores, and terminology. The goal of this project was to modify the ACE-IQ for cultural context in a low-resource, underserved community in South Africa (SA). Munsieville, SA is an undeveloped township with reports of local children seeking assistance following acts of violence (Project Hope UK 2017). It is suspected that children living in townships are disproportionately affected by violence and family dysfunction (Ward et al. 2007). These circumstances made Munsieville an ideal community to examine ACE prevalence after modification of the ACE-IQ. Residents of Munsieville aged 18 and older were eligible to participate in the study and recruited through community leaders. Local facilitators were used to conduct three focus groups and one interview to gain insight into proper modification of the ACE-IQ. Groups included: females 18–29 (N = 6); females 30–50 (N = 5); males 18–29 (N = 5); and a male 30–50-year-old (N = 1). Discussion of the overall project and operational definitions of trauma, abuse, neglect, and violence for this setting were completed at the beginning of each session. For each question on the ACE-IQ, participants were asked: