Higher educational attainment but not higher income is protective for cardiovascular risk in Deaf American Sign Language (ASL) users

BackgroundHigher educational attainment and income provide cardiovascular protection in the general population. It is unknown if the same effect is seen among Deaf American Sign Language (ASL) users who face communication barriers in health care settings.ObjectiveWe sought to examine whether educational attainment and/or annual household income were inversely associated with cardiovascular risk in a sample of Deaf ASL users.MethodsThis cross-sectional study included 302 Deaf respondents aged 18–88 years from the Deaf Health Survey (2008), an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) administered in sign language. Associations between the self-reported cardiovascular disease equivalents (CVDE; any of the following: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) with educational attainment (≤high school [low education], some college, and ≥4 year college degree [referent]), and annual household income (<$25,000, $25,000–<$50,000, or ≥$50,000 [referent]) were assessed using a multivariate logistic regression adjusting for age, sex, race/ethnicity, and smoking history.ResultsDeaf respondents who reported ≤high school education were more likely to report the presence of a CVDE (OR = 5.76; 95% CI = 2.04–16.31) compared to Deaf respondents who reported having ≥4 year college degree after adjustment. However, low-income Deaf individuals (i.e., household incomes <$25,000) were not more likely to report the presence of a CVDE (OR = 2.24; 95% CI = 0.76–6.68) compared to high-income Deaf respondents after adjustment.ConclusionLow educational attainment was associated with higher likelihood of reported cardiovascular equivalents among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect for Deaf respondents.     

Factors Affecting the Use of Dietary Supplements by Korean Adults: Data from the Korean National Health and Nutrition Examination Survey III

We investigated the use of dietary supplements among adult Korean consumers, including associations involving sociodemographic variables, lifestyle characteristics, health-related factors, and dietary supplement use. The data were derived from the 2005 third Korean National Health and Nutrition Examination data among 4,775 adults (1,983 men and 2,792 women) regarding medical examinations and diet. In general, 21.8% of the male and 32.0% of the female respondents used dietary supplements regularly. Dietary supplement users tended to reside in large cities and to have higher monthly incomes. People with bone diseases consumed 1.71 times higher (95% confidence interval [CI] 1.19 to 2.46) amounts of supplements than those without such diseases. Among dietary supplement users, female respondents expressed a preference for carbohydrates (adjusted odds ratio [OR] 3.79; 95% CI 1.33 to 10.79). The intake rates for vitamin/mineral complexes tended to increase with age (P for trend 0.007) and respondents earning higher incomes expressed a preference for minerals, vitamin/mineral complexes, and terpenes. Carbohydrate use decreased among those with higher education levels: high school graduates were 0.48 times (95% CI 0.23 to 0.99) and those with college or above were 0.24 times (95% CI 0.07 to 0.83) more likely to use carbohydrates. Nonsmokers (OR 2.63; 95% CI 1.68 to 4.13), nondrinkers (OR 1.73; 95% CI 1.09 to 2.73), and those with bone disease (OR 2.19; 95% CI 1.24 to 3.86) expressed a preference for vitamins. Those who had been diagnosed with a chronic disease showed a preference for terpenes (OR 2.81; 95% CI 1.03 to 7.68). These results indicate that dietary supplement use might be affected by certain sociodemographic, lifestyle, and health characteristics.     

Reversal of Associations Between Spanish Language Use and Mammography and Pap Smear Testing

Latina women are less likely to utilize cancer screening services than are non-Latina White women. The purpose of this study is to examine the relationship between preferred language (English vs. Spanish) and receipt of mammography and Pap-smear testing among US Latinas and non-Latinas. Cross-sectional analysis of the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. While Latinas responding to the BRFSS in English or in Spanish had unadjusted lower odds of receiving mammography testing, in multivariable analysis Latinas responding-in-Spanish had 2.20 times the odds (OR = 2.20, 95 % CI, 1.90–2.55) of reporting mammography compared to non-Latinas. Similarly, Latinas responding-in- Spanish had lower unadjusted odds of receiving Pap-smear testing. However, Latinas responding-in-Spanish had 2.37 times the odds (OR = 2.37 CI, 2.04–2.75) of reporting having received Pap smear testing compared to non-Latinas in multivariate analysis. The results of this paper further confirm the “reversed associations” among Latinas and mammography and Pap smear testing described in previous studies and suggest that in addition to insurance status, preferred language may be a key variable contributing to the reversal phenomenon observed among Latinas.     

Prevalence of self-rated visual impairment among adults with diabetes.

OBJECTIVES: This study estimated the prevalence of self-rated visual impairment among US adults with diabetes and identified correlates of such impairment. METHODS: Self-reported data from the 1995 Behavioral Risk Factor Surveillance System survey of adults 18 years and older with diabetes were analyzed. Correlates of visual impairment were examined by multiple logistic regression analysis. RESULTS: The prevalence of self-rated visual impairment was 24.8% (95% confidence interval [CI] = 22.3%, 27.3%). Among insulin users, multivariable-adjusted odds ratios were 4.9 (95% CI = 2.6, 9.2) for those who had not completed high school and 1.8 (95% CI = 1.0, 2.8) for those who had completed high school compared with those with higher levels of education. Comparable estimates of odds ratios for nonusers of insulin were 2.2 (95% CI = 1.4, 3.4) and 1.3 (95% CI = 0.9, 2.0), respectively. Among nonusers, the adjusted odds for minority adults were 2.4 (95% CI = 1.0, 3.7) times the odds for non-Hispanic Whites. CONCLUSIONS: By these data, 1.6 million US adults with diabetes reported having some degree of visual impairment. Future research on the specific causes of visual impairment may help in estimating the avoidable public health burden.     

Father’s Education: An Independent Marker of Risk for Preterm Birth

To explore the association between paternal education and preterm birth, taking into account maternal social and economic factors. We analyzed data from a population-based cross-sectional postpartum survey, linked with birth certificates, of women who gave birth in California from 1999 through 2005 (n = 21,712). Women whose infants’ fathers had not completed college had significantly higher odds of preterm birth than women whose infants’ fathers were college graduates, even after adjusting for maternal education and family income [OR (95% CI) = 1.26 (1.01–1.58)]. The effect of paternal education was greater among unmarried women than among married women. Paternal education may represent an important indicator of risk for preterm birth, reflecting social and/or economic factors not measured by maternal education or family income. Researchers and policy makers committed to understanding and reducing socioeconomic disparities in birth outcomes should consider paternal as well as maternal socioeconomic factors in their analyses and policy decisions.     

Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003

OBJECTIVE: We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors. METHODS: Using the National Health Interview Survey 2000-2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents). RESULTS: The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03). CONCLUSIONS: This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.     

Lack of Health Insurance Coverage Among Working-age Adults, Evidence From the Behavioral Risk Factor Surveillance System, 1993–2006

To use data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine trends in the lack of health insurance coverage among working-age US adults and to identify populations without coverage. The BRFSS data from 1993 to 2006 were analyzed. SUDAAN software was used to generate estimates of prevalence and corresponding standard errors, and logistic regression techniques were used to examine trends in the data. An estimated 18.59% of working adults (aged 18-64 years) did not have health insurance coverage in 2006. Trend in uninsurance remained somewhat stable from 1993 to 2000 (OR = 1.01; 95% CI 1.00-1.02); however, it changed more rapidly from 2001 to 2006 (OR = 1.03; 1.02-1.03). Similar patterns were observed from 2001 to 2006 for those <35 years of age, employed, Hispanics and those with less than or high school education. Effective approaches to reducing uninsurance and the consequences related to lack of coverage are needed in the face of increasing health disparities in the United States.     

Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey

OBJECTIVES: We investigated hysterectomy prevalence among Hispanic women. METHODS: We obtained data from 4684 Hispanic women and 20 604 non-Hispanic White women from the 1998-1999 National Health Interview Survey. We calculated nationally representative odds ratios of previous hysterectomy, controlling for confounders. RESULTS: Compared with non-Hispanic White women, the odds ratio for hysterectomy was 0.36 (95% confidence interval [CI] = 0.30, 0.44) for Hispanic women with no high school diploma, 0.57 (95% CI = 0.44, 0.74) for high school graduates, and 0.67 (95% CI = 0.42, 0.87) for college attenders. Country of origin had little influence on hysterectomy prevalence. Hysterectomy was positively associated with acculturation. CONCLUSIONS: Hispanic women undergo fewer hysterectomies than do non-Hispanic White women. The reasons for this, as well as information on ethnicity-specific appropriateness of hysterectomy, should be explored.     

Travel to,and use of,twenty-one Michigan trails

Objective and methodsThis study examined trail use among 857 trail users on 21 trails in Michigan from 2008 to 2011 using a valid and reliable intercept survey.ResultsMost of the 857 participants traveled to the trail from their home (92.6%), lived within 15 min of the trails (74.8%), and used active transport to travel to the trails 69.7%. The odds of active transport to the trails were greater among those who had not graduated high school (OR = 3.49; 95% CI = 1.02, 11.99) and high school graduates (OR = 7.432; 95% CI = 2.02, 27.30) compared to college graduates. Whites and adults also had greater odds of active transport than non-Whites (OR = 3.160, 95% CI: 1.65, 6.05), and older adults (OR = 1.75; 95% CI: 1.20, 2.54). The majority of respondents (89.7%) reported using trails for recreational purposes. A significantly greater proportion of females (73.3%) compared to males (64.7%) reported using the trail with others.ConclusionsThe findings from this study might enable health and parks and recreation professionals to better promote physical activity on trails.     

Factors associated with self-reported, pesticide-related visits to health care providers in the agricultural health study.

To investigate factors associated with pesticide-related visits to health care providers (i.e., doctor or hospital visits), responses to self-administered questionnaires received from 35,879 licensed restricted-use pesticide applicators participating in the Agricultural Health Study were analyzed. (In Iowa, applicators are actually certified, whereas in North Carolina they are licensed; for ease of reference, the term license will be used for both states in this paper.) The cohort reported a total of more than 10.9 million pesticide-application days. These applications were associated with one or more pesticide-related health care visits by 2,214 applicators (7.0% of the applicator cohort for whom health care visit data were available). The odds of a pesticide-related health care visit were increased for commercial applicators compared to private applicators [odds ratio (OR = 1.77; 95% confidence interval (CI), 1.52-2.06) and for applicators who used insecticides 70 times or more in their lifetime compared to those who used insecticides less frequently (OR = 1.43; CI, 1.26-1.63). After adjusting for the number of applications in a logistic regression model, significantly higher odds of health care visits were observed among North Carolina applicators compared to Iowa applicators (OR = 1.35; CI, 1.17-1.52), among applicators who mixed their own pesticides (OR = 1.65; CI, 1. 22-2.23), and among applicators who personally repaired their pesticide application equipment at least once per year (OR = 1.12; CI, 1.06-1.25). Significantly lower odds were found among female versus male applicators (OR = 0.68; CI, 0.46-0.99) and among applicators who graduated from high school versus those who did not (OR = 0.82; CI, 0.71-0.94 for high school graduates and OR = 0.79; CI, 0.68-0.91 for those with at least some college). Several methods of pesticide application to crops, seed, or stored grain were also associated with significantly elevated odds ratios of health care visits. These observations suggest that several steps can be taken to reduce the number of health care visits resulting from occupational exposure to pesticides. The implications of this pattern of pesticide-related health care visits may have etiologic implications for cancer and other chronic diseases.     

Imported Compounded Diet Pill Use Among Brazilian Women Immigrants in the United States

In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18–50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.     

Healthy behaviors among women in the United States and Ontario: the effect on use of preventive care.

OBJECTIVES: This study examined how several healthy behaviors among women in Ontario and the United States explained (1) the use of preventive health services, (2) differences in use between socioeconomic groups, and (3) differences in use between the two health systems. METHODS: 1990 data on women from the Ontario Health Survey (n = 22,985) and the US National Health Interview Survey (n = 19,092) were analyzed. A woman who avoided smoking and obesity, used seatbelts, and regularly engaged in aerobic exercise was defined as having a healthy lifestyle. Women were considered screened if they reported a mammogram or a breast exam within the previous year or a Pap smear within 2 years. RESULTS: A healthy lifestyle was more common in the United States than Canada among more highly educated groups (odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.22, 1.60 for college educated) but less common in the United States for those with less than a high school education (OR = 0.52; 95% CI = 0.40, 0.67). Each additional unhealthy behavior decreased the odds of having undergone a mammogram in the previous year by 20%. However, adjusting for the number of unhealthy behaviors did not substantially change the relationship between socioeconomic status and use of preventive services. CONCLUSIONS: The number of healthy behaviors is an important measure of demand for preventive health services. This measure varies across country and socioeconomic group.     

The role of economic and educational factors in asthma: evidence from the Portuguese health survey

OBJECTIVE: To evaluate the importance of economic and educational factors in determining the risk of asthma in adults. STUDY DESIGN AND METHODS: This was a cross-sectional study in a representative sample of Portuguese adults (20,977 females and 18,663 males) from the main regions of mainland Portugal. Participants were categorized according to years of education (< or = 4, 5-9, 10-12 and >12 years) and income (< or = 314, 315-547, 548-815 and >815Euros/month). Information on asthma was based on answers to the following question: 'Have you had asthma in the previous year?' Logistic regression models were fitted to estimate the magnitude of the association between asthma and education/income, adjusting for confounders (body mass index, age, smoking habits, physical activity, area of residence, number of household members and income/education). RESULTS: In females and males, the odds of having asthma decreased with increasing income (P-value for trend <0.001), with odds ratios of 0.52 [95% confidence intervals (CI) 0.41-0.66] and 0.55 (95%CI 0.44-0.68) for those with a monthly income >815 Euros compared with those with a monthly income 314 Euros, respectively. For both genders, the odds of having asthma were not significantly associated with years of education. CONCLUSION: A significant positive association between per capita national income and asthma reinforces that public policy should stress the importance of economic growth as a means for preventing asthma occurrence and improving quality of life.     

Reduced low birth weight for teenagers receiving prenatal care at a school-based health center: effect of access and comprehensive care.

PURPOSE: To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based. METHODS: Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics. RESULTS: Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24). CONCLUSIONS: School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.     

Relations between individual and neighborhood-based measures of socioeconomic position and bone lead concentrations among community-exposed men: the Normative Aging Study.

To examine the association between lead exposure and both individual and geographic area indicators of socioeconomic position, the authors measured tibia lead concentration, a biomarker of cumulative lead exposure, using K x-ray fluorescence in a cross-sectional survey of 538 white males aged 50-92 years who were healthy when enrolled in the Normative Aging Study (Boston, Massachusetts) in the 1960s. Data on individual risk factors, education, occupation, and income were collected by questionnaire. Using subjects' residential addresses at the time of the tibia lead measurements, the authors obtained geographic area-specific measures of education, social class, and poverty by linking records to 1990 US Census block group data. In multivariate linear regression analysis controlling for age and cumulative smoking, tibia lead concentrations were 10.39 microg/g (95% confidence interval (CI) 7.80-12.97) higher in men who did not graduate from high school than in men with > or =4 years of college. Among the former men (non-high school graduates), living in an undereducated area was associated with a 9.28 microg/g (95% CI 1.59-16.97) increase in tibia lead level compared with living in a non-undereducated area; among the latter men (college graduates), no difference existed by residential area education (beta = 0.72, 95% CI -5.35 to 6.78). The authors conclude that the influence of individual socioeconomic position on cumulative lead exposure is modified by geographic area conditions.     

Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.     

Peer Reviewed: Awareness of Racial and Socioeconomic Health Disparities in the United States: The National Opinion Survey on Health and Health Disparities, 2008-2009

Introduction

Recent initiatives aim to improve public awareness of health disparities. However, little research has actually documented the US public''s awareness of racial/ethnic and socioeconomic health disparities. We sought to determine 1) whether the US public is aware of racial, educational, and income disparities in health, 2) whether awareness differs across these disparity domains, and 3) what respondent characteristics are associated with awareness of racial, educational, and income disparities in health.

Methods

We conducted the National Opinion Survey on Health and Health Disparities with 2,791 US adults. We asked respondents to answer questions about disparities in health between 1 of several pairs of population subgroups: African Americans versus whites, non–high school graduates versus high school graduates, high school graduates versus college graduates, the poor versus the middle class, or the middle class versus the rich. We used χ² tests and logistic regression to compare correlates of respondents'' awareness of disparities across the different pairs of population subgroups.

Results

Most respondents were aware of health disparities between the poor and middle class (73%); fewer were aware of health disparities between African Americans and whites (46%). Although respondents recognized that education is associated with many positive life outcomes, they were less aware of the link between education and health. Respondents who were younger, less educated, lower-income, healthier, or politically conservative were less likely to be aware of health disparities.

Conclusion

Public awareness of disparities in health differs depending on both the type of disparity and the characteristics of the individual respondent.     

重庆市进城务工者乙肝疫苗接种情况及影响因素分析

目的 了解重庆市进城务工者乙肝疫苗接种情况及其影响因素。方法 采用目的性抽样的方法,调查重庆市主城区不同行业、18岁及以上的进城务工者1188名。结果 重庆市进城务工者乙肝疫苗接种率为51.09%,其中男性、女性疫苗接种率分别为50.21%和51.66%。随着研究对象年龄的增高,疫苗接种水平相对下降（OR=0.97,95%CI:0.95～0.98）;文化程度为高中（OR=1.42,95%CI:1.07～1.89）和大专及以上者（OR=1.80,95%CI:1.21～2.67）疫苗接种水平高于初中及以下者;未婚有恋人/已婚者（OR=2.00,95%CI:1.47～2.74）乙肝疫苗接种水平高于单身者。结论 重庆市进城务工者乙肝疫苗接种水平尚可。应加强对进城务工者的乙肝知识宣教和接种疫苗的动员,重点关注年龄较大、文化程度较低、单身的进城务工者。     

Pregnancy Intention and Contraceptive Use Among Adult Women

Objectives: We examined pregnancy intention measures and contraceptive use behaviors among reproductive-age women using data from two CDC-based surveillance systems. Methods: We analyzed data for women aged 18–44 from 4 states that collected information on pregnancy and contraceptive use from both the Behavioral Risk Factor Surveillance System (BRFSS, n = 4201) and the Pregnancy Risk Assessment Monitoring System (PRAMS, n = 7761) in 2000. Standard definitions of intended and unintended pregnancy were used. Results: BRFSS data show that 4% (95% CI: 2.8–5.2) of the women were pregnant at the time of interview and that 57% (95% CI: 41.9–71.9) of these pregnancies were intended. Women who had been pregnant within the last 5 years but were not currently pregnant reported that 61% (95% CI: 55.9–65.3) of their most recent pregnancies had been intended. According to PRAMS, 58% (95% CI: 56.5–60.5) of women with live births had intended pregnancies. Contraceptive use varied across the surveys; 68% (95% CI: 65.7–70.7) of all non-pregnant women from BRFSS and 87% (95% CI: 85.1–87.9) of women with a recent live birth from PRAMS reported using contraceptives. Conclusions: Although contraceptive use differed between the BRFSS and PRAMS, the patterns of pregnancy intention were similar for women who had a pregnancy within the past 5 years, those who recently delivered a live-born infant, and those who were currently pregnant. It appears that reporting of pregnancy intention is not affected by timing of assessment across the two surveys.     

When aspirations and achievements don't meet. A longitudinal examination of the differential effect of education and occupational attainment on declines in self-rated health among Canadian labour force participants

BACKGROUND: To examine the association of a mismatch between educational qualifications and occupational attainment and subsequent declines in self-rated health (SRH) in a longitudinal nationally representative Canadian population sample. METHODS: This study used longitudinal data from 4045 healthy, working respondents of the Canadian National Population Health Survey. Respondents were categorized as either qualified, overqualified, or underqualified based on the match between their education and the skills required for their current occupation over a 2-year period. Logistic regression analysis estimated the odds of decline in SRH over the following 4-year period, using the match between occupation and education as the main independent variable. Analyses were controlled for a number of confounding variables including health behaviours, mental health, self-esteem, job control, and demographic information. RESULTS: Relative to respondents with university education working in occupations for which they were qualified, respondents with university education, working in occupations for which they were overqualified had a significant risk of decline in SRH between 1996 and 2000, even after adjusting for a number of potential confounders (OR = 2.08, 95% CI 1.11-3.91). In respondents with secondary education or less, differences in occupational attainment were not associated with differences in the odds of decline in SRH. CONCLUSIONS: The effect of occupational attainment on health is important for individuals who have invested the most time in their education. Conversely, differential occupational attainment is not associated with differences in the odds of decline in health for participants with lower levels of education.