Neighbourhood level and individual level SES effects on child problem behaviour: a multilevel analysis

OBJECTIVE: This study examined whether neighbourhood level socioeconomic variables have an independent effect on reported child behaviour problems over and above the effect of individual level measures of socioeconomic status. DESIGN AND SETTING: Multilevel analysis of cross sectional survey data relating individual level child behavioural problems and parental measures of socioeconomic status with neighbourhood level measures of socioeconomic deprivation in the city of Maastricht, the Netherlands. PARTICIPANTS: Children born in the years 1990-1991 attending the second grade of normal kindergarten schools in the city of Maastricht, the Netherlands. Out of 1417 eligible 5-7 year olds, the parents of 734 children (51.8%) agreed to participate. MAIN RESULTS: Child behaviour problems were more frequent in families of low parental occupation and education (F=14.51, df 3, 721, p<0.001; F=12.20, df 3, 721, p<0.001, respectively) and in families living in deprived neighbourhoods (F=13.26, df 2, 722, p<0.001). Multilevel random effects regression analysis showed that the effect of neighbourhood level deprivation remained after adjustment for individual level socioeconomic status (B over three levels of deprivation: 1.36; 95%CI=0.28, 2.45). CONCLUSIONS: Living in a more deprived neighbourhood is associated with higher levels of child problem behaviour, irrespective of individual level socioeconomic status. The additional effect of the neighbourhood may be attributable to contextual variables such as the level of social cohesion among residents.     

Neighbourhood social participation and women's use of anxiolytic-hypnotic drugs: a multilevel analysis

Study objectives: To identify and quantify a hypothesised collective effect of the neighbourhood on individual use of anxiolytic-hypnotic drugs (AHD). To analyse the general impact of neighbourhood social participation on use of AHD, adjusting for individual characteristics. Design: Cross sectional analysis performed by multilevel logistic regression with women at the first level and neighbourhoods at the second level. Setting: Malmö (250 000 inhabitants), Sweden. Participants:15 456 women aged 45 to 73, residing in 95 neighbourhoods in Malmö, who took part in the Malmö diet and cancer study (1991–1996). Main results: The prevalence of AHD use was 5.5% in the study sample. Overall, 1.7% of the total individual differences in the propensity for using AHD were explained by the neighbourhood level. This percentage, however, differed between different individuals. Low level of social participation in the neighbourhood was associated with higher probability of AHD use (OR = 3.10 (95% CI 1.51 to 6.41)), independently of individual age, low social participation, low educational level, and living alone. This association was reduced (OR = 2.01 (95% CI 0.97 to 4.14)) after the additional accounting for individual disability pension, low self rated health, stress, and medication for somatic disorders. Conclusions: The neighbourhood level of social participation seems to affect individual use of AHD, possibly through individual characteristics. However, neighbourhood boundaries play a minor part in understanding individual AHD use in the city of Malmö.     

Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors

OBJECTIVE: To explore the association between physical neighbourhood stressors and smoking, and the contribution of these stressors to neighbourhood and individual socioeconomic inequalities in smoking. METHODS: Data were analysed of participants of the baseline measurement of the Dutch GLOBE study (1991), aged 20 years and older, who lived in 79 neighbourhoods of the city of Eindhoven (n = 9062). The neighbourhood socioeconomic environment was assessed from aggregated self reported information of participants' education and occupation level, and employment status. Neighbourhood stressors included were the physical quality (decay), required police attention, noise pollution from traffic, and population density in neighbourhoods. Current smokers were distinguished from previous and never smokers. RESULTS: Compared with those living in the most advantaged neighbourhoods, residents living in the socioeconomically most disadvantaged neighbourhoods were more likely to smoke (adjusted for age, sex, education, occupation, and employment status) (OR = 1.24, 95% CI 1.05 to 1.46). An increase in a summary neighbourhood stressor score was associated with smoking, independently of the neighbourhood socioeconomic environment (OR = 1.57, 95% CI 1.11 to 2.21, in the neighbourhoods with the highest stress score). Adjustment for the score substantially reduced the odds ratio for living in the socioeconomic most disadvantaged neighbourhoods (OR = 1.03, 95% CI 0.84 to 1.28, for those in the most disadvantaged neighbourhoods). Neighbourhood stressors contributed 10% to the increased probability of smoking in the lowest educated persons. CONCLUSIONS: Physical neighbourhood stressors are related to smoking and contribute substantially to neighbourhood inequalities in smoking over and above individual level characteristics.     

Taking action to lose weight: toward an understanding of individual differences

The purpose of the present study was to understand differences in obese/overweight individuals who do and do not seek ongoing external assistance for weight loss. Help-seeking was examined as a dichotomous and as a continuous variable. Measures of body mass index, comorbid medical conditions, socioeconomic status, psychological distress, disordered eating behavior, body image, and obesity-related knowledge were administered to a community sample of 120 overweight women (age: 22-65 y, BMI: 25-63 kg/m(2)). Fewer predictors of help-seeking were identified when measuring help-seeking as a dichotomy than when measuring it as a continuum. All predictors were from psychosocial domains, with obesity-related knowledge being the strongest, most consistent predictor. Help-seeking for weight control in a community sample of overweight and obese individuals appears to be motivated by psychological aspects of obesity, rather than obesity's physical or medical burden.     

Size estimation versus figural ratings of body image disturbance: Relation to body dissatisfaction and eating dysfunction

The current investigation compared several different measures of body image disturbance in college males and females. Measures of perceptual size overestimation, figure rating preferences, and questionnaire indices of body dissatisfaction and eating disturbance were collected. Subjects also rated body sizes based on ideal, affective, and cognitive/rational rating protocols. The results revealed little connection between indices of perceptual overestimation and body dissatisfaction or eating dysfunction. Alternatively, figural ratings were strongly associated with these measures. Regression analyses revealed that body dissatisfaction and figural discrepancy measures were highly related to eating disturbance for both males and females. In addition, discrepancies based on affective versus cognitive/rational rating protocols explained unique variance associated with eating disturbance. The findings are discussed with regard to the need to conduct a multifaceted assessment of body image disturbance.     

Neighbourhood characteristics, individual level socioeconomic factors, and depressive symptoms in young adults: the CARDIA study

STUDY OBJECTIVE: To investigate the relation between neighbourhood socioeconomic and ethnic characteristics with depressive symptoms in a population based sample. DESIGN: Cross sectional data from the CARDIA study, including the Center for Epidemiological Studies depression scale score (CES-D). Neighbourhoods were 1990 US census blocks of 1000 people; six census variables reflecting wealth/income, education, and occupation investigated separately and as a summary score; neighbourhood racial composition (percentage white and black) and individual level income and education were also examined. SETTING: Participants recruited in 1985/86 from community lists in Birmingham, AL; Chicago, IL; Minneapolis MN; from a health plan in Oakland, CA. PARTICIPANTS: 3437 adults aged 28-40 years in 1995/96: 24% white men, 27% white women, 20% black men, 29% black women. MAIN RESULTS: For each race-sex group, CES-D was inversely related to neighbourhood score and individual income and education. Associations of neighbourhood score with CES-D became weak and inconsistent after adjusting for individual level factors; personal income remained strongly and inversely associated with CES-D. Age adjusted mean differences (standard errors) in CES-D between the lowest and highest income categories were 3.41 (0.62) for white men, 4.57 (0.64) for white women, 5.80 (0.87) for black men, and 5.74 (0.83) for black women. For both black and white participants, CES-D was associated negatively with percentage of white people and positively with percentage of black people in their census block, before, but not after, adjustment for individual and neighbourhood socioeconomic variables. CONCLUSIONS: Neither neighbourhood socioeconomic characteristics nor ethnic density were consistently related to depressive symptoms once individual socioeconomic characteristics were taken into account.     

Precarious ordering: toward a formal theory of women's caring

Given the current societal and political trends toward increasing demands on women to provide care, a conceptualization of caring that captures the common processes of diverse women's caring experiences, and makes the consequences of caring for women's health visible, is critical for the development of a health and social policy that is responsive to women. The findings of this feminist grounded theory study go beyond the current theoretical understandings of women's caring, framed as either burden or fulfilment. The complex strategies women use to manage the dissonance created by competing and changing caring demands are revealed as a process I have named precarious ordering. This middle range theory demonstrates the power and resilience in women's management through the interdependent processes of setting boundaries, negotiating, and repatterning care. In addition, the method of theoretical sampling used in this study is explicated to move toward a formal theory applicable to diverse women's caring in a wide range of health, illness, and developmental situations.     

Women's global self-determination, eating regulation, and body dissatisfaction: exploring the role of autonomy support

Body dissatisfaction is an important correlate of dysfunctional eating. In the present study (N = 208) the primary aim was to test whether women's internal and autonomous motivation can protect against endorsements of societal pressures regarding the ideal female body and against body dissatisfaction. Additionally, the role of others' autonomy support was investigated. Women who reported more Global Self-Determination (GSD) were lower in internalisation of the thin ideal and this association was fully mediated by perceived sociocultural pressure to be thin. Moreover, the positive association between perceived pressure and body dissatisfaction was partially mediated by thin ideal internalisation. Body dissatisfaction was associated with a more controlled regulation of eating, and GSD moderated the association between body dissatisfaction and autonomous regulation of eating. Autonomy support played a role in eating regulation as women with more support reported more autonomous eating. Yet, the support did not moderate the relationship between body dissatisfaction and eating regulation. Future studies should continue to explore the potential facilitative role of autonomy support in promoting a self-determined approach to eating regulation.     

Neighbourhood environment correlates of physical activity: a study of eight Czech regional towns

An adequate amount of physical activity (PA) is a key factor that is associated with good health. This study assessed socio-environmental factors associated with meeting the health recommendations for PA (achieving 10,000 steps per day). In total, 1,653 respondents randomly selected from across eight regional towns (each >90,000 inhabitants) in the Czech Republic participated in the study. The ANEWS questionnaire assessed the environment in neighbourhoods, and participants' weekly PA was objectively monitored (Yamax Digiwalker SW-700 pedometer). About 24% of participants were sufficiently active, 27% were highly active; 28% participants were overweight and 5% were obese. Although BMI was significantly inversely associated with the daily step counts achieved only in females, for both genders, BMI was generally not significantly associated with the criterion of achieving 10,000 steps per day during the week. Increased BMI in both genders was accompanied with a decline in participation in organized PA and with increasing age. As regards to the demographic/lifestyle factors, for females, more participation in organized PA was significantly positively correlated with the achieved daily step counts. In contrast, older age and higher BMI (for females) and smoking (for males) were significantly negatively correlated with the achieved daily step counts. In terms of the environmental aspects, pleasant environments were significantly positively correlated to daily step counts for both genders. Additionally, for males, better residencies (more family homes rather than apartment blocks) in the neighbourhood were significantly positively correlated with their daily step counts. For females, less accessibility of shops and non-sport facilities (depending on walking distance in minutes) were significantly negatively correlated to the achieved daily step counts. Individuals who lived in pleasant neighbourhoods, with better access to shops and who participated in organized PA (≥ 2 times a week) tended to meet the recommendations for health-enhancing PA levels. The creation of physical activity-friendly environments could be associated with enhancing people's achieved daily step counts and meeting the health criteria for PA.     

Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany

Background

The objective of the present study was to compare three different sampling and questionnaire administration methods used in the international KIDSCREEN study in terms of participation, response rates, and external validity.

Methods

Children and adolescents aged 8–18 years were surveyed in 13 European countries using either telephone sampling and mail administration, random sampling of school listings followed by classroom or mail administration, or multistage random sampling of communities and households with self-administration of the survey materials at home. Cooperation, completion, and response rates were compared across countries and survey methods. Data on non-respondents was collected in 8 countries. The population fraction (PF, respondents in each sex-age, or educational level category, divided by the population in the same category from Eurostat census data) and population fraction ratio (PFR, ratio of PF) and their corresponding 95% confidence intervals were used to analyze differences by country between the KIDSCREEN samples and a reference Eurostat population.

Results

Response rates by country ranged from 18.9% to 91.2%. Response rates were highest in the school-based surveys (69.0%–91.2%). Sample proportions by age and gender were similar to the reference Eurostat population in most countries, although boys and adolescents were slightly underrepresented (PFR <1). Parents in lower educational categories were less likely to participate (PFR <1 in 5 countries). Parents in higher educational categories were overrepresented when the school and household sampling strategies were used (PFR = 1.78–2.97).

Conclusion

School-based sampling achieved the highest overall response rates but also produced slightly more biased samples than the other methods. The results suggest that the samples were sufficiently representative to provide reference population values for the KIDSCREEN instrument.     

Husband's preference for a son and women's nutrition: examining the role of actual and desired family composition on women's anaemia and body mass index in India

This study examines the relationship between the husband's preference for a son, sex composition of children and risk of anaemia and underweight among married Indian women. Information was collected regarding 29,517 couples having at least one child in the nationally representative 2005-06 National Family Health Survey of India. The exposures were husband's preference for a son and sex composition of children: sons only, daughters only and mixed. Outcome included maternal underweight and moderate/severe anaemia. Husband's preference for a son was not found to be associated with his wife's risk of anaemia or underweight. Sex composition of the children was modestly associated with increased odds of anaemia among women from households with daughters only as compared with those with sons only [AOR: 1.19; 95% CI 1.04, 1.35]. The findings from this population-based study of socio-cultural norms around preference for a son and married Indian women's nutritional status do not support the hypothesis that husband's preference for sons influences the nutritional status of their wives. However, having daughters only is associated with maternal anaemia for reasons that remain to be established.     

Representation of women's health in general medical versus women's health specialty journals: a content analysis

Background  

Women's health, traditionally defined, emphasises reproductive and maternal conditions without consideration of social contexts. Advocates urge a broader conceptualisation. The medical literature influences the definitions and delivery of women's health care. We compared how women's health was represented in leading general medical (GM) versus women's health specialty (WS) journals.     

Perfectionism and symptoms of eating disturbances in female college students: considering the role of negative affect and body dissatisfaction

This study examined body dissatisfaction and negative affect in understanding the link between perfectionism and dieting and bulimic symptoms in a sample of 307 female college students. Perfectionism was found to be associated with dieting and bulimic symptoms. Body dissatisfaction was found to interact with socially prescribed perfectionism in predicting both dieting and bulimic symptoms. Support for a prediction model involving negative affect as a mediator between socially prescribed perfectionism and bulimic symptoms was found only among those who reported a moderate level of body dissatisfaction. For those who reported a high level of body dissatisfaction, socially prescribed perfectionism was the only significant predictor of bulimic symptoms. Implications of the present findings for future research and for working with female college students at risk for eating disturbances are discussed.     

Change of individual BMI in Switzerland and the USA: a multilevel model for growth

Objective  

The aim is to analyze and compare individual body mass index (BMI) growth patterns of adults from Switzerland and the US.