Do health behaviors moderate the effect of socioeconomic status on metabolic syndrome?

PURPOSE: The purpose of this study is to determine whether the effect of socioeconomic factors on metabolic syndrome is influenced by such covariates as health behavior and psychosocial factors. METHODS: This study used data collected from 4400 households during the 2001 Korea National Health and Nutrition Examination Survey. A stratified multistage probability sampling method was applied and the final sample included 6601 subjects older than 20 years who had completed necessary health examinations. RESULTS: The prevalence of metabolic syndrome in Koreans was 25.5% (95% confidence interval [CI], 23.8-27.2) for men and 28.7% (95% CI, 27.2-30.2) for women. Analysis of moderator effects showed that interactions between education and smoking or exercise status and between income and alcohol or smoking status were significant. The significance of the interaction terms indicates that health behavior and psychosocial factors modified the relationship between socioeconomic factors and metabolic syndrome. CONCLUSIONS: Results of this study provide evidence that such behaviors as smoking, drinking alcohol, and insufficient exercise contribute to the incidence of metabolic syndrome. Changes to higher socioeconomic status may not reduce the odds of metabolic syndrome unless behavior also is adapted.     

The impact of unemployment on school leavers’ perception of health. Mediating effect of financial situation and social contacts?

Summary Objectives: The main purpose of this paper is to explore whether unemployment influences adolescents’ subjective perception of health and whether perceived financial stress and social contacts can mediate the effect of employment status on health. We are also interested in the differences in financial situation and social contacts between unemployed secondary school leavers and their employed and studying counterparts. Methods: Data were obtained from 844 adolescents (mean age 19.6) from Slovakia. The effect of unemployment on several health indicators was measured and subsequently controlled for perceived financial strain of respondents and their social contacts. Results: The results showed highest financial strain among unemployed, whereas only small differences in social contacts were found between three groups. Negative influence of unemployment on perceived health of respondents was confirmed. Nevertheless, strong influence was found only on long-term well-being and mental health. Financial situation and social contacts contributed to the prediction of almost all health outcomes, and to some extent mediated the effect of unemployment. Conclusions: Although unemployment was found to have a negative impact on health of adolescents, sufficiency of social contacts and good financial situation seem to decrease this effect and protect the health of unemployed people. Submitted: 22 May 2006; Revised: 16 February 2007; Accepted: 27 February 2007     

The health and nutritional status of primitive populations†

Bread made and consumed by villagers of Fars Province in Iran contains high concentrations of phytate (phytic acid) because of the use of flours of high extraction rate, and omission of leaven and fermentation. Leavened breads made in commercial bakeries in cities of the same region from similar flours contain only half to two‐thirds as much phytate. It is concluded that leaven and fermentation are more important determinants of the phytate concentration of bread than is the rate of extraction of flour.

Seasonal changes in phytate concentrations of urban but not village breads were observed. Concentrations were lowered in the warm months.

The literature dealing with the effects of phytate upon human nutrition has been reviewed. It is concluded that the importance of high phytate intakes as a cause of disturbed mineral metabolism has been underestimated.     

The effect of work on mental health: does occupation matter?

This paper considers the effect of work choices on mental health and looks at whether this differs across occupations. This requires a model that can deal with the endogeneity in the relationship between health, occupation and work choices. We specify such a model and estimate it on a unique UK panel survey. The survey, called the National Child development Survey (NCDS), follows a cohort since their birth in 1958 until age 42. The analyses show us that early childhood health and ability have long lasting consequences for the mental health at the later ages. Females have lower levels of mental health. Mental health deteriorates with age for males and females, but the rate of deterioration is substantially lower for females. We also find that the rate of depreciation is lower when individuals work. For females we find large effects of occupation, for males we do not find this. Employment status is important for males, but not for females. For both genders we find very large effects of the onset of a long-standing illness. The probability of experiencing such an event depends on employment status, occupation and life style variables.     

What does voluntary disenrollment from Medicare+Choice plans mean to beneficiaries?

The Balanced Budget Act (BBA) of 1997 required CMS to report publicly Medicare managed care (MMC) plan voluntary disenrollment rates. To ensure disenrollment rates would be meaningful to beneficiaries in health plan choice, CMS funded the development of surveys and reporting formats to identify and present the reasons that beneficiaries voluntarily leave plans. Public reporting of reasons on the Medicare Web site began in 2002. We discuss results from extensive audience testing of disenrollment rates and reasons materials. Medicare beneficiaries do not easily understand disenrollment. We also discuss challenges in presenting useful disenrollment information and policy implications for public reporting.     

Why do parents decide against immunization? The effect of health beliefs and health professionals

OBJECTIVES: To explore the knowledge, attitudes and concerns with respect to immunization and vaccine-preventable infections in parents whose children have not completed the recommended course of immunization. SETTING: Parents of children resident in the London Borough of Hackney. METHODS: Children born between 1 January 1999 and 15 February 1999 were identified from the child health database, and cases were defined as those who had defaulted for one or more primary immunization by 18 months of age. After validation of immunization status from health records, questionnaires were sent to parents. Ten respondents from this sample were interviewed. RESULTS: Questionnaires were sent to 129 parents of children identified as not completing the recommended immunization course. Nine questionnaires were returned 'address unknown', and 76 parents returned the completed questionnaire. The response rate from known residents was 76/110 (69%). Eight parents stated that their child had been immunized, leaving 68 questionnaires available for further analysis. Measles, mumps, rubella (MMR) and meningococcal C were most frequently omitted, usually because of concerns about vaccine safety. Twenty-three out of 68 respondents perceived that having their child immunized with a particular vaccine was more risky than non-immunization, particularly for MMR and meningococcal C vaccines. Those who agreed to be interviewed were notably concerned about the MMR vaccine, but not immunization in general. They perceived the information provided by health professionals to be poor. CONCLUSIONS: The decision-making process around childhood immunization is complex. Parents require information that is up to date, tailored to their individual needs and provided by health professionals who are well informed.     

The effect of families’ socioeconomic status on the self-concept development of learners

ABSTRACT

This article investigates the effect of families’ socioeconomic status on the self-concept development of learners. The data were collected using a questionnaire from 31 learners who participated in the community engagement project. During the execution of this project, in addition to assisting learners using self-esteem development intervention methods, certain factors emerged, which apart from the original projects methods for self-concept development, seemed to impact self-concept development. These factors suggested that the school-environment and families’ socioeconomic status may additionally influence self-concept development. This was used to conduct the necessary statistical analyses. Findings indicated that there is no significant relationship between the self-concept and any of the three components of the socioeconomic factor. But significant dependencies could be established between isolated elements of the socioeconomic factor and self-concept. A collaboration is, therefore, recommended between parents or guardians, teachers, counsellors and social welfare agencies to cater for the needs of these learners.     

Do health plans influence quality of care?

OBJECTIVE: To investigate the relative impact of physician groups and health plans on quality of care measures. DESIGN: Secondary data analysis of receipt of preventive care services included in the Health Plan Employer Data and Information Set (HEDIS) among 10 758 patients representing 21 health maintenance organizations and 22 large provider groups in the San Francisco and Los Angeles, California, areas in 1997. Each patient was eligible for (at least) one of six HEDIS-measured services. Data identify whether or not the service was provided, the patient's health plan, and the provider group responsible for the care. We used logistic regression to examine variations across plans in HEDIS rates, and whether variations persist after controls for provider groups are included. SETTING: Patients from 21 health maintenance organizations serving San Francisco and Los Angeles, California, in 1997. MAIN OUTCOME MEASURES: Breast cancer screening, childhood immunizations, cervical cancer screening, diabetic retinal exam, prenatal care in the first trimester, and check-ups after delivery among patients for whom these services are appropriate. RESULTS: There are statistically significant differences across health plans in utilization rates for the six services examined. These differences are not substantially affected when we control for the provider group that cared for the patient. That is, controlling for provider group does not explain variations across plans, consistent with the view that health plans have an impact on HEDIS quality measures independent of the providers that they contract with. CONCLUSIONS: There are activities that plans can undertake which influence their HEDIS scores. On the face of it, these results suggest that plans can independently improve quality, in contrast to hypotheses that plans would be "too far" from patients to have an influence. Continued attention to collecting plan-level data is warranted. Further work should address other possible sources of variations in HEDIS scores, such as variability in the quality of plan administrative databases.     

The impact of the European Environment and Health Process on UK environment and health policy, plans and practice: what difference has it made?

The European Environment and Health Process (EEHP), led by theWorld Health Organization (WHO) Regional Office for Europe,aims to support WHO Member States as they plan and implementnational and international environment and health policies.An evaluation of the impact of the EEHP in the UK was conductedin preparation for the fourth Ministerial Conference on Environmentand Health in Budapest, 2004. The evaluation identified a numberof impacts and influences of the EEHP. This concluded that theprocess had only a marginal direct influence on policy withinthe UK. However, it was also concluded that the process hadresulted in several indirect influences, including better cooperationbetween government departments, greater awareness of environmentand health issues from an international perspective, and a higherpolitical profile of environment and health issues. A few outcomesof the EEHP also appear to have been taken into account in somenational and local policy documents. The National EnvironmentalHealth Action Plan, which was produced as a direct result ofthe EEHP, appears to have had little direct impact in the UK,probably because of the lack of an implementation process andindicators, and because it was superseded by other policy initiativesrelatively soon after publication. A need for better coordinationand promotion of the EEHP amongst stakeholders responsible forenvironment and health policy areas was also identified.     

Do cigarette taxes affect children's body mass index? The effect of household environment on health

Several recent studies demonstrate a positive effect of cigarette prices and taxes on obesity among adults, especially those who smoke. If higher cigarette costs affect smokers' weights by increasing calories consumed or increasing food expenditures, then cigarette taxes and prices may also affect obesity in children of smokers. This study examines the link between child body mass index (BMI) and obesity status and cigarette costs using data from the National Longitudinal Survey of Youth-79 (NLSY79). Controlling for various child, mother, and household characteristics as well as child-fixed effects, I find that cigarette taxes and prices increase BMI in the children of smoking mothers. Interestingly, and unlike previous research findings for adults, higher cigarette taxes do not increase the likelihood of obesity in children. These findings are consistent with a causal mechanism in which higher cigarette costs reduce smoking and increase food expenditures and consumption in the household.     

Antioxidant status and risk of cancer in the SU.VI.MAX study: is the effect of supplementation dependent on baseline levels?

The SUpplementation en VItamines et Mineraux AntioXydants (SU.VI.MAX) study, a randomised double-blind, primary-prevention trial showed that after 7.5 years, low-dose antioxidant supplementation lowered the total cancer incidence in men, but not in women. To explain this difference in the impact of antioxidant supplementation in men and women, we hypothesised that the effect of supplementation is dependent on initial antioxidant status; 12 741 French adults (7713 females aged 35--60 years; 5028 males aged 45--60 years) received daily antioxidant supplementation (120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 microg Se, 20 mg Zn daily) or a matching placebo. Cut-off limits for baseline serum concentrations of the different antioxidant vitamins and minerals were defined as follows for both men and women: 0.3 micromol/l for beta-carotene, 11.4 micromol/l for vitamin C, 15 micromol/l for vitamin E, 0.75 micromol/l for Se and 10.7 micromol/l for Zn. The percentage of men with serum concentrations under cut-off limits was higher for vitamins C and E and beta-carotene in those who developed a cancer than in those who did not. The risk of cancer was higher in men with baseline concentrations of serum vitamin C or vitamin E under cut-off limits, but not in women. The effect of supplementation was greater in men with baseline serum concentrations of vitamin C, vitamin E and beta-carotene below the cut-off limits compared with those above it. This effect was maintained only for vitamin E after adjustment for age, tobacco, and alcohol consumption and BMI. No effect of supplementation could be seen in women. Baseline antioxidant status is related to the risk of cancer in men but not in women and therefore does not entirely explain the differences observed in the effect of antioxidant supplementation on cancer risk between sexes in the SU.VI.MAX study.     

How are health plans supporting physician practice? The physician perspective

IPA-model HMOs are now the dominant organizational structures for delivering "managed care" in the United States. Are they taking advantage of opportunities to support physician practices in ways that arguably could improve care? In this paper we report the findings from a survey of generalist and specialist physicians in nineteen health plans. Not surprisingly, we found that generalists are much more likely than specialists are to be the target of health plans' efforts to support care delivery. However, our survey data indicate that these opportunities generally are not being fully exploited; also, efforts that plans do make to provide information to support care often are not seen as useful by physicians.     

Effect of psychiatric illness and labour market status on suicide: a healthy worker effect?

STUDY OBJECTIVE: To describe the association between labour market status and death by suicide with focus on admission with a psychiatric disorder. DESIGN: Nested case-control study. Data from routine registers. SETTING: Entire Danish population. PARTICIPANTS: 9011 people aged 25-60 years who committed suicide during 1982-1997 and 180 220 matched controls. MAIN RESULTS: In the general population, not being fully employed is associated with a twofold to threefold increased relative risk of death by suicide, compared with being fully employed. In contrast, fully employed people who have been first admitted to a psychiatric hospital within the past year are at increased suicide risk. Patients who are unemployed, social benefits recipients, disability pensioners, or otherwise marginalised on the labour market have a suicide risk of 0.60 (95% CI: 0.46 to 0.78), 0.41 (0.23 to 0.74), 0.70 (0.45 to 1.08), and 0.86 (0.53 to 1.41), respectively. Although a similar risk decrease is found in women, men, people younger than 30 years, people older than 45 years, and in people who become unemployed, the reversed effect attenuates with time since admission, and little association is seen when a marginal structural model is applied. CONCLUSIONS: Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.