The health of students in institutes of higher education: an important and neglected public health problem?

BACKGROUND: A survey of students in three UK higher education establishments was undertaken to obtain information about students' physical and emotional well-being, their attitudes to, and beliefs about health, and the prevalence of risk factors for future ill health. METHODS: Health was measured by the prevalence of longstanding illness and by the SF-36 health status measurement tool. Survey results were compared with equivalent data for 18- to 34-year-olds in the local population. The prevalence of long-standing illness was also compared with two national surveys. RESULTS: The survey achieved a 49 per cent response rate. More than one-third of respondents reported a long-standing illness, a higher prevalence than in all comparison surveys. Students scored significantly worse than their peers in the local population on all eight SF-36 dimensions. The greatest difference was for role limitations as a result of emotional problems. The main sources of emotional distress were study or work problems and money. CONCLUSION: The poor response rate in this survey dictates the need for caution in interpretation of the results. However, they suggest that the health of students is poor relative to that of their peers, and that their emotional health is more of a problem than their physical health. Public health practitioners might want to pay more attention to the health of this important and relatively neglected group. Worries about studies and money appear to be affecting students' academic work, and this should be of concern to higher education establishments.     

School differences in pupil smoking: a consequence of a trade-off between health and education agendas?

Current policy documents stress that raising standards in education and health are inextricably linked, with schools identified as well placed to advance both agendas. This paper considers these assumptions in the light of data derived from 27 staff interviews conducted in two secondary schools. These schools served relatively disadvantaged communities, but differed in their pupil smoking rates with one school being 'high-smoking', the other 'low-smoking'. It explores whether this difference reflects the differential emphasis placed by each school on education or health. Analysis reveals that the 'low-smoking' school subscribes to holistic values and operates according to a child-centred bottom-up philosophy offering a differentiated programme of pupil support contingent on needs. In contrast, the 'high-smoking' school maintains a narrow focus on educational outcomes, and its high expectations are viewed as running counter to those held by pupils and parents. The contrasting school philosophies bring different unintended consequences. The holistic focus of the low-smoking school is associated with tempered educational expectations, thus conflicting with recommendations in education policies. The singular education focus of the high-smoking school leaves little room for a health agenda, and can overlook and disenfranchise the educationally disinclined. The school systems' impact on pupil engagement may explain their different smoking rates.     

Mental health status and diabetes among Whites and Native Americans: is race an effect modifier?

Depressive symptoms are common among patients with diabetes and may have a significant impact on self-management and health outcomes. The prevalence of both depression and diabetes varies by race. We examined whether race is also an effect modifier in the association between mental health rated "not good" and diabetes using the national Behavioral Risk Factor Surveillance System (BRFSS) data from 2002 to 2005. We found that the prevalence of diabetes among Native American respondents was almost double that among Whites. Respondents with at least two weeks of mental health rated "not good" are significantly higher among diabetic patients than among non-diabetic patients. Native Americans (NAs) with at least two weeks of mental health rated "not good" were more likely to have diabetes. This association is stronger in NAs than in Whites. Future research should focus on a better understanding of the pathophysiological mechanisms underlying this plausible association between poor mental health and diabetes.     

The three domains of public health: an internationally relevant basis for public health education?

By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilized 'three domains of practice' framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.     

Women and heart transplantation: an issue of gender equity?

Heart transplantation (HT) is increasingly commonplace in countries with advanced health care systems. A review of the family and HT literature points to a gender inequity in the field: Men are more likely to be heart transplant recipients; women are more likely to contribute as their caregivers. In this critique, we argue that there are not only physiological but also social and economic issues that contribute to inequitable access to HT for women. Further, we point out that another invisible inequity in the heart transplant field is the lack of acknowledgment of, and support for, women whose contributions as family caregivers to the heart transplant process often ensure the success of heart transplant procedures. The authors call for recognition of these inequities and the development of policies that have the potential to ensure that women have equitable access to cardiovascular care in general and HT in particular, and that woman are recognized for, and supported in, their role as caregivers.     

Whither gender in urban health?

The past decade has witnessed the rapid expansion of the field of urban health, including the establishment of an international society of urban health and annual conference, the publication of several books and the growing popularity of a peer-reviewed journal on urban health. Relatively absent is an emphasis on the role of gender in urban health, despite scholarly and theoretical work on gender and place by feminist geographers, sociologists, public health researchers and others. This essay examines the treatment of gender within urban health and, drawing on insights from the social sciences, offers suggestions as to how urban health researchers might adopt an intersectional and gendered approach that will advance our understanding of the production of urban health for women and men.     

Do gender, education, and income modify the effect of air pollution gases on cardiac disease?

OBJECTIVE: We sought to determine whether gender, education, and income influence the susceptibility to ambient air pollution. METHODS: We determined the association between daily cardiac hospitalizations and daily concentrations of gaseous air pollutants in 10 large Canadian cities using time-series analyses adjusted for day-of-the week, temperature, barometric pressure, relative humidity. RESULTS: Percentage increases in hospitalization associated with an increase in air pollution equivalent to its mean value were statistically significant for ozone, carbon monoxide and nitrogen dioxide individually (P < 0.05) and the combined pollutant effect was 8.5% (95% confidence interval: 1.8, 14.6). The air pollution-cardiac disease association was not significantly influenced by gender or community level of education or income. CONCLUSION: Short-term changes in air pollution may adversely affect cardiac disease but gender, and community education and income do not accurately identify those with increased susceptibility.     

Preventive health patient education and counseling: a role for medical assistants?

Collaborative office-based team approaches may provide a unique means to increase the low rates of preventive services delivery. This study aimed to assess what role medical assistants may have in the delivery of preventive services to patients. A 35-item questionnaire was mailed to 402 medical assistants living in Maryland in July 2005. The questionnaire assessed current levels of preventive service delivery, attitudes toward patient education, and willingness to educate patients. A total of 281 surveys were returned for a response rate of 71%. Study findings revealed that a fair amount of preventive services delivery was already being delivered in health care settings by medical assistants. Medical assistants were more likely to discuss diet/nutrition and exercise with patients. Findings also highlight that medical assistants held positive beliefs about educating patients and nearly all respondents (90%) were willing to deliver preventive services. Given the increased presence of medical assistants in the health care setting, it may be feasible to delegate some preventive care delivery to this willing team member. Future research needs to explore how to better incorporate and delegate preventive health care delivery in medical settings.     

The timing, format and content of school based sex education: an experience with a lasting effect?

School based sex education provides an opportunity to prepare young people for their sexual careers. However, research has criticised the education provided in terms of it being too late, using didactic teaching methods and focusing on biological information. The present study aimed to explore young peoples' experiences of, and beliefs about, their school sex education in terms of its timing, format and content, and to examine the relationship between these factors and their intentions to use condoms. Sixteen to 19 year olds (n = 967) from educational institutions within the South Thames region completed a questionnaire about their sex education. The results showed that the median age of first receiving sex education was 11, that the majority of subjects believed that the timing was about right and a third believed it was too late. In terms of format, didactic methods such as facts, videos and leaflets were more commonly reported than interactive methods such as role-play and discussions about relationships, with the subjects reporting a preference for the latter. In terms of content the results suggested that the greatest emphasis was on biological information, with least emphasis being placed on relationship information. However, many subjects indicated that they had received practical advice such as how to use a condom correctly. In addition, the results indicated that although the timing and format of sex education were unrelated to behavioural intentions, a greater emphasis on practical advice was related to a greater intention to use a condom in the future. The results are discussed in terms of the contemporary nature of school based sex education programmes and evidence for changes following recent recommendations.     

Social inequalities in health: are there gender differences?

Some studies suggest that socio-economic status (SES) inequalities in health are smaller in women than men, but the evidence is inconsistent as to whether this applies across various health measures and life stages. The first aim of this paper was to establish whether the magnitude of social inequality in health differs for men and women during early adulthood, specifically in respect to self rated health, limiting long-standing illness, psychological distress, respiratory symptoms, asthma/wheezing, height and obesity; second, to determine whether explanations for socioeconomic inequality in poor self rated health differ for men and women. Analyses are based on longitudinal data from the British 1958 birth cohort study using information from birth to age 33. When gender differences in inequalities were examined using social class, no significant differences emerged across the seven health measures examined at ages 23 and 33. SES inequalities based on education, however, showed greater inequality among men at age 33 for limiting long-standing illness and respiratory symptoms, but greater inequality among women for poor rated health at age 23 and psychological distress at age 33. Hence, gender differences in the magnitude of health inequality were inconsistent across age and health measures. An analysis of the contribution of explanatory factors to social class differences in self-rated health suggested that causes of inequality were similar for men and women. However, some discrepancies emerged, notably in the greater contribution of job insecurity to class differences for men and in the greater contribution of age at first child for women. The magnitude and explanations for gender differences in SES health inequalities are likely to vary according to life stage and health measure.     

Do gender differences in mental health contribute to gender differences in physical health?

Previous research has demonstrated that women and men tend to have different types of mental and physical health problems. Using data from the US National Comorbidity Survey Replication (NCS-R) of 2001–2003, we consider whether the female excess in internalizing disorders contributes to the female excess in chronic debilitating conditions and whether the male excess in externalizing disorders contributes to the male excess in life threatening conditions. We find that women have significantly higher odds of meeting the DSM-IV criteria for one or more lifetime internalizing disorders and significantly lower odds of meeting the DSM-IV criteria for one or more lifetime externalizing disorders. We also find that women have higher odds of reporting four of the ten chronic debilitating conditions examined, including arthritis, frequent or severe headaches, seasonal allergies, and gallbladder removal, and lower odds of reporting three of the six life threatening conditions examined, including stroke, heart disease, and high blood pressure. We conclude that the female excess in internalizing disorders partially mediates, or explains, the female excess in arthritis, headaches, and gallbladder removal, while the male excess in externalizing disorders partially accounts for the male excess in heart disease and high blood pressure.     

The gift of time? School starting age and mental health

Using linked Danish survey and register data, we estimate the causal effect of age at kindergarten entry on mental health. Danish children are supposed to enter kindergarten in the calendar year in which they turn 6 years. In a "fuzzy" regression‐discontinuity design based on this rule and exact dates of birth, we find that a 1‐year delay in kindergarten entry dramatically reduces inattention/hyperactivity at age 7 (effect size = –0.73), a measure of self‐regulation with strong negative links to student achievement. The effect is primarily identified for girls but persists at age 11.