Correspondence analysis of the Spanish National Health Survey

This report gives a comprehensive explanation of the multivariate technique called correspondence analysis, applied in the context of a large survey of a nation's state of health, in this case the Spanish National Health Survey. It is first shown how correspondence analysis can be used to interpret a simple cross-tabulation by visualizing the table in the form of a map of points representing the rows and columns of the table. Combinations of variables can also be interpreted by coding the data in the appropriate way. The technique can also be used to deduce optimal scale values for the levels of a categorical variable, thus giving quantitative meaning to the categories. Multiple correspondence analysis can analyze several categorical variables simultaneously, and is analogous to factor analysis of continuous variables. Other uses of correspondence analysis are illustrated using different variables of the same Spanish database: for example, exploring patterns of missing data and visualizing trends across surveys from consecutive years.     

Smoking habits in Germany -- results of the German National Telephone Health Survey 2003

Analyses are based on the National German Telephone Health Survey 2003, which provides data on current smoking behaviour among residents aged 18 years and older in Germany. Smoking prevalence is approximately 37 % for men and 28 % for women. About 95 % of the smokers prefer cigarettes, whereas other tobacco goods are secondary and predominantly consumed by men from middle age onwards. Among cigarette consumers, almost half of the men and one third of the women smoke 20 or more cigarettes per day. Over the years, the average age at onset of smoking has become earlier in life, particularly among women. Women born between 1970 and 1985 started smoking at the age of nearly 16, which is comparable to the age at onset among men. Considering data of preceding German National Health Surveys, the percentage of smokers has slightly decreased among men but increased among women during the past twenty years. The presented analyses confirm previous results on unequivocal social and socio-economic differences in smoking.     

Gender,mental health service use and objectively measured physical activity: Data from the National Health and Nutrition Examination Survey (NHANES 2003–2004)

ObjectiveTo examine the relationship between physical activity levels measured objectively by accelerometry and the use of mental health services (MHS) in a representative sample of males and females.MethodNHANES 2003–2004 is a cross-sectional study of the civilian, non-institutionalized US adult population. Participants reported whether or not they had seen a mental health professional during the past 12 months. Three measures of daily physical activity (light minutes, moderate-vigorous minutes, and total activity counts) and sedentary minutes were determined by accelerometry. The relationship between physical activity and use of MHS was modeled with and without adjustments for potential socioeconomic and health confounders.ResultsOf the 1846 males and 1963 females included in this analysis, 7 and 8% reported seeing mental health professionals during the past 12 months, respectively. Men who used MHS were significantly less active than men who did not use MHS (227,700 versus 276,900 total activity counts, respectively, p < 0.05). Men who did not use MHS engaged in 38 min (95% CI 16.3, 59.0) more of light or moderate-vigorous physical activity per day than men who used MHS. Physical activity levels of women, regardless of MHS use, were significantly lower than men who did not use MHS. Differences in total physical activity between women who did and did not use MHS were small (1.3, 95% CI −14.0, 11.4).ConclusionMen and women who used MHS were relatively sedentary. Additional research is warranted to determine if increasing physical activity levels results in improved mental health in individuals who use MHS.     

Sexual health of adolescents according to the National Survey of School Health

The objective of this study was to describe situations related to sexual health of adolescents, according to the National Survey of School Health (PeNSE). It is a cross-sectional study performed by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the Ministry of Health that involved 60,973 students and 1,453 public and private schools. Data analysis points out that 30.5% (95%CI 29.9-31.2) of the adolescents had already had sexual relations sometime in their lives, being more frequent for males (43.7%; 95%CI 42.7-44.7) than females (18.7%; 95%CI 18.0-19.4), especially those who go to public schools (33.1%; 95%CI 32.4-33.9), aged 15 years or older (47.3%; 95%CI 45.7-48.9) and 16 years (63.5%; 95%CI 61,5-65.4). The sexual initiation age was early and 40.1% (95%CI 38.8-41.4) reported having had only one partner in life. The use of condoms in the last sexual relation was high both for protective (75.9%; CI95% 74.8-76.9) and contraceptive methods (74.7%; 95%CI 73.6-75.7). It is necessary to emphasize actions for promoting sexual health towards adolescents in order to minimize vulnerabilities.     

The sustainability of the Spanish National Health System

The Spanish National Health System (SNHS) has sustainability problems resulting from weaknesses in institutional design and governance compounded by the economic crisis it faces. The global economic crisis has had a particularly virulent impact in Spain, characterized by high levels of unemployment and public and private debt. Fiscal adjustment policies implemented may significantly compromise the SNHS. Along with general funding problems, the strong territorial decentralization of health jurisdictions in the Autonomous Communities has not been backed up by efficient State-level health coordination. The SNHS suffers from problems in its rules of governance, its autonomous financing system, human resource policies and diversity of direct and indirect management models in different Autonomous Communities. A reform strategy in Spanish healthcare governancemust be articulated within the context of a broader review of public policies to stabilize the lines of defense of the welfare state. Within the scope of the health sector, the financing system must be improved and institutional changes to increase efficiency must be implemented.     

A comparison of the health status and health care utilization patterns between foreigners and the national population in Spain: New evidence from the Spanish National Health Survey

The increasing proportion of immigrants in Spanish society is placing pressure on the National Health Care System to accommodate the needs of this population group while keeping costs under control. In the year 2000, a law was approved in Spain according to which all people, regardless of their nationality, are entitled to use health care services under the same conditions as Spanish citizens, provided that they are registered in the local population census. However, empirical evidence about differences in health status and health care utilization between the immigrant and the Spanish population is insufficient. This paper uses the 2003 and 2006 Spanish National Health Surveys to explore the existence of inequalities in health and in the access to health services for the immigrant population living in Spain, relative to that of Spaniards. Our results show that there are different patterns in the level of health and the medical care use between the national and the foreign population in Spain: while immigrants' self-reported health relative to that of the Spanish population depends upon individual nationality, all immigrants, regardless of their nationality, seem to face barriers of entry to specialized care. Further research is needed to understand the nature of these barriers in order to design more effective health policies.     

Gender and health in Brazil: considerations based on the National Household Sampling Survey]

As in the principal industrial countries, Brazilian women have lived longer than men. However, paradoxically, women present higher morbidity indicators than men. Knowledge of the Brazilian pattern regarding this matter could be a useful contribution to an understanding of their determinants in our specific reality, as well as enabling us to foresee future trends that would make it possible to plan adjustment in the health system. A morbidity study based on data from the National Household Sample Survey (PNAD/IBGE), was undertaken in ten Brazilian states in 1986 with this in view. Coefficients of the prevalence of perceived morbidity, demand for and utilization of health services according to sex, standardized by age and using the direct method, were built up. As a measurement of the differentials, sex ratios were calculated. The excess of perceived morbidity in women was constant in all the regions. The sex differential in the utilization of health services showed regional variations, suggesting a relationship with the health services supply. Sex differentials were not observed in childhood; the highest values were found during the woman's reproductive period, decreasing sharply after 60 years of age. The pattern is very similar in all regions. In the present study, the findings could be partially explained by the methodology adopted, but they are similar to the findings reported in other countries. The intense transformations in the reproductive pattern and in the social status of Brazilian women probably have a considerable impact on the health status and on the recourse to health services, not as yet evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Predictors of adolescent self-rated health. Analysis of the National Population Health Survey

OBJECTIVE: To examine what factors predict adolescents' concepts of their health. METHODS: The study, based on the longitudinal National Population Health Survey, included 1,493 adolescents who were 12-19 at the time of interview. Sex, age, grade, family structure, income, disability, chronic health problems, social supports, social involvement, school/work involvement, smoking, alcohol bingeing, physical activities, Body Mass Index (BMI) and psychological health status variables were examined. Using ordinal multivariate regression, self-rated health was regressed on all predictors, which were entered in blocks hierarchically. RESULTS: The analyses revealed that adolescent perceptions of health are framed not only by their physical health status, but also by personal, socio-environmental, behavioural and psychological factors. Specifically, health problems, disability, age, female status, lower income, smoking, and higher BMI were associated with lower self-rated health. CONCLUSIONS: This study suggests that adolescent appraisals of their health are shaped by their overall sense of functioning, which includes both physical health and non-physical health dimensions.     

Estimates of nutrient intake from a food frequency questionnaire: the 1987 National Health Interview Survey.

Nutrient intake data are reported from a 60-item food frequency questionnaire administered in the 1987 National Health Interview Survey to a representative sample of US adults 18 to 99 years of age (n = 22,080). These data provide for the first time an estimate of the distribution of usual nutrient intakes in a national probability sample. For several nutrients, 10% to 25% of respondents may habitually consume substantially less than the Recommended Dietary Allowance, despite apparently adequate group means. Hispanics reported higher energy and carbohydrate intakes and a lower percentage of energy from fat than blacks or whites (35.6%, 38.4%, and 38.7% of energy from fat for Hispanics, blacks, and whites, respectively.) Whites had lower cholesterol intake than the other two groups, and blacks had a higher intake of sweets. Alcohol intake was lower among women and persons older than 65 years, but no other differences in alcohol intake emerged. Use of adjustment factors improved nutrient intake estimates from this shortened questionnaire to levels similar to those obtained from other national dietary surveys. The nutrient intake data from this research can be used to compare demographic subgroups and to describe the mean and distribution of nutrient intake. Furthermore, this research provides national reference data to investigators who use this or related questionnaires in nutrition research.