More than words? The status and impact of smoking policies in Scottish schools

The aim of this study was to investigate the current status of smoking policies in Scottish schools, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among pupils and teachers. A representative sample of 15-year-old school pupils from 77 Scottish secondary schools was surveyed in 1998 regarding their perceptions of smoking in several locations within and outside the school building. Two staff members from each school were also surveyed regarding school smoking policies for pupils and teachers, the nature of the school's smoking restrictions, and the extent to which the restrictions were enforced. The results showed that more schools had a written policy on teacher smoking than on pupil smoking. All schools in the sample banned smoking by pupils, but the majority allowed smoking by teachers in restricted areas. Irrespective of the type of policy or restrictions on smoking, pupils reported seeing smoking among both pupils and teachers on school premises in all of the sample schools. Whether or not a school had a written policy appeared to be unrelated to pupil smoking in the toilets or teacher smoking outdoors on school premises. However, pupils were less likely to be aware of pupils smoking outdoors and teachers smoking in the staff rooms in schools where there were written policies on pupil and teacher smoking, respectively. Consistent enforcement of a ban on pupil smoking was associated with lower levels of perceived smoking among pupils. Where a complete ban on teacher smoking existed, smoking among teachers was seen less often in the staff rooms, but more often in outside areas on school premises. The results have implications for the use of policy in promoting a healthy school environment.     

Do biomarkers of stress mediate the relation between socioeconomic status and health?

OBJECTIVES: To test the relation between socioeconomic status (SES) and biomarkers of chronic stress, including basal cortisol, and to test whether these biomarkers account for the relation between SES and health outcomes. DESIGN: Cross sectional study using data from the 2000 social and environmental biomarkers of aging study (SEBAS). SETTING: Taiwan. PARTICIPANTS: Nationally representative sample of 972 men and women aged 54 and older. MAIN OUTCOME MEASURES: Highest risk quartiles for 13 biomarkers representing functioning of the neuroendocrine system, immune/inflammatory systems, and the cardiovascular system: cortisol, adrenaline (epinephrine), noradrenaline (norepinephrine), serum dihydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor 1 (IGF1), interleukin 6 (IL6), albumin, systolic blood pressure, diastolic blood pressure, waist-hip ratio, total cholesterol-HDL ratio, HDL cholesterol, and glycosylated haemoglobin; self reported health status (1-5) and self reported mobility difficulties (0-6). RESULTS: Lower SES men have greater odds of falling into the highest risk quartile for only 2 of 13 biomarkers, and show a lower risk for 3 of the 13 biomarkers, with no association between SES and cortisol. Lower SES women have a higher risk for many of the cardiovascular risk factors, but a lower risk for increased basal readings of adrenaline, noradrenaline, and cortisol. Inclusion of all 13 biological markers does not explain the relation between SES and health outcomes in the sample. CONCLUSIONS: These data do not support the hypothesis that chronic stress, via sustained activation of stress related autonomic and neuroendocrine responses, is an important mediator in the relation between SES and health outcomes. Most notably, lower SES is not associated with higher basal levels of cortisol in either men or women. These results place an increased burden of proof on researchers who assert that psychosocial stress is an important pathway linking SES and health.     

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 pensions on health and wellbeing in rural South Africa: Does gender matter?

Unique to Africa, a means-tested non-contributory pension is available to South Africans. In 2006, women over 60 and men over 65 were pension-eligible. To explore the effect of the pension for health and wellbeing indicators of rural South African men and women, we analyze data from the WHO-INDEPTH Study of Global Ageing and Adult Health Survey, carried out in the Agincourt sub-district by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in 2006. Because pension receipt was not measured directly, our findings represent intent-to-treat (ITT) rather than treatment-on-the-treated (TOT) effects using age as an indicator for intent-to-treat. Overall, women report poorer wellbeing compared to men. However, women have a "honeymoon" period at ages 60-64, the first years of pension-eligibility, in which they report lower levels of worry and sadness, and higher overall happiness, life satisfaction, and quality of life as compared to younger and older women. For men, in contrast, reports of wellbeing worsen in the pre-pension years, followed by a similar but not as prominent pattern of favorable reports in the five years following pension-eligibility, and a decline in the next five-year period. Thus, while pensions continue to enhance financial wellbeing, our results suggest that their effect on social wellbeing may be gendered and transitory. Further research is needed to improve understanding of these dynamics.     

Simply the best? The impact of quality on choice of primary healthcare provider in Sweden

ObjectiveOne of the more important objectives with the patient choice reform, introducing non-price competition in Swedish primary healthcare, was to improve performance and quality of care. However, in order for choice to lead to quality improvements, citizens need to consider quality aspects in their choices of provider. We hypothesize that quality of care influences choice of provider and the objective of this study is to investigate if citizens are willing to make a trade-off between distance to chosen provider and quality of care.MethodsWe use conditional logit models to analyse if quality and other provider attributes influence choice of provider. The study population includes all citizens of Region Stockholm with at least one primary healthcare contact (N ~1.4 million).ResultsThe results show that distance is the most important factor in choosing a primary healthcare provider but that there seems to be a willingness to make a trade-off between distance and quality measures. However, other provider attributes, such as the Care Need Index of the registered population, seem to influence choice to a greater extent than quality.ConclusionThe results point in the same direction as the arguments behind the patient choice reform. However, the effects are marginal. To enhance quality competition, policy makers should consider making quality information at the provider level more accessible.     

Does social support mediate or moderate socioeconomic differences in self-rated health among adolescents?

Objective

Social support is assumed to be a protective social determinant of health. The aim of this cross-sectional study was to explore whether social support from the father, mother and friends mediates or moderates the association between socioeconomic position and self-rated health among adolescents.

Methods

The sample consisted of 1,863 secondary school students from the Kosice region in Slovakia (mean age 16.85; 53.3% females, response rate 98.9%). We assessed the mediation and moderation effects of social support from the mother, father and friends on the relation between socioeconomic position and self-rated health, performing binary logistic regression models. Socioeconomic position was measured by parents?? education, the family affluence scale and financial strain.

Results

Social support from the father mediated the association between family affluence and self-rated health among both males and females and the association between financial strain and self-rated health among males only. No moderating effect of social support on socioeconomic differences in self-rated health was found.

Conclusion

Father involvement seems to have the potential to mediate socioeconomic differences in health during adolescence.     

Does a working day keep the doctor away? A critical review of the impact of unemployment and job insecurity on health and social care utilisation

While the negative impact of unemployment on health is relatively well established, the extent to which that impact reflects on changes in health and social care utilisation is not well understood. This paper critically reviews the direction, magnitude and drivers of the impact of unemployment and job insecurity on health and social care utilisation across different care settings. We identified 28 relevant studies, which included 79 estimates of association between unemployment/job insecurity and healthcare utilisation. Positive associations dominated mental health services (N = 8 out of 11), but not necessarily primary care (N = 25 out of 43) or hospital care (N = 5 out of 22). We conducted a meta-analysis to summarise the magnitude of the impact and found that unemployed individuals were about 30% more likely to use health services compared to those employed, although this was largely driven by mental health service use. Key driving factors included financial pressure, health insurance, social network, disposable time and depression/anxiety. This review suggests that unemployment is likely to be associated with increased mental health service use, but there is considerable uncertainty around primary and hospital care utilisation. Future work to examine the impact across other settings, including community and social care, and further explore non-health determinants of utilisation is needed. The protocol was registered in PROSPERO (CRD42020177668).

     

Inequality in the face of death? Public expenditure on health care for different socioeconomic groups in the last year of life

OBJECTIVE: To investigate the association between public expenditure on health care in the last year of life and individual socioeconomic status in Sweden. METHODS: Population-based study of public expenditure using linked registers for all 16,617 deaths among Stockholm County Council residents in 2002 (population 1.8 million). Age-standardized, total and per capita spend were calculated by income categories, age and specialty. Multivariate analysis examined the association between socioeconomic status and public expenditure. RESULTS: County council expenditure on health care in the last year of life rose with increasing income of the deceased person. Median per capita expenditure increased from 55,417 Swedish Kronor (SEK) (US$ 7542) in the lowest income group to SEK 94,678 (US$ 12,887) in the highest. Total age-standardized spend increased by 60% across the same interval (80,227 [95% confidence interval (CI) 79,946-80,497] to SEK 127,344 [95% CI 126,969-127,719]). Expenditure decreased with increasing age over 65 years in all income groups. Higher income was independently associated with greater total public health spend in multivariate analysis, adjusting for age, sex, health-care utilization and major diagnostic groups. CONCLUSIONS: There is inequality in public expenditure on health care at the end of life across socioeconomic groups in Stockholm. This phenomenon merits attention within Sweden, and beyond, in countries with less comprehensive welfare systems.     

Has the leapfrog group had an impact on the health care market?

A number of large employers and public purchasers founded the Leapfrog Group in 2000 in an attempt to consolidate the purchaser voice and engage consumers and clinicians in improving health care quality. Drawing on evidence-based medicine, Leapfrog publicly releases information about the extent to which hospitals are adopting three safety "leaps" with the theoretical capacity to prevent thousands of deaths. Although the group has grown rapidly and achieved national recognition, employer-based initiatives historically have struggled to create changes in health care. This paper examines the impact of the Leapfrog Group and its efforts to address the challenges of employer initiatives.     

Does overweight in childhood have an impact on adult health?

The consequences of overweight in childhood, including persistence into adulthood and as a risk factor for adverse health consequences, are of substantial concern given the recent upward trend in prevalence. A recent report on an historic cohort--a British 1947 birth cohort--is largely consistent with previous estimates of persistence of overweight. Long-term health consequences of obesity were not demonstrable in this study, likely owing to the small numbers of subjects who were overweight during post-World War II Britain.     

Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

Background

Spatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application.

Methods

This study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as ‘IRIS’ (Ilot Regroupé pour l’Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the “Index of Spatial Accessibility” (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact.

Results

The results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran’s spatial autocorrelation index and local indicators of spatial autocorrelation) are not really impacted.

Conclusion

Our research has revealed minor accessibility variation when edge effect has been considered in a French context. No general statement can be set up because intensity of impact varies according to healthcare provider type, territorial organization and methodology used to measure the accessibility to healthcare. Additional researches are required in order to distinguish what findings are specific to a territory and others common to different countries. It constitute a promising direction to determine more precisely healthcare shortage areas and then to fight against social health inequalities.