The impact of being the intermediate caring generation and intergenerational transfers on self-reported health of women in Ireland

Objectives

To investigate the associations with being the “sandwich generation” in older women in Ireland and its impact on self-reported health.

Methods

Analysis of 3,196 women from wave 1 of the Irish Longitudinal Study on Ageing (TILDA) was undertaken. Poisson regression was used to determine whether intergenerational transfers, were associated with self-rated physical health and depression, when controlling for other socio-demographic variables.

Results

Multivariate analysis found that women in the sandwich generation who financially supported their children had better self-rated physical health (poor/fair health relative to excellent; RR 0.84, 95 % CI 0.72–0.97). Conversely, the women who provided other care for their children showed evidence of poorer mental health (case-level depression, RR 1.35, 95 %CI 1.05–1.73). Providing financial support for parents was associated with case-level depression (RR 2.21, 95 %CI 1.26–3.86).

Conclusions

Supporting two generations was associated with both better self-rated health and poorer mental health, depending on the type and direction of the transfers. This generation of women have substantial caring responsibilities. Strategies to address the stresses associated with bi-directional intergenerational transfers are needed.     

Health-related quality of life among adults with work-related asthma in the United States

Purpose

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

Methods

We analyzed 2006–2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

Results

Of ever-employed adults with current asthma, an estimated 9.0 % had work-related asthma, 26.9 % had poor self-rated health, 20.6 % had impaired physical health, 18.2 % had impaired mental health, and 10.2 % had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95 % confidence interval (CI), 1.31–1.60], impaired physical health (PR, 1.60; 95 % CI, 1.42–1.80), impaired mental health (PR, 1.55; 95 % CI, 1.34–1.80), and activity limitation (PR, 2.16; 95 % CI, 1.81–2.56).

Conclusions

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.     

Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study

Purpose

To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y.

Methods

The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test–retest reliability was determined. Spearman’s rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups’ validity was examined by comparing groups with a priori expected differences in HRQOL.

Results

Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1–24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8–47.3%) and Italy (4.3–39.0%). Percentages of agreement in test–retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = ?0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups’ validity.

Conclusions

Results provide preliminary evidence of the instrument’s feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses.     

Association of sleep problems and sleep duration with self-rated health and grip strength among older adults in India and China: results from the study on global aging and adult health (SAGE)

Background

Sleep is an important predictor of health and quality of life. This study examined the association between sleep problems and sleep duration with self-rated poor health and grip strength among respondents aged 50 years and above in India and China.Methods: The data for this study were derived from the first wave of WHO’s Study on Global Aging and Adult Health (SAGE), a nationally representative panel survey conducted in six LMICs. Grip strength and poor self-rated health were the main outcome variables, while sleep problems and sleep duration were the main predictors. Multivariate logistic regression models and ordinary least squares regression models were used to understand the association between sleep problems and sleep duration with poor self-rated health and grip strength.

Results

Sleep problems and sleep duration were strongly and significantly associated with poor self-rated health and grip strength in India and China. Compared to older adults with no sleep problems, the odds ratio for poor self-rated health among older adults with sleep problems was 4.86 (95% CI?=?4.12, 5.73, p?<?0.01) and 5.06 (95% CI?=?3.93, 6.51, p?<?0.01) higher for India and China, respectively. The likelihood of reporting poor health was higher among older adults who got ≤ 6 or 10+ h of sleep in both India and China. A negative and significant association was found between longer sleep duration and grip strength only in China (β?=??1.19, 95% CI?=??1.78, ?0.60, p?<?0.01).

Conclusion

We observed a significant association between sleep problems and sleep duration with poor self-rated health and grip strength. Results suggested that sleep problems are important factors in determining the health of older adults in low- and middle-income countries.

     

Gender, educational and age differences in meanings that underlie global self-rated health

Objectives

The single-item question on self-rated health has been widely used in surveys. This study aims to explore which frames of reference are used by respondents when answering this question, to describe differences in the used frame of reference according to gender, educational background and age, and to determine whether subgroup differences can be explained by differences in prior health experiences.

Methods

Face-to-face interviews were conducted in a sample of 310 adults who were asked to rate their health using a single-item question with closed-ended answering categories and to explain the reasons for the rating they gave with open-ended probes. Different indicators of prior health experiences were taken into account.

Results

Physical health problems were the most utilized referents. However, participants also mentioned reasons that go beyond the physical dimension of health. Subgroup differences were found. Prior health experiences partly explained subgroup differences for some referents, but not for others.

Conclusions

Investigators using the single question on self-rated health for comparing health across different population groups should be aware that the meaning of the question varies across different socio-demographic groups.     

Changes in socioeconomic determinants of health: comparing the effect of social and economic indicators through European welfare state regimes

Aim

This study is aimed at comparing the effect of different measures of socioeconomic status on self-rated health throughout European welfare state regimes during the period 2002–2008, in order to study how diverse socioeconomic inequalities can vary our health over time.

Subjects and methods

This study uses the European Social Survey to compare the impact of three specific socioeconomic measures (income, education and occupational status) on self-rated health.

Results

The main finding to be highlighted is that the importance of education-related inequalities surpasses differences in income and occupational status, especially in southern and eastern countries. The relationship between income and self-rated health is stronger in liberal and social-democratic regimes, where labour market regulation is characterized by its flexibility and high liberalization. The impact of occupational status is moderate among liberal, social-democratic and conservative regimes, but lower in southern and eastern ones.

Conclusion

These findings support the existence of a contextual effect among welfare states that varies the impact of social and economic indicators in self-rated health over time.     

The association of self-rated health and lifestyle behaviors among foreign-born Chinese, Korean, and Vietnamese Americans

Purpose

This study employed the 2009 California Health Interview Survey to examine the association of self-rated heath status and lifestyle behavior variables such as smoking at least 100 cigarettes or more in an entire lifetime, alcohol consumption, and physical activity level among foreign-born Chinese, Korean, and Vietnamese Americans aged 18 and older.

Methods

The total study sample consisted of 3,023 foreign-born adult Chinese (n = 812), Korean (n = 857), and Vietnamese (n = 1,354) Americans. Logistic regression via Stata 12 was employed. Odds ratios (OR) along with confidence intervals (CI) were reported in the results.

Results

Results revealed that smoking at least 100 cigarettes or more in an entire lifetime had a negative association with good health status (OR = 0.74, 95 % CI = 0.59, 0.94), while alcohol consumption had a positive association with good health status (OR = 1.20, 95 % CI = 1.00, 1.44). Moderate physical activity (OR = 1.26, 95 % CI = 1.05, 1.50) and vigorous physical activity (OR = 1.68, 95 % CI = 1.31, 2.15) had a similar positive association with good self-rated health status. The results also revealed that the predicted probability of self-rated health status based on ethnicity and lifestyle variables was more favorable for foreign-born Chinese Americans than their Korean and Vietnamese American counterparts.

Conclusions

This study’s results corroborated the findings reported in previous research on the association of lifestyle behaviors and health status. Regardless of racial or ethnic backgrounds, good lifestyles have an important role in the prevention of poor health status. However, health education and lifestyle intervention programs should take cultural differences among racial and ethnic populations into consideration.     

Joint trajectories of multiple health-related behaviors among the elderly

Objectives

The main goal of this study was to identify the multiple trajectories of the following four health behaviors among the elderly by gender: smoking, drinking alcohol, getting regular exercise, and having a health checkup

Methods

Data were from a longitudinal survey conducted among the elderly from 1996 to 2007 in Taiwan. In total, 5,880 respondents were included in the analysis

Results

The trajectories of health-related behaviors differed between males and females. Five groups of male elderly were identified: smoking, inactive, healthy lifestyle, smoking and drinking, and quitting. Three groups of female elderly were identified: smoking and drinking, inactive, and healthy lifestyle. Age, education, self-rated health, depressive symptoms, and economic satisfaction at baseline were associated with the health behavior trajectories

Conclusion

The nature of healthy behaviors and risky behaviors may differ. Thus, multiple trajectories can exhibit patterns that differ from those of single behavior trajectories. Strategies designed to promote health need to consider both gender and behavior patterns which may change over time.     

Are barriers in accessing health services in the Roma population associated with worse health status among Roma?

Objectives

The health of Roma has been found to be poorer than that of the majority population. The aim of this study was to explore the differences between Roma and non-Roma regarding perceived barriers in accessing health services. Furthermore, we aimed to assess the association between self-rated health status and Roma ethnicity and explore to what degree barriers in accessing health services explain this association.

Methods

We used data from the cross-sectional HepaMeta study conducted in 2011 in Slovakia. The final sample comprised 452 Roma (mean age 34.7; 35.2 % men) and 403 (mean age 33.5; 45.9 % men) non-Roma respondents.

Results

Roma ethnicity was found to be significantly associated with poorer self-rated health status. A considerable part of this association can be explained by barriers in accessing health services as perceived by Roma.

Conclusions

Worse health in Roma is partially mediated by worse access to health services, apart from a large educational gap between Roma living in settlements and the majority population. Interventions should focus not only on health literacy among Roma but also on the health care system and health care professionals.     

Do social relations explain health inequalities? Evidence from a longitudinal survey in a changing eastern German region

Objectives

This study explores the contribution of social relations to explain inequalities in self-rated health in a changing north-eastern German region. So far, there are only few studies that analysed the mediating effects of social relations in a longitudinal design.

Methods

We used data from the Study of Health in Pomerania (SHIP) consisting of 3,300 randomly selected men and women at baseline (2001), and at the 5-year follow-up (2006). Indicators of social inequality were education, equivalent household income and occupational status. Social relations were estimated by the Social Integration Index (SII) and the perceived instrumental and emotional support. Self-rated general health was assessed at both waves of data collection.

Results

Depending on the indicators used, social relations explain up to 35% of the inequalities in self-rated health. Changes in odds ratios are slightly more pronounced when education and income are used as inequality indicator and when adjusting for the SII.

Conclusions

Overall findings suggest that social relations are an important explanatory factor for health inequalities in a deprived German region.     

Poor self-rated health associated with an increased risk of subsequent development of lung cancer

Purpose

Self-rated health has shown to be a strong predictor of mortality and some major chronic diseases. The purpose of this study was to investigate whether poor self-rated health also was related to an increased risk of subsequent development of cancer.

Methods

Information on self-rated health, life-style factors, and other health-related risk factors was ascertained in a cohort of 25,532 persons participating in the Hordaland Health Study in 1997–1999. Information on development of cancer during 10 years of follow-up was obtained from the Norwegian Cancer Registry. The relationship between self-rated health and development of cancer was examined using Cox regression analysis adjusting for smoking and other life-style factors.

Results

Respondents reporting a poor health showed a non-significant increased risk of overall cancer. Sub-analysis of the four most common types of cancer showed a statistically significant association between self-rated health and lung cancer. The adjusted hazard ratio was 3.88 (95 % CI; 0.99, 15.8) for those rating their health as poor compared to very good (p for trend = 0.038). For the other types of cancer, we found a non-significant elevated risk associated with poor self-rated health.

Conclusion

Respondents who perceive their health as poor had an increased risk of developing lung cancer also after adjusting for smoking. This suggests that self-rated health reflects a broad range of factors important for development of this cancer type. Nevertheless, due to the explorative analysis of the specific cancer types, these findings need to be repeated before elaborate interpretations can be made.     

Social inequality and smoking in young Swiss men: intergenerational transmission of cultural capital and health orientation

Objectives

Smoking is related to income and education and contributes to social inequality in morbidity and mortality. Socialisation theories focus on one’s family of origin as regards acquisition of norms, attitudes and behaviours. Aim of this study is to assess associations of daily smoking with health orientation and academic track in young Swiss men. Further, to assess associations of health orientation and academic track with family healthy lifestyle, parents’ cultural capital, and parents’ economic capital.

Methods

Cross-sectional data were collected during recruitment for compulsory military service in Switzerland during 2010 and 2011. A structural equation model was fitted to a sample of 18- to 25-year-old Swiss men (N = 10,546).

Results

Smoking in young adults was negatively associated with academic track and health orientation. Smoking was negatively associated with parents’ cultural capital through academic track. Smoking was negatively associated with health orientation which in turn was positively associated with a healthy lifestyle in the family of origin.

Conclusions

Results suggest two different mechanisms of intergenerational transmissions: first, the family transmission path of health-related dispositions, and secondly, the structural transmission path of educational inequality.     

Watching sport on television, physical activity, and risk of obesity in older adults

Background

Television (TV) viewing has been associated with obesity although the effects of specific TV content on health and other behaviours remains unknown. We examined the association between watching sport on TV, physical activity levels, and risk of obesity.

Methods

We studied 6,733 (aged 64.9?±?9.2 yrs) men and women from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Data were collected on self reported TV time and content, and physical activity. Nurses measured height and weight for the calculation of body mass index.

Results

On average, participants reported viewing TV for 5.3?±?4.1 hours per day and 30.3% of the sample watched sport on TV at least twice a week. There was no association between watching sport and physical activity levels. Participants that watched sports every day were at higher risk of obesity [odds ratio?=?1.39, 95% CI, 1.15, 1.68) after adjustment for age, sex, smoking, alcohol, physical activity, total TV time, disability, and self-rated health.

Conclusions

Watching elite athletes may have no role in the promotion of physical activity in older adults, which has implications for staging large sporting events with physical activity legacy promises.     

Question order sensitivity of subjective well-being measures: focus on life satisfaction,self-rated health,and subjective life expectancy in survey instruments

Purpose

This study examines the effect of question context created by order in questionnaires on three subjective well-being measures: life satisfaction, self-rated health, and subjective life expectancy.

Methods

We conducted two Web survey experiments. The first experiment (n = 648) altered the order of life satisfaction and self-rated health: (1) life satisfaction asked immediately after self-rated health; (2) self-rated health immediately after life satisfaction; and (3) two items placed apart. We examined their correlation coefficient by experimental condition and further examined its interaction with objective health. The second experiment (n = 479) asked life expectancy before and after parental mortality questions. Responses to life expectancy were compared by order using ANOVA, and we examined interaction with parental mortality status using ANCOVA. Additionally, response time and probes were examined.

Results

Correlation coefficients between self-rated health and life satisfaction differed significantly by order: 0.313 (life satisfaction first), 0.508 (apart), and 0.643 (self-rated health first). Differences were larger among respondents with chronic conditions. Response times were the shortest when self-rated health was asked first. When life expectancy asked after parental mortality questions, respondents reported considering parents more for answering life expectancy; and respondents with deceased parents reported significantly lower expectancy, but not those whose parents were alive.

Conclusion

Question context effects exist. Findings suggest placing life satisfaction and self-rated health apart to avoid artificial attenuation or inflation in their association. Asking about parental mortality prior to life expectancy appears advantageous as this leads respondents to consider parental longevity more, an important factor for true longevity.

     

Contextual effects of community mobilization and communication capacity as a positive factor for self-rated health status: a multi-level analysis

Objectives

We examined relationships between individual-level community participation, two types of contextual effects―community capacity for mobilization and capacity for health communication—and residents’ self-reported health status in order to explore the role health communication may play in community building for health.

Methods

To estimate multi-level effects of the community participation and the two contextual indicators with self-rated health status, we applied hierarchical generalized linear regression to crosssectional data from the Korean National Health and Nutrition Examination Survey.

Results

After adjusting for individual- and community-level confounders, the likelihood of having high self-rated health status is significantly higher among those who live in a region with higher community capacity for mobilization, higher health communication capacity at the community level, and higher participation in community groups at the individual-level.

Conclusions

Our findings suggest that living in a community characterized by higher levels of communication and mobilization capacity is beneficial to residents’ self-rated health status—increasing the odds of high health status by up to 9 %. Thus, building community capacity in mobilization and health communication may help develop better health promotion campaigns.     

Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China

Purpose

There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements. However, little is known about the quality of life (QoL) of older people living alone in Mainland China. This study aimed to investigate QoL and its related factors among Chinese older people who live alone.

Methods

A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured questionnaire through face-to-face interviews. QoL was measured using the Older People’s Quality of Life Questionnaire. Other data collected included self-rated health, physical health, cognitive function, depression, functional ability, loneliness, social support, physical activity, health services satisfaction, satisfaction with overall dwelling conditions and socio-demographic variables.

Results

Older people living alone in Mainland China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, previous occupation and health services satisfaction were independently related to QoL, accounting for 68.8 % of the variance. Depression and previous occupation had an interaction effect upon QoL.

Conclusions

This study identified nine factors influencing the QoL of older people living alone in Mainland China. Interventions to increase satisfaction with dwelling conditions, improve economic level, social support and functional ability, decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their QoL.     

No negative effects of a multi-factorial, intensified treatment on self-reported health status, treatment satisfaction, and diabetes-related distress in screen-detected type 2 diabetes patients. The ADDITION-Netherlands study

Purpose

To examine the effects of a multi-factorial, intensified treatment on self-reported health status, treatment satisfaction, and diabetes-related distress in screen-detected type 2 diabetes patients.

Methods

Cluster-randomised controlled trial; A total of 498 screen-detected type 2 diabetes patients from 79 general practices were assigned to intensified (n = 255) or routine treatment according to Dutch guidelines (n = 243). At baseline and after 3 years, patients completed the Short Form-36 and the European Quality of Life-5 Dimensions questionnaires. After 4.5 years, patients completed the Diabetes Treatment Satisfaction Questionnaire and the Problem Areas In Diabetes scale. We analysed the effects of intensified treatment on self-rated health status, treatment satisfaction, and diabetes-related distress, using random effects models to account for clustering at practice level.

Results

Three to 5 years after type 2 diabetes was detected by screening, there were no differences between intensified and routine treatment in self-reported health status, treatment satisfaction, and diabetes-related distress.

Conclusions

Multi-factorial, intensified treatment did not influence self-rated health status, treatment satisfaction, and distress in screen-detected type 2 diabetes patients. Therefore, health care professionals do not have to fear negative effects of an intensified treatment on these psychological outcomes.     

Wirkung schulischer Gesundheitsförderung auf soziale Ungleichheit

Background

According to the inverse equity hypothesis public health interventions are usually more effective among privileged social groups. The objective of this article is to find out whether this assumption also applies to health promotion in schools.

Method

A systematic review provided evidence to assess, if relevant interventions tended to have an increasing effect on social inequality. Two reviewers independently screened the results of comprehensive database queries. Based on pre-defined inclusion criteria 25 publications were selected.

Results

Most interventions concerning nutrition and physical activity resulted in an increased gender inequality, but this hardly applies to ethnic and socioeconomic inequalities. Regarding dental health, no intervention that increased social inequality was found. As far as mental health and substance use are concerned interventions had mixed effects depending on the form of intervention and outcome measures.

Conclusion

The inverse equity hypothesis can only partly be applied to health promotion in schools. The use of certain kinds of intervention can apparently help to reduce the risk of increasing inequalities in health among students.     

Specific versus general self-reported health indicators predicting mortality among older adults in Europe: disparities by gender employing SHARE longitudinal data

Objectives

The study aims at assessing the relative importance of specific versus general self-reported indicators of health and disability in predicting mortality among older adults and at exploring the potential value of the global activity limitation indicator (GALI), a recently validated general measure of activity restrictions, as predictor of death.

Methods

Longitudinal data from two waves (2004 and 2006–2007) of the Survey of Health, Ageing and Retirement in Europe were employed. The sample comprises 17,941 persons aged 50+ at baseline, representing 11 countries. Associations were estimated by sex using Cox’s proportional hazards regression models.

Results

Most specific and general indicators of health and disability are strong and independent predictors. There are disparities by sex; among general measures, controlling for all indicators under consideration, self-rated health (SRH) only remains significantly associated with mortality among males and GALI among females.

Conclusions

A combination of specific and general measures is more efficient in predicting mortality than either of these alone. SRH and GALI seem to share some traits, adding health and disability dimensions over specific measures, representing though different aspects by gender.     

Evolution of educational inequalities in mortality among young adults in an urban setting

Objectives

To gain insight into the evolution in educational inequalities in adolescent and young adult all-cause and cause-specific mortality in the urban setting of the Brussels-Capital Region.

Methods

Data were derived from record linkage between the censuses of 1991 and 2001 and register data on all-cause and cause-specific mortality and emigration in the respective periods of 1st October 1991 to 1st January 1996 and 1st October 2001 to 1st January 2006. Both directly and indirectly standardised mortality rates and the relative index of inequality (RII) were computed.

Results

Mortality rates among adolescents and young adults have dropped significantly, especially infections and traffic accidents. However, educational inequalities among men have slightly increased: men with a maximum primary education are four times more likely to die than those who are higher educated [RII = 4.09 (2.78–6.03)]. Among women, no social gradient is observed in either period, but a clear split between the lowest educated and other educational groups is apparent in the 2000s.

Conclusions

There is a positive evolution towards lower mortality among adolescents and young adults, but educational inequalities remain a public health concern.