Neighbourhood characteristics,social capital and self-rated health - A population-based survey in Sweden

Background

In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health.

Methods

We used data from the survey 'Life &; Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model.

Results

The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer.

Conclusions

The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital - all important determinants of health.

     

Differences in self-rated health by immigrant status and language preference among Arab Americans in the Detroit Metropolitan Area

Arab Americans are a growing minority in the U.S., yet only a few studies have examined their health utilizing representative samples. Using data from the 2003 Detroit Arab American Study, which is based on a probability sample, we examined the self-rated health (SRH) of Arab Americans by two measures of acculturation – immigrant status and language preference. We specified logistic regression models to test whether immigrants report better or poorer health status compared to U.S.-born Arab Americans and whether language preference among the immigrant generation accounts for the association between immigrant status and SRH. Our findings reveal that the health status of Arab Americans improves with acculturation. Arab immigrants are more likely to report poorer SRH compared to U.S.-born Arab Americans. When language preference is taken into account, Arabic-speaking immigrants are more likely to report poorer SRH compared to both U.S.-born Arab Americans and to English-speaking immigrants. We discuss these findings in light of similar ones obtained in the literature on SRH among other immigrant groups in the U.S. We conclude by arguing that language is an important measure to include in SRH studies among Arab Americans as well as other non-English speaking ethnic groups.     

Neighbourhood deprivation and self-rated health: the role of perceptions of the neighbourhood and of housing problems

It has been known for a long time that people living in socially and economically deprived neighbourhoods generally experience poorer health. However, it is often not clear what processes underlie the relationship between neighbourhood deprivation and individual health. In this study we explore the association between neighbourhood socio-economic status and self-rated health using the Caerphilly Health and Social Needs Survey (n=10,892). We found that the association between neighbourhood deprivation and self-rated health was substantially reduced after adjusting for individual socio-economic status, but remained statistically significant. This suggests that the health effects of neighbourhood deprivation are partly contextual. We also found that the association between neighbourhood deprivation and self-rated health was further attenuated when controlling for perceptions of the neighbourhood and of housing problems, suggesting that these variables may play a role in mediating the health effects of neighbourhood deprivation. The implications of the results are that health policy should target 'places' as well as 'people'; and that policies aimed at improving the quality of housing, access to amenities, neighbourhood safety, and social cohesion may help to reduce health inequalities.     

Factors associated with self-rated health in Greece: a population-based postal survey

BACKGROUND: Self-rated health (SRH), as an indicator of population health, is a concept useful both for research and planning. This study reports SRH, and factors related to it, in Greece. METHODS: Population-based postal survey, using World Health Organisation (WHO) questionnaires with a sample of randomly selected geographically stratified individuals. Response rate reached 41%. RESULTS: As expected, age, income and education were related to SRH, but accounted for only 20% of the variance. CONCLUSIONS: SRH in Greece is related to sociodemographic factors, but perhaps not as strongly as in other populations. Other explanatory variables will require further research.     

Psychosocial and neo-material dimensions of SES and health revisited: predictors of self-rated health in a Canadian national survey

This study addresses questions concerning psychosocial processes of relative comparison in the production of socio-economic inequalities in health. Specifically, the importance for health of perceptions of status, different 'reference groups' and 'reference points' in such comparisons is problematized and investigated empirically. Using data from a cross-sectional telephone survey of the Canadian population in 2000 (n=1331), the paper investigates relationships between self-rated health status (SRHS) and: (1) 'actual' absolute socio-economic standing, (2) perceived relative socio-economic standing (relative to other Canadians and to Canadians of the previous generation), and (3) 'actual' relative socio-economic standing (relative to others in respondents' province of residence and neighbourhood of residence). Measures of actual absolute socio-economic status (SES) (household income, personal income and education) were strongly related to SRHS. Results for perceived relative SES were mixed. Perceived SES relative to all Canadians was a strong predictor of SRHS before and after controlling for age and gender while perceived SES relative to the previous generation was unrelated to SRHS. Actual relative income was strongly related to SRHS for all reference points (10th, 50th and 90th percentiles) in both reference groups analysed (neighbourhoods and provinces). Within neighbourhoods, however, comparisons with those at the top of the income ladder appeared to be somewhat more salient for SRHS than were comparisons to other levels. We conclude that there is some evidence of the importance of both psychosocial and neo-material aspects of SES for Canadians' self-rated health, but that further empirical research is needed that accounts for the numerous ways in which psychosocial processes of relative social comparison may take place.     

Housing and inequalities in health: a study of socioeconomic dimensions of housing and self reported health from a survey of Vancouver residents

STUDY OBJECTIVE: To investigate the relation between housing, socioeconomic status, and self reported general and mental health. This study is an empirical investigation of social and economic dimensions of housing, specifically, demand, control, and material (affordability, dwelling type) and meaningful (pride in dwelling, home as a refuge) dimensions of everyday life as they occur in the domestic environment. DESIGN: A cross sectional telephone survey was administered to a random sample of households. Survey items included measures of demand, control, and meaningfulness of the domestic environment, as well as standard measures of socioeconomic status and social support. Main outcome measures were self reported health (excellent, very good, good, fair, poor) and self reported frequency of feeling "downhearted and blue" in the two weeks before interview (from the Rand Mental Health Index). SETTING: Households (n=650) from 12 neighbourhood areas in the city of Vancouver, Canada. PARTICIPANTS: One randomly selected adult from each of 650 households completed the interview and constitute the sample for this study. Main results: In bivariate analyses, measures of housing demand, control and meaningfulness exhibited strong and significantly graded relations with self reported health and somewhat less strong relations with mental health. In logistic regression analyses housing demand and control variables made significant contributions to health both general and mental health. Respondents were more likely to report fair/poor health if they: reported that they couldn't stand to be at home sometimes (OR=2.29, p<0.05); rated their domestic housework as somewhat or quite a strain (OR=5.71, p<0.001); were somewhat or very dissatisfied with their social activities (OR=3.41, p<0.001); and reported that they were constantly under stress a good bit of the time or more (OR=3.56, p<0.05). In terms of mental health, respondents were more likely to report poorer mental health if they: lived longer in their neighbourhood (OR=1.05, p<0.05); reported their housework duties to be somewhat or quite a strain (OR=5.55, p<0.001); reported that they did not have somebody that could help them if they needed it (OR=9.28, p<0.001); and reported that they were constantly under stress a good bit of the time or more in the two weeks before the interview (OR=5.26, p<0.001). One of the main hypotheses investigated-that meaningful dimensions of housing are associated with health status-found support in bivariate analyses without controls, but did not contribute to multivariable models. CONCLUSIONS: The influence of housing demand and control variables superseded a well known correlate of health status, educational attainment, attesting to their importance. The findings of this paper lend support to the hypothesis that features of the domestic environment, especially as they pertain to the exercise of control and the experience of demand, are significant predictors of self reported general and mental health status. Housing is a concrete manifestation of socioeconomic status, which has an important part to play in the development of explanations of the social production of health inequalities.     

Adolescent distinctions between quality of life and self-rated health in quality of life research

Background  

In adult quality of life (QOL) research, the QOL construct appears to differ from self-rated health status. Although increased QOL continues to be recognized as an important outcome in health promotion and medical intervention, little research has attempted to explore adolescent perceptual differences between self-rated health and QOL.     

An Ecological Study to Identify Census Blocks Supporting a Higher Burden of Disease: Infant Mortality in the Lille Metropolitan Area, France

In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.     

Social capital and self-rated health: results from the US 2006 social capital survey of one community

Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.     

Neighbourhood environment correlates of physical activity: a study of eight Czech regional towns

An adequate amount of physical activity (PA) is a key factor that is associated with good health. This study assessed socio-environmental factors associated with meeting the health recommendations for PA (achieving 10,000 steps per day). In total, 1,653 respondents randomly selected from across eight regional towns (each >90,000 inhabitants) in the Czech Republic participated in the study. The ANEWS questionnaire assessed the environment in neighbourhoods, and participants' weekly PA was objectively monitored (Yamax Digiwalker SW-700 pedometer). About 24% of participants were sufficiently active, 27% were highly active; 28% participants were overweight and 5% were obese. Although BMI was significantly inversely associated with the daily step counts achieved only in females, for both genders, BMI was generally not significantly associated with the criterion of achieving 10,000 steps per day during the week. Increased BMI in both genders was accompanied with a decline in participation in organized PA and with increasing age. As regards to the demographic/lifestyle factors, for females, more participation in organized PA was significantly positively correlated with the achieved daily step counts. In contrast, older age and higher BMI (for females) and smoking (for males) were significantly negatively correlated with the achieved daily step counts. In terms of the environmental aspects, pleasant environments were significantly positively correlated to daily step counts for both genders. Additionally, for males, better residencies (more family homes rather than apartment blocks) in the neighbourhood were significantly positively correlated with their daily step counts. For females, less accessibility of shops and non-sport facilities (depending on walking distance in minutes) were significantly negatively correlated to the achieved daily step counts. Individuals who lived in pleasant neighbourhoods, with better access to shops and who participated in organized PA (≥ 2 times a week) tended to meet the recommendations for health-enhancing PA levels. The creation of physical activity-friendly environments could be associated with enhancing people's achieved daily step counts and meeting the health criteria for PA.     

Social capital and self-rated health: a contextual analysis.

OBJECTIVES: Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. METHODS: Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. RESULTS: Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. CONCLUSIONS: These results extend previous findings on the health advantages stemming from social capital.     

Determining the health status of a population: role and quality of survey questions

Zusammenfassung Die Rolle und Güte von Befragungsdaten im Rahmen der Messung des Gesundheitszustands der Bevölkerung wird untersucht. Dabei werden zunächst die Informationsbedürfnisse im Gesundheitswesen abgesteckt und der Beitrag von Bevölkerungserhebungsdaten angegeben. Befragungsdaten stellen wiederum eine Untermenge dieser letzten Datengruppe dar.Zur Beurteilung von Rolle und Güte solcher Daten wird auf die methodischen Eigenschaften von Befragungsdaten eingegangen und gezeigt, da die Dokumentation der Methoden dieser Datenkörper nicht nur zur Gütebeurteilung notwendig ist sondern vielmehr deren Rolle im Kanon der Information im Gesundheitswesen wesentlich mitbestimmt. Wenn dieses so ist, müssen Anstrengungen zur Qualitätsverbesserung sich nicht nur um die Verbesserung traditionell berücksichtigter Methodikaspekte kümmern (wie z.B. Stichprobenziehung, Responseraten) sondern auch um die Verbesserung der methodischen Voraussetzungen für bessere Nutzungsmöglichkeiten von Befragungsdaten. Diese sind zu erreichen durch Erhöhung der Verknüpfungsmöglichkeiten, durch Einführung von einheitlichen Mindestdatensätzen, einheitliche Definitionen, einheitliche Ausdrücke und durch Beibehaltung von identischen Fragen in einem Erhebungstyp über längere Zeit hinweg. Güte von Befragungsdaten wird daher wesentlich durch ihre methodischen Eigenschaften und Rolle durch die Nutzungsmöglichkeiten dieser Daten bestimmt.

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Measuring population health levels: Role and quality of interview data

Summary Role and quality of interview data are examined with respect to their importance for the measurement of population health levels. Starting from general information requirements in health services, the contribution of population survey data is described. Interview data constitute just a subset of such survey data.When role and quality of interview survey data are to be judged, survey methods are of major importance. They not only determine the quality but also the role of health interview survey data in the framework of all information about the population's health. If this is so, efforts to improve health survey data quality should not only be directed towards improvement of traditional methodological aspects (such as sampling procedures and response rates) but also towards the implementation of prerequisites for wider usage of health interview data. This may be achieved by improving their linkage potential, by implementing uniform minimal basic data sets, by introducing identical terms and definitions and by keeping identical survey methods (including questions) for several years in a row.Quality of health interview data is, therefore, determined by the methodological standards underlying their collection and the potential for usage of these data sets determines the role they play as part of the information about the population's health.

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La mésure du niveau de la santé de la population: role et qualité de dates de questionnaires

Résume Cet article s'occupe du rôle et de la qualité des dates de questionnaires dans le domaine de l'état de santé de la population. On s'interesse d'abord à des besoins d'informations du système de la santé pour en déduire l'importance des enquêtes de la population. Des dates de questionnaires sont un sous-groupe des dates mentionnes ci-dessus.Pour juger le rôle et la qualité de telles dates on regarde de près les méthodes des dates de questionnaires tout en montrant que la documentation des méthodes de ce corps de dates n'est pas seulement nécessaires pour juger sa qualité mais également pour déterminer son rôle dans le cadre de l'information du système de la santé. Si c'est ainsi, il faut faire des efforts pour améliorer la qualité des aspects méthododiques auxquels on se réfère traditionellement et pour augmenter les suppositions de meilleurs possibilites d'emploi des dates d'enquêtes. Cet objectif est atteint par l'augmentation des possibilites de joindre les corps de dates, par l'introduction des dates minimes uniformes, des définitions et termes uniformes et par l'insistance en de mêmes questions pendant une certaine période. Or, la qualité des dates de questionnaires est deternminée essentiellement par ses charactéristiques méthodiques et le rôle de celles-ci par ses possibilités d'emploi.

     

Social trust and self-rated health in US communities: a multilevel analysis

This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborbood effects.