Social capital, political trust and self rated-health: a population-based study in southern Sweden

AIM: To investigate the association between political trust (an aspect of institutional trust) and self-rated health, taking generalized (horizontal) trust in other people into account. METHODS: The 2004 public health survey in Sk?ne is a cross-sectional postal questionnaire study answered by 27,963 respondents aged 18-80 years, yielding a 59% response rate. A logistic regression model was used to investigate the associations between political trust in the Riksdag (national parliament) and self-rated health. Multivariate analyses of political trust and self-rated health were performed in order to investigate the importance of possible confounders. RESULTS: Poor health was reported by 28.7% of the men and 33.2% of the women. In total, 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the Riksdag. The addition of generalized (horizontal) trust in the multivariate models reduced the odds ratios of poor self-rated health in the "no political trust at all' category as compared to the "very high political trust' category from 2.4 (1.8-3.1) to 2.1 (1.6-2.7) among men and from 1.9 (1.4-2.4) to 1.6 (1.3-2.1) among women. CONCLUSIONS: Low political trust in the Riksdag seems to be significantly associated with poor self-rated health, even after adjustments for plausible confounders, including generalized (horizontal) trust.     

Social capital,political trust and self-reported psychological health: A population-based study

This study investigates the association between political trust (an aspect of institutional trust) in the Riksdag (the national parliament in Sweden) and self-reported psychological health, taking generalized (horizontal) trust in other people into account. The 2004 public health survey in Skåne in Southern Sweden is a cross-sectional postal questionnaire study that was answered by 27,757 respondents aged 18–80 yielding a 59% response rate. A logistic regression model was used to investigate the associations between political trust and self-reported psychological health adjusting for possible confounders (age, country of origin, education, economic stress and generalized trust in other people i.e. horizontal trust). We found that 13.0% of the men and 18.9% of the women reported poor psychological health. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, born abroad, with high education, high levels of economic stress, low horizontal trust and low political trust had significantly higher levels of self-reported poor psychological health. There was a significant association between low political trust and low horizontal trust. After adjustments for age, country of origin, education and economic stress, the inclusion of horizontal trust reduced the odds ratios of self-reported poor psychological health in the “no political trust at all” category compared to the “very high political trust” category from 1.6 to 1.4 among men and from 1.7 to 1.4 among women. It is concluded that low political trust in the Riksdag seems to be significantly and positively associated with poor mental health.     

Social capital, the miniaturization of community and cannabis smoking among young adults

OBJECTIVES: The impact of social participation, trust and the miniaturization of community, i.e. the combination of high social participation and low trust, on cannabis smoking was investigated. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons aged 18-80 years, of which 3,978 persons aged 18-34 years were included in this study, answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between the social capital variables and ever having experienced cannabis smoking. The multivariate analysis was performed to investigate the importance of possible confounders (age, country of origin and education) on the differences in having experienced cannabis smoking according to social participation, trust and their four combination categories. RESULTS: Cannabis smoking is not associated with social participation, but positively associated with low trust among both men and women, and the miniaturization of community, i.e. the combination of high social participation and low trust, among men. CONCLUSIONS: This study suggests that the miniaturization of community, i.e. the combination of high social participation and low levels of generalized trust of other people, may enhance the experience of cannabis smoking.     

Social capital, political trust and purchase of illegal liquor: a population-based study in southern Sweden

AimsTo investigate the association between political trust in the Riksdag (the national parliament in Sweden) and having purchased illegal liquor during the past 12 months.MethodsThe 2004 public health survey in Skåne is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18–80 with a 59% response rate. A logistic regression model was used to investigate the associations between political trust and having purchased illegal liquor during the past 12 months. Multivariate analyses of political trust and having purchased illegal liquor were performed in order to investigate the importance of possible confounders (including generalized/horizontal trust in other people).ResultsA 21.2% fraction of the men and 9.6% of the women had purchased illegal alcohol during the past 12 months. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, with medium/low education, economic stress, low horizontal trust and not particularly high and no political trust at all and no opinion had significantly higher levels of having purchased illegal liquor. The significant odds ratios of having purchased illegal liquor in the not particularly high political trust and no political trust at all categories were somewhat reduced although still significant after multiple adjustments.ConclusionThe results suggest that political trust may have an independent effect on the propensity to purchase illegal liquor in Sweden.     

Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study

This study investigates the association between anticipated ethnic discrimination and self-reported psychological health, taking generalized trust in other people into consideration. The 2004 Public Health Survey in Skåne, Sweden, is a cross-sectional postal questionnaire study including a total of 27,757 respondents aged 18–80 with a 59% response rate. Multivariate analyses of anticipated discrimination and self-reported psychological health were performed using logistic regressions in order to investigate the importance of possible confounders (age, country of origin, education and horizontal trust). Poor psychological health was reported by 13.0% of men and 18.9% of women, and 44.8% and 44.7%, respectively, reported that 50% or more of employers would discriminate according to race, colour of skin, religion, or cultural background. Respondents in younger age groups, born abroad, with high education, low trust and high levels of self-reported anticipated discrimination, had significantly higher levels of poor self-reported psychological health. There was a significant association between anticipated discrimination and low horizontal trust. After multiple adjustments for age, country of origin and education, the addition of trust in the model reduced the odds ratio of poor self-reported psychological health in the “most employers” category from 1.8 (1.4–2.1) to 1.5 (1.3–1.9) among men and from 2.2 (1.8–2.6) to 1.8 (1.5–2.2) among women. Generalized trust in other people may be a confounder of the association between anticipated discrimination and poor psychological health. Anticipated discrimination may have effects on the mental health of not only the affected minorities, but also on the mental health of the general population.     

Social capital, institutional (vertical) trust and smoking: a study of daily smoking and smoking cessation among ever smokers

OBJECTIVES: The associations between vertical (institutional) trust in the healthcare system and the mass media (newspapers and television), and daily smoking and smoking cessation were investigated. METHODS: The 2004 public-health survey in Scania is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the associations between institutional trust in the healthcare system and the mass media, and daily smoking and smoking cessation. A multivariate analysis was performed to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people) on the differences in daily smoking and smoking cessation according to trust in the healthcare system and the mass media. RESULTS: 14.9% of the men and 18.1% of the women were daily smokers. Middle-aged respondents were daily smokers to a significantly higher extent than the young. Respondents with low trust in the healthcare system had significantly higher odds ratios of daily smoking, 1.88 (95% CI 1.38-2.57) among men and 2.05 (95% CI 1.51-2.78) among women, while respondents with low trust in the mass media had no significant odds ratios of daily smoking, 1.01 (0.67-1.52) among men and 1.55 (0.97-2.47) among women, after multiple adjustments. CONCLUSIONS: Institutional (vertical) trust in the healthcare system but not the mass media was significantly associated with lower odds of daily smoking and higher odds of having quit smoking if ever smoker. The healthcare system seems to be a potent arena for tobacco prevention.     

Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study

This paper investigates the relationship between institutional trust in the health-care system, i.e. an institutional aspect of social capital, and self-rated health, and whether the strength of this association is affected by access to health-care services. The 2004 public health survey in the Scania region of Sweden is a cross-sectional study; a total of 27,963 respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. Logistic regression model was used to investigate the association between institutional trust and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people, and care-seeking behaviour) on this association. A 28.7% proportion of the men and 33.2% of the women reported poor self-rated health. A total of 15.0% and 58.3% of the respondents reported "very high" and "rather high" trust in the health-care system, respectively. Almost one-third of all respondents reported low institutional trust. Respondents born outside Sweden, with low/medium education, low generalized trust and low institutional trust had significantly higher odds ratios of poor self-rated health. Multiple adjustments for age, country of origin, education, economic stress, and horizontal trust had some effect on the significant relationship between institutional trust and poor self-rated health, for both men and women, but the additional introduction of care-seeking behaviour in the model substantially reduced the odds ratios. In conclusion, low trust in the health-care system is associated with poor self-rated health. This association may be partly mediated by "not seeking health care when needed". However, this is a cross-sectional exploratory study and the causality may go in both directions.     

Trust, self-rated health and mortality: a longitudinal study among ageing people in Southern Finland

Poor self-rated health (SRH) predicts mortality significantly. High trust has been shown to associate with better SRH in cross-sectional studies and survival in longitudinal studies. However, little is known about the associations between trust, SRH and mortality among ageing people. The present study examined whether low trust at the baseline predicted higher all-cause mortality in a follow-up of over five years among ageing people, and whether the trust to mortality relationship varied by SRH. The study used longitudinal, questionnaire-based survey data gathered in 2002 (n = 2815; 66%) among three age cohorts (born in 1926-30, 1936-40 and 1946-50) living in the Lahti region, Southern Finland. Two survey follow-ups were done, the first in 2005 (n = 2476, 60%) and the second in 2008 (n = 2064, 73%). Deaths during the follow-up were obtained from the covering National Population Registry. Those who died within the first one year of follow-up were excluded from the analyses to reduce potential bias due to early deaths. Cox proportional hazard models were used to derive the results. Mortality proved to be higher among men with low trust, even if their SRH had been good at the baseline. Among women, no significant associations were found. The risk attenuated after adjustment for background health-related covariates, but the gradient remained statistically significant in all models. Initial SRH did not substantially explain the gradient of trust in mortality among men. Moreover, a Sobel test of indirect effects showed that SRH had no significant mediating role in links between trust and mortality. Thus, low trust is a sensitive indicator of higher mortality risk among ageing men.     

Smoking, alcohol and drug use in Utrecht, The Netherlands, risk groups and socioeconomic differences in 1999 and 2003

OBJECTIVE: To investigate trends in socio-economic inequalities in smoking, alcohol and drug use in the community of Utrecht, the Netherlands. DESIGN: Repeated cross-sectional population surveys. METHOD: Questionnaires were used to collect information about smoking, (problematic) alcohol use and the use of cannabis, ecstasy and other drugs in the general population aged 15-64 years in Utrecht, the Netherlands. Data were collected in 1999 on 2485 responders (response: 56%) and in 2003 on 1840 responders (54%). The male-female ratio was 4:6. RESULTS: The percentage of smokers was 43 in 1999 and 34 in 2003. Excessive use of alcohol was reported by 21% in both 1999 and 2003, cannabis use was reported in 13% and 14%, respectively, and use of hard drugs was reported in 1-3% in both 1999 and 2003. Native Dutch people, men, unmarried people and people with a low education or income level were at increased risk for drinking, smoking and using drugs. People with a low socio-economic status were just as likely to smoke in 1999 as in 2003, while the use of alcohol, cannabis and ecstasy increased. Those with a higher socio-economic status were much less likely to smoke in 2003 than in 1999, while fewer used cannabis and ecstasy use remained the same. CONCLUSION: Socio-economic inequalities in substance abuse were greater in 2003 than in 1999 in the studied population in Utrecht. People with a low socio-economic status showed an increase in unhealthy behaviour concerning the use of alcohol, cannabis and ecstasy.     

The role of trust in use of preventive services among low-income African-American women

BACKGROUND: This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women. METHODS: We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable. RESULTS: More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents (P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics. CONCLUSIONS: Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient-provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.     

Ethnic differences in anticipated discrimination, generalised trust in other people and self-rated health: a population-based study in Sweden

This paper investigates the relationship between anticipation that employers may discriminate against certain people (not specified, but not specifically the respondent) according to race, colour of skin, religion or cultural background, and self-rated health, adjusting for social capital in the form of generalised (horizontal) trust in other people. It also investigates ethnic differences in anticipated discrimination in relation to self-rated health. The 2004 Public Health Survey in the Scania region of Sweden is a cross-sectional study. Twenty-seven thousand nine hundred and sixty-three respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to assess the association between anticipated discrimination and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, and generalised trust) on this association. Of the men and the women, 28.7 and 33.2%, respectively, rated their health as poor. Of the respondents, 16.0 and 28.7% reported that they anticipated that 'most employers' or 'approximately 50% of employers' would discriminate, respectively. Respondents with high age, born outside Sweden, with low/medium education, economic stress, low horizontal trust, and with anticipation that most or approximately 50% of employers (among men born in Sweden and all women) would discriminate had significantly higher odds ratios of poor self-rated health. Multiple adjustments had a slight effect on the significant relationship between anticipated discrimination and poor self-rated health for both men and women. The introduction of generalised trust in the models reduced the odds ratios to a limited extent. In conclusion, the anticipation that employers may discriminate against certain people (not the respondent) according to race, colour of skin, religion or cultural background is associated with poor self-rated health. However, this is a cross-sectional exploratory study and causality may go in both directions.     

Materialist and post-materialist values and cannabis smoking among young adults: a population-based study in southern Sweden

OBJECTIVES: The association between materialist, mixed and post-materialist values, and the experience of cannabis smoking among young adults was investigated. METHODS: The 2004 public health survey in Sk?ne, southern Sweden, is a cross-sectional study with a 59% response rate. The 6787 persons aged 18-34 years included in this study answered a postal questionnaire. A logistic regression model was used to investigate the association between materialist, mixed and post-materialist values and ever having experienced cannabis smoking. The multivariate analysis was performed to investigate the importance of possible confounders (age and education) on the differences in ever having experienced cannabis smoking according to materialist, mixed and post-materialist values. RESULTS: 28% of the men and 17% of the women had ever experienced cannabis smoking. The experience of cannabis smoking was significantly and positively associated with post-materialist values among both men and women. The odds ratios were 2.4 (1.8-3.1) for men with post-materialist values compared to men with materialist values, and 3.1 (2.4-4.0) for women with post-materialist values compared to women with materialist values. CONCLUSIONS: This study suggests that post-materialist values are positively associated with the risk of ever smoking cannabis. Because this is a cross-sectional study, the direction of causality remains to be investigated.     

Cardiovascular risk factors and educational attainment in Southern Spain: A study of a random sample of 3091 adults

Study objective: To analyze the associations between educational attainment and major cardiovascular disease risk factors in the Murcia Region (Southern Spain). Design: During 1992 we conducted a survey by interview, with multi-stage random sampling, representative of the general adult population. We calculated odds ratios (OR) and trends by logistic regression as a measure of the association between educational levels and cardiovascular risk factors, taking the university level as the reference category. Participants: A total of 1514 men and 1577 women aged between 18 and 65 years was included in the study. Rate of response to the questionnaire was 61%. Seventy-eight percent of the respondents provided a blood sample. A telephone survey on a representative sample of non-respondents (n=347), showed no statistical differences in the level of studies. Measurements: We asked for educational level (highest schooling qualification completed), and according to the WHO MONICA protocol we measured: blood pressure, cigarette smoking, height, weight and total cholesterol, tryglicerides and HDL-cholesterol. We also obtained the leisure-time physical activity by a validated questionnaire. Main results: In a context of a low level of schooling, mainly among the older age groups, the prevalence of risk factors – except smoking in women – is higher in the lower educational levels. Systolic blood pressure tends slightly to increase as schooling level decreases (both genders, p < 0.02). Conversely, serum total cholesterol and triglycerides decrease with higher level of schooling in men. The high levels of HDL- cholesterol observed in all educational groups show no trend in both genders. Arterial hypertension in men and women and overweight in women tend to decrease with higher educational attainment. Moreover, higher level of education is associated with vigorous physical exercise in both genders and cigarette smoking in women. We observed the strongest significant magnitude association in non-schooling with hypertension in men (OR:1.82; 95% CI: 1.15, 2.89), in women (OR:2.39; 95% CI: 1.05, 5.44), and with overweight in women (OR: 3.22; 95% CI: 1.97, 5.27), meaning that compared to people at the university level, people without schooling showed two to three times higher prevalence of hypertension and overweight (only women). Also non-schooling obtained the lowest significant association with protective physical exercise for coronary heart disease in men (OR: 0.32; 95% CI: 0.18, 0.56) and in women (OR: 0.31; 95% CI: 0.15, 0.62) pointing out that people at the university level of education had three times the prevalence of vigorous physical activity than their non schoolarized counterparts. Conclusions: After adjusting for environmental factors, in our adult general population, educational attainment is inversely associated with arterial hypertension in both genders and with overweight in women, and directly associated with cigarette smoking in women and with leisure-time physical activity in both genders.     

Social capital, the miniaturisation of community, traditionalism and first time acute myocardial infarction: a prospective cohort study in southern Sweden

This longitudinal study investigates the impact of social participation, trust and the combinations of social participation and trust on the incidence of first time acute myocardial infarction (AMI) in the population of Scania, southern Sweden. It is based on the cross-sectional 2000 public-health survey in Scania with a 59% participation rate and 13,604 participants, and prospective morbidity/mortality data collected for three years (January 2000-December 2002). The study cohort was followed prospectively to examine first ever AMI. Hazard rate ratios (HRR) for first time AMI in the social participation, trust and social participation/trust combinations were calculated in a Cox regression model with adjustments for age, sex, education, economic stress, daily smoking, leisure time physical activity, body mass index (BMI), and self-reported health. The prevalence of low social participation was 32.8% among men and 31.5% among women. The prevalence of low trust was 40.0% among men and 44.2% among women. The three-year first time AMI rate was significantly higher among people with higher age, low education, daily smoking, poor self-reported health (among men), low social participation, and the combinations of low social participation/high trust and low social participation/low trust. The results show that low social participation but not trust was significantly associated with first time AMI after adjustment for age and sex. The positive association between low social participation and myocardial infarction remained significant after further adjustments for education, economic stress, daily smoking, physical activity and BMI, and became not significant only after additional adjustment for self-reported health, HRR 1.3 (0.9-2.0). High trust in combination with low social participation as well as low social capital (low trust/low social participation) were significantly associated with AMI, but after multiple adjustments only the low social participation/high trust category remained significant, HRR 1.6 (1.0-2.6).     

Health-related behaviour in a small Scottish community

A survey of health-related behaviours was carried out in a small Scottish town. A random sample stratified by age and sex was drawn from the records of the sole local health centre. A previously validated questionnaire was sent by post with a covering letter from the general practitioners and a reply paid envelope. An overall response rate of 71.3% was achieved. The results indicated very high rates of smoking for women with manual jobs, but differences between men in manual & non manual groups were not significant. Younger women reported higher alcohol consumption than older women, but there were no significant differences between occupational groups or employed and unemployed men. Only a minority of respondents reported regular consumption of high fibre products, low fat milk and polyunsaturated margarine and few claimed to undertake vigorous exercise. In general health-related behaviours showed little association with self-rated health. Whilst the data confirm the importance of socio-demographic factors in certain behaviours they also indicate that these are inadequate to predict the pattern of such behaviours within a community.     

Does gender modify associations between self rated health and the social and economic characteristics of local environments?

OBJECTIVES: To examine whether area level socioeconomic disadvantage and social capital have different relations with women's and men's self rated health. METHODS: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. RESULTS: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women's self rated health but not for men's. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. CONCLUSIONS: These finding suggest that women may benefit more than men from higher levels of area social capital.     

Measuring dimensions of social capital: evidence from surveys in poor communities in Nicaragua

A dominant perspective in social capital research emphasizes a "structural" dimension of social capital, consisting of network connections, and a "cognitive" dimension, consisting of attitudes toward trust. Correspondingly, membership in organizations (i.e., membership density) and general trust in people (i.e., social trust) are two indicators commonly used to relate structural and cognitive social capital, respectively, to a variety of health and other outcomes. This study analyzed relationships between membership density, social trust and a more comprehensive set of household-level social capital indicators as well as selected civic and health behaviors in the context of Nicaragua. The sample of respondents was drawn from 6 communities and interviews were conducted with 482 heads of households, resulting in data on 2882 individuals. Factor analyses suggest that membership density loaded strongly (loading=0.81) onto an "organizational participation" factor which contained a number of qualitative characteristics of involvement, including bridging social capital. Further, this structural dimension of social capital appears to be a construct consisting of more than just informal social networks. However, factor analyses suggest that distinctions between levels of trust are warranted in Nicaragua: social trust loaded weakly (loading=0.32) onto a factor characterized by institutional trust in a factor analysis of trust items, and well below 0.30 in a factor analysis of both structural and cognitive dimensions of social capital. A nuanced understanding of these household-level indicators of structural and cognitive social capital held implications for civic and health behaviors. While membership density and institutional trust were positively related to an index of political engagement, social trust was either not related or negatively associated (among urban respondents). Similarly, social trust was associated with over 50% reduced odds of an additional childhood vaccinations whereas institutional trust was associated with increased odds (OR=1.7) of an additional vaccination. The findings highlight the complexity of social capital and the importance of exploring more comprehensive indicators.     

Cost-effectiveness of a community anti-smoking campaign targeted at a high risk group in London

Surveys of Turkish speaking people in London found 74% of men and 45% of women were smokers, and knowledge of the health effects of smoking was low. Camden and Islington Health Authority has a substantial Turkish community. We report an economic evaluation of a community smoking cessation intervention, aimed at the Turkish community, undertaken by Camden and Islington Health Promotion Agency. The intervention aimed to highlight the dangers of smoking, and to reduce the amount smoked and the number of current smokers. It included a play, a poster and media campaign, and purpose-designed leaflets. A panel survey of the Turkish population determined smoking habits, attitudes to smoking and knowledge about the health effects at baseline and 12 months. The intervention effect was estimated from the changes between baseline and final surveys. To allow for the non-response to the second survey we analysed effectiveness in two ways: first by assuming that the responders represented the true situation, and secondly by making a more pessimistic assumption that there was no change in the non-responders. Fifty-seven per cent of the Turkish population were smokers at baseline, compared with 39% in the general population of Camden and Islington. Levels were particularly high in younger women. At follow-up there was a net reduction in smokers of 6.4% [95% confidence interval (CI) 0-13.6%] in responders. When all study subjects were included the net reduction was 2.9% (CI 0-6.3%). Most quitters were light smokers to start with. At follow-up, 51% of respondents recognized at least one of the Turkish language interventions. The estimated cost-effectiveness of this intervention was 105 pound (range 33-391 pound) per life year gained. Campaigns targeted at groups with high smoking prevalence may be more cost-effective than general population campaigns.     

Cigarette smoking behavior among US Latino men and women from different countries of origin

OBJECTIVES: This study sought to compare smoking behavior among Latino men and women from different countries of origin. METHODS: A telephone-administered survey was conducted in 8 cities with Latino men and women of different national origin living in census tracts with at least 70% Latino individuals. RESULTS: A total of 8882 participants completed the survey; 53% were women. The average age of respondents was 44 years; 63% were foreign-born, and 59% preferred Spanish for the interview. Current smoking was more prevalent among men (25.0%, 95% confidence interval [CI] = 23.7, 26.3) than among women (12.1%, 95% CI = 11.1, 13.0). Smoking rates were not significantly different by national origin among men, but Puerto Rican women had higher rates of smoking than other women. Central American men and women had the lowest smoking rates. Foreign-born respondents were less likely to be smokers (odds ratio [OR] = 0.77, 95% CI = 0.66, 0.90) than US-born respondents, and respondents with 12 years or less of education had an increased odds of smoking (OR = 1.17, 95% CI = 1.01, 1.35). High ac culturation was associated with more smoking in women (OR = 1.12, 95% CI = 1.00-1.25) and less smoking in men (OR = 0.86, 95% CI = 0.78-0.95). Puerto Rican and Cuban respondents were more likely to be current smokers and to smoke more than 20 cigarettes per day. CONCLUSIONS: Older, US-born, and more-educated respondents were less likely to be current smokers. Respondents of Puerto Rican and Cuban origin were more likely to smoke. Acculturation has divergent effects on smoking behavior by sex.     

Socioeconomic disadvantage and primary non-adherence with medication in Sweden.

OBJECTIVE: Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. DESIGN: Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. PARTICIPANTS: The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. RESULTS: Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. CONCLUSIONS: Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.