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1.  Social inequalities and correlates of psychotropic drug use among young adults: a population-based questionnaire study 
Background
Use of psychotropic drugs is widespread in Europe, and is markedly more common in France than elsewhere. Young adults often fare less well than adolescents on health indicators (injury, homicide, and substance use). This population-based study assessed disparities in psychotropic drug use among people aged 18–29 from different socio-occupational groups and determined whether they were mediated by educational level, health status, income, health-related behaviours, family support, personality traits, or disability.
Methods
A total of 1,257 people aged 18–29, randomly selected in north-eastern France completed a post-mailed questionnaire covering sex, date of birth, height, weight, educational level, occupation, smoking habit, alcohol abuse, income, health-status, diseases, reported disabilities, self-reported personality traits, family support, and frequent psychotropic medication for tiredness, nervousness/anxiety or insomnia. The data were analyzed using the adjusted odds ratios (ORa) computed with logistic models.
Results
Use of psychotropic drugs was common (33.2%). Compared with upper/intermediate professionals, markedly high odds ratios adjusted for sex were found for manual workers (2.57, 95% CI 1.02–6.44), employees (2.58, 1.11–5.98), farmers/craftsmen/tradesmen (4.97, 1.13–21.8), students (2.40, 1.06–5.40), and housewives (3.82, 1.39–10.5). Adjusting for all the confounders considered reduced the estimates to a pronounced degree for manual workers (adjusted OR 1.49, non-significant) but only slightly for the other socio-occupational groups. The odds ratio for unemployed people did not reach statistical significance. The significant confounders were: sex, not-good health status, musculoskeletal disorders and other diseases, being worried, nervous or sad, and lack of family support (adjusted odds ratios between 1.60 and 2.50).
Conclusion
There were marked disparities among young adults from different socio-occupational groups. Sex, health status, musculoskeletal diseases, family support, and personality traits were related to use of psychotropic drugs. These factors mediated the higher risk strongly among manual workers and slightly among the other groups.
doi:10.1186/1475-9276-7-3
PMCID: PMC2262083  PMID: 18205942
2.  The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort 
BMC Public Health  2011;11:104.
Background
Social inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association.
Methods
8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected.
Results
Compared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position.
Conclusions
Status inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.
doi:10.1186/1471-2458-11-104
PMCID: PMC3045944  PMID: 21324154
3.  Health literacy of Dutch adults: a cross sectional survey 
BMC Public Health  2013;13:179.
Background
Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex.
Methods
The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex.
Results
Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information.
Conclusions
Perceived difficulties with health information vary between competences and domains of health. Health literacy competences are associated with indicators of socio-economic position and with the domain in which health information is provided.
doi:10.1186/1471-2458-13-179
PMCID: PMC3599856  PMID: 23445541
Health literacy; Socio-economic position; General population; Netherlands
4.  Role of childhood health in the explanation of socioeconomic inequalities in early adult health 
STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.
 
PMCID: PMC1756612  PMID: 9604036
5.  Socio-economic position and mental disorders in a working-age Finnish population: the health 2000 study 
Background: Mental disorders are more common in people with lower socio-economic position (SEP) but it is not known which specific SEP component is most strongly linked to poor mental health. We compared the strength of associations of three SEP components—occupation, income and education—with common mental disorders in a Finnish population. Methods: Cross-sectional analysis of a nationally representative sample of 4561 men and women aged 30–65 years. Mental disorders were assessed using the Composite International Diagnostic Interview resulting in 12-month DSM-IV diagnoses of depressive, anxiety and alcohol use disorders. Participants were classified as having low SEP if they worked in a manual occupation, lacked secondary-level education or had income below the Organisation for Economic Co-operation and Development (OECD) definition of relative poverty. Results: In models comparing the simultaneous association of all three socio-economic indicators with mental disorders, low income was associated with increased risk for depressive disorder [odds ratio (OR)=1.73, 95% confidence interval (CI) =1.31–2.29] and anxiety disorder (OR=1.56, 95% CI 1.14–2.12). Manual occupational class was modestly associated with risk for alcohol use disorder (OR=1.44, 95% CI 1.06–1.95). Low income was the only socio-economic component associated with psychiatric comorbidity, that is, a combination of various disorders within the same individual (OR 2.26, 95% CI 1.52–3.37 for any combination). Conclusion: Low income seems to be a more important correlate of mental disorders than education or occupation in a high-income country such as Finland.
doi:10.1093/eurpub/ckr127
PMCID: PMC3358631  PMID: 21953062
6.  Population-based study of migraine in Spanish adults: relation to socio-demographic factors, lifestyle and co-morbidity with other conditions 
The Journal of Headache and Pain  2009;11(2):97-104.
The aim of this study was to estimate the prevalence of migraine in the general Spanish population and its association with socio-demographic and lifestyle factors, self-reported health status, and co-morbidity with other conditions. We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey (SNHS), an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian non-institutionalized population residing in main family dwellings (household) of Spain. We analyzed socio-demographic characteristics (gender, age, marital status, educational level, occupational status, and monetary monthly income); self-perceived health status; lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, and obesity); and presence of other concomitant diseases. The 1-year prevalence of diagnosed migraine (n = 3,433) was 11.02% (95% CI 10.55–11.51). The prevalence was significantly higher among female (15.94%) than male (5.91%) and showed the highest value in the 31–50 years age group (12.11%). Migraine was more common in those of lower income (AOR 1.19, 95% CI 1.01–1.41) and who sleep <8 h/day (AOR 1.18, 95% CI 1.04–1.33). Furthermore, worse health status (AOR 2.04, 95% CI 1.76–2.36) and depression (AOR 1.82 95% CI 1.58–2.11) were related to migraine. Finally, subjects with migraine were significantly more likely to have comorbid conditions, particularly chronic (more than 6 month of duration) neck pain (AOR 2.31, 95% CI 1.98–2.68) and asthma (AOR 1.62, 95% 1.27–2.05). The current Spanish population-based survey has shown that migraine is more frequent in female, between 31 and 50 years and associated to a lower income, poor sleeping, worse health status, depression and several comorbid conditions, particularly chronic neck pain and asthma.
doi:10.1007/s10194-009-0176-5
PMCID: PMC3452289  PMID: 20012124
Headache; Migraine; Co-morbidity; Population-based
7.  Examining Alternative Measures of Social Disadvantage Among Asian Americans: The Relevance of Economic Opportunity, Subjective Social Status, and Financial Strain for Health 
Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.
doi:10.1007/s10903-009-9258-3
PMCID: PMC2891922  PMID: 19434494
Asian Americans; Socioeconomic status; Economic opportunity; Subjective social status; Financial strain; Physical health; Body mass index; Smoking
8.  Examining Alternative Measures of Social Disadvantage Among Asian Americans: The Relevance of Economic Opportunity, Subjective Social Status, and Financial Strain for Health 
Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.
doi:10.1007/s10903-009-9258-3
PMCID: PMC2891922  PMID: 19434494
Asian Americans; Socioeconomic status; Economic opportunity; Subjective social status; Financial strain; Physical health; Body mass index; Smoking
9.  Incident HIV Infection among Men Attending STD Clinics in Pune, India: Pathways to Disparity and Interventions to Enhance Equity 
Systematic disparities in rates of HIV incidence by socioeconomic status were assessed among men attending three sexually transmitted disease (STD) clinics in Pune, India, to identify key policy-intervention points to increase health equity. Measures of socioeconomic status included level of education, family income, and occupation. From 1993 to 2000, 2,260 HIV-uninfected men who consented to participate in the study were followed on a quarterly basis. Proportional hazards regression analysis of incident HIV infection identified a statistically significant interaction between level of education and genital ulcer disease. Compared to the lowest-risk men without genital ulcer disease who completed high school, the relative risk (RR) for acquisition of HIV was 7.02 (p<0.001) for illiterate men with genital ulcer disease, 3.62 (p<0.001) for men with some education and genital ulcer disease, and 3.02 (p<0.001) for men who completed high school and had genital ulcer disease. For men with no genital ulcer disease and those with no education RR was 1.09 (p=0.84), and for men with primary/middle school it was 1.70 (p=0.03). The study provides evidence that by enhancing access to treatment and interventions that include counselling, education, and provision of condoms for prevention of STDs, especially genital ulcer disease, among disadvantaged men, the disparity in rates of HIV incidence could be lessened considerably. Nevertheless, given the same level of knowledge on AIDS, the same level of risk behaviour, and the same level of biological co-factors, the most disadvantaged men still have higher rates of HIV incidence.
PMCID: PMC3516674  PMID: 14717571
Health equity; HIV; Acquired immunodeficiency syndrome; Sexually transmitted infections; Sexually transmitted diseases; Socioeconomic status; Prospective studies; India
10.  Socio-economic inequalities in physical activity practice among Italian children and adolescents: a cross-sectional study 
Aim
The aim of the study was to evaluate whether socio-economic inequalities in the practice of physical activity existed among children and adolescents, using different indicators of socio-economic status (SES).
Subjects and methods
Data were derived from the Italian National Health Interview Survey carried out in 2004–2005, which examined a large random sample of the Italian population using both an interviewer-administered and a self-compiled questionnaire. This study was based on a sample of 15,216 individuals aged 6–17 years. The practice of physical activity was measured on the basis of questions regarding frequency and intensity of activity during leisure time over the past 12 months. Parents’ educational and occupational level, as well as family’s availability of material resource, were used as indicators of SES. Multivariable logistic regression analyses were performed to estimate the contribution of each SES indicator to the practice of physical activity, adjusting for potential confounding factors. The results of the regression models are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).
Results
About 64% of children and adolescents in the sample declared that they participated in moderate or vigorous physical activity at least once a week. After adjustment for gender, age, parental attitudes towards physical activity and geographical area, the practice of physical activity increased with higher parental educational and occupational level and greater availability of material resources. Children and adolescents whose parents held a middle or high educational title were 80% more likely to practice moderate or vigorous physical activity than subjects whose parents had a lower level of education (OR = 1.80, 95% CI: 1.40–2.33), while subjects with unemployed parents had an odds of practicing moderate or vigorous physical activity 0.43 times that of those children whose parents belonged to the top job occupation category (administrative/professionals). Socio-economic differences were about the same when the practice of vigorous physical activity only was considered instead of that of moderate or vigorous physical activity.
Conclusion
Interventions that promote the practice of physical activity, and especially those aimed at the wider physical and social environment, are strongly needed to contrast socio-economic differences in physical activity among children and adolescents.
doi:10.1007/s10389-009-0267-4
PMCID: PMC2967259  PMID: 21088692
Children and adolescents; Physical activity; Socio-economic factors
11.  Socio-economic inequalities in health care utilisation in Norway: a population based cross-sectional survey 
Background
Norway provides universal health care coverage to all residents, but socio-economic inequalities in health are among the largest in Europe. Evidence on inequalities in health care utilisation is sparse, and the aim of this population based study was to investigate socio-economic inequalities in the utilisation of health care services in Tromsø, Norway.
Methods
We used questionnaire data from the cross-sectional Tromsø Study, conducted in 2007–8. All together 12,982 persons aged 30–87 years participated with the response rate of 65.7%. This is slightly more than one third of the total population (33.8%) in the mentioned age group in Tromsø municipality. By logistic regression analyses we studied associations between household income, education and self-rated occupational status and the utilisation of general practitioner, somatic and psychiatric specialist outpatient services. The outcome variables were probability and frequency of use during the previous 12 months. Analyses were stratified by gender and adjusted for age, marital status, and self-rated health.
Results
Self-rated health was the dominant predictor of health care utilisation. Women’s probability of visiting a general practitioner did not vary by socio-economic status, but high income was associated with less frequent use (odds ratio [OR] for trend 0.89, 95% confidence interval [CI] 0.81-0.98). In men, high income predicted lower probability and frequency of general practitioner utilisation (OR for trend 0.85, CI 0.76-0.94, and 0.86, 0.78-0.95, respectively). Women’s probability of visiting a somatic specialist increased with higher income (OR for trend 1.11, CI 1.01-1.21) and higher education (OR for trend 1.27, CI 1.16-1.39). We found the same trends for men, though significant only for education (OR for trend 1.14, CI 1.05-1.25). The likelihood of visiting psychiatric specialist services increased with higher education and decreased with higher income in women (OR for trend 1.57, CI 1.24-1.98, and 0.69, 0.56-0.86, respectively), but did not vary significantly by socio-economic variables in men. Higher income predicted more frequent use of psychiatric specialist services in men (OR for trend 2.02, CI 1.12-3.63).
Conclusions
This study revealed important inequalities in the utilisation of health care services in Norway, inequalities which may contribute to sustaining inequalities in health outcomes.
doi:10.1186/1472-6963-12-336
PMCID: PMC3508955  PMID: 23006844
Cross-sectional study; Socio-economic inequalities; Health care utilisation; General practitioner; Somatic specialist; Psychiatric specialist; Norway
12.  Socioeconomic and Employment Status of Patients with Rheumatoid Arthritis in Korea 
Epidemiology and Health  2012;34:e2012003.
OBJECTIVES
This study investigates the prevalence of rheumatoid arthritis (RA) by gender and socio-economic characteristics. It also explores the differences in the employment status between RA patients and the general population without RA in Korea.
METHODS
We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) conducted from 2007 to 2009. Prevalence rates were estimated for female and male patients with RA in terms of age, residence, education, income level, and occupation type. The female respondents aged 45 to 64 were divided into the RA population and the non-RA population in order to compare the employment status between the two groups.
RESULTS
The annual physician-diagnosed RA prevalence rate was 1.45%. The prevalence rate was 2.27% for women and 0.62% for men. Individuals with RA had a significantly lower employment rate than individuals without RA (41.7 vs. 68.1%). The main reason for non-employment among RA patients was health-related problems (47.1%). There was statistically significant difference in employment type among the two groups. The experience rates for sick leave and sick-in-bed due to RA were 1.7 and 3.9%, respectively.
CONCLUSION
Middle- and old-aged women accounted for the majority of the Korean RA population, which had a significant lower employment rate compared to the population without RA for both sexes. RA resulted in considerable productivity loss in Korea.
doi:10.4178/epih/e2012003
PMCID: PMC3350820  PMID: 22611518
Rheumatoid arthritis; Employment; Prevalence; Korea National Health and Nutrition Examination Survey
13.  A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable? 
BMC Public Health  2011;11:737.
Background
The estimated life expectancy at birth for Indigenous Australians is 10-11 years less than the general Australian population. The mean family income for Indigenous people is also significantly lower than for non-Indigenous people. In this paper we examine poverty or socioeconomic disadvantage as an explanation for the Indigenous health gap in hospital morbidity in Australia.
Methods
We utilised a cross-sectional and ecological design using the Northern Territory public hospitalisation data from 1 July 2004 to 30 June 2008 and socio-economic indexes for areas (SEIFA) from the 2006 census. Multilevel logistic regression models were used to estimate odds ratios and confidence intervals. Both total and potentially avoidable hospitalisations were investigated.
Results
This study indicated that lifting SEIFA scores for family income and education/occupation by two quintile categories for low socio-economic Indigenous groups was sufficient to overcome the excess hospital utilisation among the Indigenous population compared with the non-Indigenous population. The results support a reframing of the Indigenous health gap as being a consequence of poverty and not simplistically of ethnicity.
Conclusions
Socio-economic disadvantage is a likely explanation for a substantial proportion of the hospital morbidity gap between Indigenous and non-Indigenous populations. Efforts to improve Indigenous health outcomes should recognise poverty as an underlying determinant of the health gap.
doi:10.1186/1471-2458-11-737
PMCID: PMC3203263  PMID: 21951514
14.  Occupational safety and health: progress toward the 1990 objectives for the nation. 
Public Health Reports  1983;98(4):324-336.
Occupational safety and health is 1 of 15 areas addressed in the Public Health Service's Objectives for the Nation. This area represents 104 million working men and women and the deaths, diseases, and injuries that result from exposures to hazards in their work environment. Characteristics of public health practice are compared with characteristics of occupational safety and health practice. The National Institute for Occupational Safety and Health (NIOSH), created by the Occupational Safety and Health Act, is discussed. NIOSH has developed a list of 10 leading work-related diseases and injuries. The list is headed by occupational lung diseases. Twenty Objectives for the Nation in the area of occupational safety and health are reviewed, and the status of NIOSH efforts toward their attainment is discussed. Five categories of objectives are covered: (a) improved health status, (b) reduced risk factors, (c) improved public and professional awareness, (d) improved service and protection, and (e) improved surveillance and evaluation. The potential for achieving these objectives is discussed, with special attention given to the lack of a data base for monitoring progress. A major conclusion is that surveillance in occupational safety and health needs to be strengthened.
PMCID: PMC1424463  PMID: 6310668
15.  Effects of mothers' socio-economic status on the management of febrile conditions in their under five children in a resource limited setting 
Background
Public health research is shifting focus to the role of socioeconomic indicators in the promotion of health. As such an understanding of the roles that socio-economic factors play in improving health and health-seeking behaviour is important for public health policy. This is because the share of resources devoted to different policy options should depend on their relative effectiveness.
Objective
To measure the effect of socio-economic status (age, education, occupation, income, religion and family structure) of mothers on the management of febrile conditions in under-fives children
Method
Two hundred mothers who brought their febrile under-five children to a health facility were interviewed on the treatment they gave to their children before reporting at health facility. Data collected were entered and analyzed using the SPSS software. Binary logistic regression was adopted for the quantitative analysis of the effect of socio-economic variables on the mothers' actions prior to utilizing the health facility.
Results
Results showed that while mothers' age was negatively correlated (-0.13), occupation was positively correlated (0.17) with under-fives mothers' action. Education, religion, income and family structure were however insignificant at 5% level
Conclusion
This poses a lot of challenges to policy makers in the developing nations where women's education and earning capacity is low. There is therefore a need to increase the number of women benefiting from micro credit. This will ensure that more women are engaged in a form of occupation that is profitable and can sustain the economic and health needs of the family.
doi:10.1186/1472-698X-6-1
PMCID: PMC1395328  PMID: 16426450
16.  The Impact of Socio-Economic Status on Self-Rated Health: Study of 29 Countries Using European Social Surveys (2002–2008) 
Studies show that the association between socio-economic status (SES) and self-rated health (SRH) varies in different countries, however there are not many country-comparisons that examine this relationship over time. The objective of the present study is to determine the effect of three SES measures on SRH in 29 countries according to findings in European Social Surveys (2002–2008), in order to study how socio-economic inequalities can vary our subjective state of health. In line with previous studies, income inequalities seem to be greater not only in Anglo-Saxon and Scandinavian countries, but especially in Eastern European countries. The impact of education is greater in Southern countries, and this effect is similar in Eastern and Scandinavian countries, although occupational status does not produce significant differences in southern countries. This study shows the general relevance of socio-educational factors on SRH. Individual economic conditions are obviously a basic factor contributing to a good state of health, but education could be even more relevant to preserve it. In this sense, policies should not only aim at reducing income inequalities, but should also further the education of people who are in risk of social exclusion.
doi:10.3390/ijerph10030747
PMCID: PMC3709282  PMID: 23439514
European countries; self-rated health (SRH); socio-economic status (SES); health inequalities; education
17.  Public health implications of dietary differences between social status and occupational category groups. 
STUDY OBJECTIVE--As there is a social status gradient in chronic disease mortality in Australia, this study aimed to establish whether there were substantial differences among socioeconomically defined groups with respect to food choice and nutrient intake, in the context of risk of nutrition related chronic diseases. DESIGN AND PARTICIPANTS--Cross sectional data were collected from a randomly selected population sample of 1500 urban Australian adults. Data were collected by postal questionnaire, which included an assessment of dietary intake and questions on sociodemographic details. Three measures of social position were collected: occupation, educational status, and income status. Occupation was interpreted both on a continuous, prestige scale, and also as categorical occupational groupings. MAIN RESULTS--The study achieved a 70% response rate. Higher social status was generally associated with healthier dietary intakes, with lower fat and refined sugar densities, and higher fibre densities, but also with higher alcohol density. No differences were found in salt, polyunsaturated fat, protein, or complex carbohydrate densities across groups. Food intake differences were also found between occupational status groups, with the upper social groups tending to consume more wholegrain cereal foods, low fat milk, and fruit, and less refined cereal foods, full cream milk, fried meat, meat products, and discretionary sugar; but also more cheese and meat dishes. CONCLUSIONS--Although this study did show statistically significant differences across social status groups in relation to nutrient and food intakes, these differences were small compared to the disparity between intakes of all groups and the recommended patterns of intake, and did not appear to be great enough to be a major explanatory variable in differences in disease risk across groups.
PMCID: PMC1059611  PMID: 1431718
18.  Association among Education Level, Occupation Status, and Consanguinity in Tunisia and Croatia 
Croatian medical journal  2006;47(4):656-661.
Aim
To investigate the association between education level, occupation status (a proxy for socio-economic status), and consanguinity in 2 large data sets from Tunisia and Croatia countries with different attitudes toward consanguinity.
Methods
The sample of 1016 students, attending 5 university institutions in Monastir, Tunisia, were interviewed about the educational level and occupation status of their parents and the degree of parental relatedness. In Croatia, a sample of 1001 examinees from 9 isolated island populations was interviewed about their own educational level, occupation status, and consanguinity.
Results
Prevalence of consanguinity (offspring of second cousins or closer) among 1016 Tunisian students was 20.1%, and 9.3% among 1001 Croatian isolates. In Tunisia, the association between consanguinity and both parental degree of education and parental occupation status was highly significant in women (P<0.001), but not significant in men. In Croatia, no statistically significant associations were noted, although there was a consistent trend of increased prevalence of consanguinity with lower education level or occupation status in both genders, but more pronounced in women.
Conclusion
Association between education level, socio-economic status, and consanguinity needs to be taken into account in inbreeding studies in human populations. The relationship may be specific for each studied population and highly dependent on the cultural context. It is generally more pronounced among women in most settings.
PMCID: PMC2080442  PMID: 16912991
19.  Sociodemographic Determinants for Oral Health Risk Profiles 
The present study aimed to explore the association between caries risk profiles and different sociodemographic factors . The study sample (n = 104) was randomly selected within an urban population in Flanders, Belgium. Caries risk was assessed by anamnesis, clinical examination, salivary tests, and a questionnaire. Age, gender, and socio-economic status were extracted from social insurance data files. Social indicators were “occupational status,” “being entitled to the increased allowance for health care interventions” and having access to the “Maximum Bill” (MAF), initiatives undertaken to protect deprived families. In the bivariate analysis there were significant differences in risk profiles between occupational groups (P < .001), between entitled and non-entitled individuals to the increased allowance (P = .02), and between access or no-access to the MAF (P < .01). The multiple logistic model showed a significantly higher chance of being in the low risk group for individuals with no-access to the MAF compared to those with access (OR:14.33–95% C.I. 2.14–95.84).
doi:10.1155/2010/938936
PMCID: PMC2836788  PMID: 20339491
20.  Socio-economic status and body mass index in low-income Mexican adults 
Social science & medicine (1982)  2007;64(10):2030-2042.
The study reported here explored the associations of body mass index (BMI), socio-economic status (SES), and beverage consumption in a very low income population. A house-to-house survey was conducted in 2003 of 12,873 Mexican adults. The sample was designed to be representative of the poorest communities in seven of Mexico’s thirty-one states.
Greater educational attainment was significantly associated with higher BMI and a greater prevalence of overweight (25≤BMI<30) and obesity (30≤BMI) in men and women. The combined prevalence of overweight and obesity was over 70% in women over the median age of 35.4 years old with at least some primary education compared with a prevalence of 45% in women below the median age with no education. BMI was positively correlated with five of the six SES variables in both sexes: education, occupation, quality of housing conditions, household assets, and subjective social status. BMI and household income were significantly correlated in women but not in men. In the model including all SES variables, education, occupation, housing conditions and household assets all contributed independently and significantly to BMI, and household income and subjective social status did not.
Increased consumption of alcoholic and carbonated sugar beverages was associated with higher SES and higher BMI in men and women. Thus, in spite of the narrow range of socio-economic variability in this population, the increased consumption of high calorie beverages may explain the positive relationship between SES and BMI.
The positive associations between SES and BMI in this low-income, rural population are likely to be related to the changing patterns of food availability, food composition, consumption patterns and cultural factors. Contextually sensitive population-level interventions are critically needed to address obesity and overweight in poor populations, particularly in older women.
doi:10.1016/j.socscimed.2007.02.002
PMCID: PMC1924923  PMID: 17368895
nutrition transition; socio-economic status (SES); social status; poverty; Mexico; body mass index (BMI)
21.  Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008 
Quality of Life Research  2010;20(3):309-320.
Purpose
To measure and analyse national EQ-5D data and to provide norms for the Chinese general population by age, sex, educational level, income and employment status.
Methods
The EQ-5D instrument was included in the National Health Services Survey 2008 (n = 120,703) to measure health-related quality of life (HRQoL). All descriptive analyses by socio-economic status (educational level, income and employment status) and by clinical characteristics (discomfort during the past 2 weeks, diagnosed with chronic diseases during the past 6 months and hospitalised during the past 12 months) were stratified by sex and age group.
Results
Health status declines with advancing age, and women reported worse health status than men, which is in line with EQ-5D population health studies in other countries and previous population health studies in China. The EQ-5D instrument distinguished well for the known groups: positive association between socio-economic status and HRQoL was observed among the Chinese population. Persons with clinical characteristics had worse HRQoL than those without.
Conclusions
This study provides Chinese population HRQoL data measured by the EQ-5D instrument, based on a national representative sample. The main findings for different subgroups are consistent with results from EQ-5D population studies in other countries, and discriminative validity was supported.
Electronic supplementary material
The online version of this article (doi:10.1007/s11136-010-9762-x) contains supplementary material, which is available to authorized users.
doi:10.1007/s11136-010-9762-x
PMCID: PMC3052443  PMID: 21042861
China; EQ-5D; General population; Health surveys; Inequalities; Socio-economic status
22.  Contribution of smoking and air pollution exposure in urban areas to social differences in respiratory health 
BMC Public Health  2008;8:179.
Background
Socio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health. We assessed the contribution of occupational exposures, smoking and outdoor air pollution as competing factors for the association between socio-economic status and respiratory health indicators in a cohort of women from the Ruhr area aged 55 at the time of investigation between 1985 and 1990.
Methods
Data of 1251 women with spirometry and complete questionnaire information about respiratory diseases, smoking and potential confounders were used in the analyses. Exposure to large-scale air pollution was assessed with data from monitoring stations. Exposure to small-scale air pollution was assessed as traffic-related exposure by distance to the nearest major road. Socio-economic status was defined by educational level. Multiple regression models were used to estimate the contribution of occupational exposures, smoking and outdoor air pollution to social differences in respiratory health.
Results
Women with less than 10 years of school education in comparison to more than 10 years of school education were more often occupationally exposed (16.4% vs. 10.1%), smoked more often (20.3% vs. 13.9%), and lived more often close to major roads (26.0% vs. 22.9%). Long-term exposure to increased levels of PM10 was significantly associated with lower school education. Women with low school education were more likely to suffer from respiratory symptoms and had reduced lung function. In the multivariate analysis the associations between education and respiratory health attenuated after adjusting for occupational exposure, smoking and outdoor air pollution. The crude odds ratio for the association between the lung function indicator FEV1 less than 80% of predicted value and educational level (<10 years vs. >10 years of school education) was 1.83 (95% CI: 1.22–2.74). This changed to 1.56 (95% CI: 1.03–2.37) after adjusting for occupational exposure, smoking and outdoor air pollution.
Conclusion
We found an association between socio-economic status and respiratory health. This can partly be explained by living conditions indicated by occupational exposure, smoking behaviour and ambient air pollution. A relevant part of the social differences in respiratory health, however, remained unexplained.
doi:10.1186/1471-2458-8-179
PMCID: PMC2426697  PMID: 18505547
23.  Associations of multiple socio-economic circumstances with physical functioning among Finnish and British employees 
Background: To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain.
Methods: Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45–60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure.
Results: Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations.
Conclusions: Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies.
doi:10.1093/eurpub/ckn123
PMCID: PMC2639014  PMID: 19060329
comparisons; employees; physical functioning; socio-economic position
24.  Socioeconomic inequalities in general and psychological health among adolescents: a cross-sectional study in senior high schools in Greece 
Background
Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.
Methods
This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.
Results
One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.
Conclusions
Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.
doi:10.1186/1475-9276-9-3
PMCID: PMC2837664  PMID: 20181002
25.  Social Engagement, Health, and Changes in Occupational Status: Analysis of the Korean Longitudinal Study of Ageing (KLoSA) 
PLoS ONE  2012;7(10):e46500.
Background
We focused on whether changes in the occupational status of older male adults can be influenced by social engagement and health status measured at the baseline.
Methods
This study used a sample of the Korean Longitudinal Study of Aging (KLoSA), and the study population was restricted to 1.531 men who were aged 55 to 80 years at the 2006 baseline survey and participated in the second survey in 2008. Social engagement and health status, measured by the number of chronic diseases, grip strength, and depressive symptoms as well as covariates (age, marital status, educational level, and household income) were based on data from the 2006 baseline survey. Occupational engagement over the first and second survey was divided into four categories: ‘consistently employed’ (n = 892), ‘employed-unemployed’ (n = 152), ‘unemployed-employed’ (n = 138), and ‘consistently unemployed’ (n = 349).
Results
In the multinomial model, the ‘consistently employed’ and ‘unemployed-employed’ groups had significantly higher social engagement (1.19 and 1.32 times, respectively) than the referent. The number of chronic diseases was significantly associated with four occupational changes, and the ‘unemployed-employed’ had the fewest chronic conditions.
Conclusion
Our finding suggests that social engagement and health status are likely to affect opportunities to continue working or to start working for older male adults.
doi:10.1371/journal.pone.0046500
PMCID: PMC3462751  PMID: 23056323

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