Socioeconomic disadvantage, social participation and networks and the self-rated health of English men and women with mild and moderate intellectual disabilities: cross sectional survey.
(9/2192)
BACKGROUND: Extremely high rates of mortality and morbidity have been reported among people with intellectual disabilities. Virtually no research has addressed the potential social determinants of health status within this very vulnerable population. METHOD: Cross-sectional survey of self-reported health status and indicators of socioeconomic disadvantage and social connectedness in 1273 English adults with mild or moderate intellectual disabilities. RESULTS: Indicators of socioeconomic disadvantage accounted for a statistically significant proportion of variation in health status, over and above any variation attributable to the personal characteristics and living circumstances of participants. Indicators of social participation and networks did not add to the explanatory power of the model. Among the indicators of socioeconomic disadvantage, hardship was more strongly associated with variation in health status than either employment status or area-level deprivation. CONCLUSION: As in the general population, self-reported health was associated with indicators of socioeconomic disadvantage, especially hardship. In contrast, there was no evidence of any association between health status and social participation and networks. (+info)
Community-based lifestyle interventions: changing behaviour and improving health.
(10/2192)
OBJECTIVE: To explore the association between change in physical activity levels and fruit and vegetable consumption and changes in self-reported overall health and mental health, of residents living in deprived English communities. DESIGN: Household survey conducted in 2002 and repeated in 2004. SETTING: Thirty-nine deprived UK communities in areas participating in the New Deal for Communities (NDCs), a major government funded community development initiative. PARTICIPANTS: Ten thousand four hundred and nineteen residents in NDC areas and neighbouring comparator areas. MAIN RESULTS: Overall levels of physical activity and fruit and vegetable consumption are low but a large positive change in diet or levels of physical activity is associated with a significant change in mental health (2.86 and 2.71, respectively: P < 0.01). Smaller, but also statistically significant, changes were found in physical health (0.07 and 0.05, P < 0.01). Specific dimensions of mental health which showed a large change in association with lifestyle change were those associated with 'peacefulness' and 'happiness'. CONCLUSIONS: These findings suggest that, for residents of these neighbourhoods, positive lifestyle changes such as increasing physical activity levels and increase in fruit and vegetable consumption are associated with positive changes in mental health. WHAT THIS PAPER ADDS: What is already known? Mental health, a key area of health inequality is related to physical health, and associated with education, employment, environment and community issues. There is known to be a relationship between improved lifestyle (increased physical activity levels and better diet) and better health. What does this study add? This study shows that over two years, measurable changes in lifestyle were associated with improvements in both mental health and self-reported overall health. The association of lifestyle changes with overall health, although statistically significant, were less significant than those with mental health over the same period, suggesting those wanting to measure the impact of community activity on health will be more likely to see a measurable short-term impact on mental, rather than overall self-reported health. (+info)
The importance of social context: neighborhood stressors, stress-buffering mechanisms, and alcohol, drug, and mental health disorders.
(11/2192)
This study examines the relationship among neighborhood stressors, stress-buffering mechanisms, and likelihood of alcohol, drug, and mental health (ADM) disorders in adults from 60 US communities (n=12,716). Research shows that larger support structures may interact with individual support factors to affect mental health, but few studies have explored buffering effects of these neighborhood characteristics. We test a conceptual model that explores effects of neighborhood stressors and stress-buffering mechanisms on ADM disorders. Using Health Care for Communities with census and other data, we found a lower likelihood of disorders in neighborhoods with a greater presence of stress-buffering mechanisms. Higher neighborhood average household occupancy and churches per capita were associated with a lower likelihood of disorders. Cross-level interactions revealed that violence-exposed individuals in high crime neighborhoods are vulnerable to depressive/anxiety disorders. Likewise, individuals with low social support in neighborhoods with high social isolation (i.e., low-average household occupancy) had a higher likelihood of disorders. If replicated by future studies using longitudinal data, our results have implications for policies and programs targeting neighborhoods to reduce ADM disorders. (+info)
Evidential preferences: cultural appropriateness strategies in health communications.
(12/2192)
While there is widespread agreement that communication programs and materials will be more effective when they are 'culturally appropriate' for the populations they serve, little is known about how best to achieve this cultural appropriateness. The specific strategies used to realize the potential of culturally appropriate communication take many forms. This paper discusses an approach to assessing and understanding the presentation of statistical information (an evidential strategy) to enhance the perceived relevance of communications targeted to older African American men and women. Formative research on African Americans' attitudes and knowledge of colorectal cancer explored preferences for presentation of statistical data. Focus group interviews elicited participants' (n = 49) thoughts and attitudes on and anticipated behavioral response to five strategies for presenting cancer data and evidence-general, race specific, disparity, social math and framing approximately 5-year probability of death or survival. A description is provided of the application of this approach to the development of a colorectal cancer campaign for African Americans. This strategy may prove useful in understanding and structuring the presentation of targeted cancer evidence that could result in more effective health communication. (+info)
Bridging the gap in health inequalities with the help of health trainers: a realistic task in hostile environments? A short report for debate.
(13/2192)
BACKGROUND: From a public health theoretical perspective, there is acknowledgement that synchronized policies, which address both individual and area level risks to health, are important to reduce inequalities and improve health. Despite this, much research focuses on just one of these two approaches (often pitting them against each other) and much practice tends to focus on individual level interventions. Efforts to address health inequalities between rich and poor in the UK continue to focus on individual-based interventions, with the most recent initiative being health trainers. METHODS: In this debate piece, we will use health trainers as a specific example, and focusing primarily on levels of physical activity, we will argue that neither individual level interventions nor environmental change alone are likely to improve levels of activity or reduce health inequalities. CONCLUSIONS: We argue that synchronized policies that tackle both individual and neighbourhood environmental barriers to improving health behaviours are essential. (+info)
Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach.
(14/2192)
OBJECTIVE: To determine factors associated with breastfeeding in rural communities. METHODS: We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N=1292) of infants born September 2003-2004 and (2) a parallel ethnographic study (N=30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding. RESULTS: Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance. CONCLUSIONS: Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative. (+info)
Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context.
(15/2192)
The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension. (+info)
The built environment and collective efficacy.
(16/2192)
Collective efficacy, i.e., perception of mutual trust and willingness to help each other, is a measure of neighborhood social capital and has been associated with positive health outcomes including lower rates of assaults, homicide, premature mortality, and asthma. Collective efficacy is frequently considered a "cause", but we hypothesized that environmental features might be the foundation for or the etiology of personal reports of neighborhood collective efficacy. We analyzed data from the Los Angeles Family and Neighborhood Study (LAFANS) together with geographical data from Los Angeles County to determine which social and environmental features were associated with personal reports of collective efficacy, including presence of parks, alcohol outlets, elementary schools and fast food outlets. We used multi-level modeling controlling for age, education, annual family income, sex, marital status, employment and race/ethnicity at the individual level. At the tract level, we controlled for tract-level disadvantage, the number of off-sale alcohol outlets per roadway mile, the number of parks and the number of fast food outlets within the tract and within 1/2 mile of the tract's boundaries. We found that parks were independently and positively associated with collective efficacy; alcohol outlets were negatively associated with collective efficacy only when tract-level disadvantage was not included in the model. Fast food outlets and elementary schools were not linearly related to collective efficacy. Certain environmental features may set the stage for neighborhood social interactions, thus serving as a foundation for underlying health and well-being. Altering these environmental features may have greater than expected impact on health. (+info)