Predicting tuberculosis among migrant groups.
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In industrialized countries migrants remain a high-risk group for tuberculosis (TB). Multiple linear regression analysis was used to determine the ability of indicators of TB incidence in the country of birth to predict the incidence of TB among migrants in Australia during 1997. World Health Organization total case notifications, new smear-positive case notifications and the estimated incidence of TB by country of birth explained 55, 69 and 87% of the variance in TB incidence in Australia, respectively. Gross national income of the country of birth and unemployment level in Australia were also significant predictors of TB in migrant groups. Indicators of the incidence of TB in the country of birth are the most important group-level predictors of the rate of TB among migrants in Australia. (+info)
Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US).
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STUDY OBJECTIVES: : To determine which area based socioeconomic measures can meaningfully be used, at which level of geography, to monitor socioeconomic inequalities in childhood health in the US. DESIGN: Cross sectional analysis of birth certificate and childhood lead poisoning registry data, geocoded and linked to diverse area based socioeconomic measures that were generated at three geographical levels: census tract, block group, and ZIP code. SETTING: Two US states: Massachusetts (1990 population=6,016,425) and Rhode Island (1990 population=1,003,464). PARTICIPANTS: All births born to mothers ages 15 to 55 years old who were residents of either Massachusetts (1989-1991; n=267,311) or Rhode Island (1987-1993; n=96 138), and all children ages 1 to 5 years residing in Rhode Island who were screened for lead levels between 1994 and 1996 (n=62,514 children, restricted to first test during the study period). MAIN RESULTS: Analyses of both the birth weight and lead data indicated that: (a) block group and tract socioeconomic measures performed similarly within and across both states, while ZIP code level measures tended to detect smaller effects; (b) measures pertaining to economic poverty detected stronger gradients than measures of education, occupation, and wealth; (c) results were similar for categories generated by quintiles and by a priori categorical cut off points; and (d) the area based socioeconomic measures yielded estimates of effect equal to or augmenting those detected, respectively, by individual level educational data for birth outcomes and by the area based housing measure recommended by the US government for monitoring childhood lead poisoning. CONCLUSIONS: Census tract or block group area based socioeconomic measures of economic deprivation could be meaningfully used in conjunction with US public health surveillance systems to enable or enhance monitoring of social inequalities in health in the United States. (+info)
Factors influencing the impact of unemployment on mental health among young and older adults in a longitudinal, population-based survey.
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OBJECTIVES: This study examined the relationship between unemployment and mental health. It particularly emphasized the potential differences in mental health status between younger workers entering the labor market and older workers with established laborforce involvement. METHODS: With the use of the National Population Health Survey in Canada, over 6000 respondents between 18 and 55 years of age in 1994 were followed up 2 years later. RESULTS: The results suggest that, among the 31- to 55-year-olds, becoming unemployed led to increases in distress and, to some extent, clinical depression at follow-up. This association between unemployment and mental health was not found among younger adults 18 to 30 years of age. Possible explanations for the null finding among young adults, such as decreased likelihood of low household income or increased likelihood of distressed young adults completely withdrawing from the workforce, were not supported. The notion that baseline mental health affects the chances of being unemployed at the time of a 24-month follow-up were partially supported. CONCLUSIONS: These findings from a representative sample suggest that both causation and selection processes lead to an association between unemployment and distress among older adults. (+info)
Influence of lack of full-time employment on attempted suicide in Manitoba, Canada.
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OBJECTIVES: Unemployment has been repeatedly associated with suicide; however, whether the association is causal remains unclear. Little is known about the relationship between part-time work and either attempted or completed suicide. The objective of this study was to compare the relationships of unemployment, part-time work, nonlaborforce participation, and full-time work with attempted suicide. METHODS: This study utilized a database consisting of 27446 potential laborforce participants that combines information on health care utilization in Manitoba, Canada, with detailed information from the 1986 census. Persons who attempted suicide after the census (N=144) were identified using established definitions based on hospital claims to identify serious attempts only. RESULTS: Step-wise multiple logistic regression, which controlled for multiple confounding variables, revealed that unemployment [odds ratio (OR) 3.68, 95% confidence interval (95% CI) 1.76-7.71, part-time work (OR 1.99, 95% CI 1.07-3.71) and being out of the labor force (OR 2.11, 95% CI 1.12-3.97)] were all associated with attempted suicide. A dose-response relationship was observed between weeks worked in 1985 and suicide attempts after the census. CONCLUSIONS: All three groups of those who were not working full-time had an elevated likelihood of attempted suicide after adjustment for potential confounding factors. This finding suggests that working full-time is protective against suicide attempts. Suicide attempts related to lack of full-time work may be more preventable than other causes of attempted suicide and may be decreased by social policies that limit "under" and unemployment. (+info)
Educational level as a contextual and proximate determinant of all cause mortality in Danish adults.
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STUDY OBJECTIVE: To examine the educational level in the area of living as a determinant of all cause mortality, controlling for individual and other correlated contextual factors. DESIGN: Pooled data from two population based cohort studies were linked to social registers to obtain selected socioeconomic information at parish and individual level. A total of 18 344 men and women were followed up from 1980 until October 1999. SETTING: Copenhagen, Denmark. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: During follow up 2614 men and women died. Educational status both at parish (hazard ratio (HR): 0.87 (95% CI 0.77 to 0.98) and individual level (HR: 0.76 (95% CI 0.64 to 0.88) were inversely associated with mortality, when comparing the higest educated groups with the least educated. However, at parish level the effect was only present, when information on subject's income, behaviour (smoking, exercise, alcohol use, and body mass index) and contextual factors (local area unemployment, income share, and household composition) were included in the Cox model. CONCLUSION: In this study the educational level of an area influenced subject's mortality, but first after adjustment for behavioural and other contextual risk factors. Neighbourhood education is one of different characteristics of adverse social conditions in an area increasing mortality. (+info)
Formative evaluation of a men's health center.
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We describe an innovative approach for evaluating a men's health center. Using observation and interview, we assessed patient flow, referral patterns, patient satisfaction, and perceptions of the services' usefulness. Student assistants designed evaluation tools, hired and trained research assistants, supervised data collection, interacted with city and center officials, analyzed data, and drafted a report. To ensure patient confidentiality and anonymity, we designed an innovative observation system. The men had unique perceptions of family, requiring culturally sensitive approaches to engage them in the study. Of patients reporting to the center, 20.3% received referral services. Average satisfaction level was 5.2 (scale = 1-10). Perceived benefits to the family for 23% of respondents included cost savings, improved access, and higher service quality. (+info)
Health insurance for workers who lose jobs: implications for various subsidy schemes.
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A number of proposals have been made to help laid-off workers purchase health insurance. We use data from the 1996 Medical Expenditure Panel Survey to profile the insurance status of workers who left a job. Our descriptive analysis suggests that it might be difficult to design policies that target those who would otherwise be uninsured and that large subsidies might be needed to help laid-off workers. (+info)
Risk factors associated with dropout and readmission among First Nations individuals admitted to an inpatient alcohol and drug detoxification program.
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BACKGROUND: There is a need for clinically relevant research into treatment for substance abuse among Aboriginal people. In this study, I aimed to provide a predictive model of dropout from and readmission to an inpatient detoxification program in a large treatment sample of Aboriginal patients. METHODS: I reviewed the medical charts of all self-reported First Nations people (n = 877) admitted to an inpatient detoxification centre in British Columbia, between Jan. 4, 1999, and Jan. 30, 2002, and used binary logistic regression models to identify predictors of dropout from and readmission to the program. Each of these models was validated using an independent subset of the treatment sample. RESULTS: Overall, 254 (29.0%) people dropped out of the program, and 219 were readmitted. Statistically significant predictors of treatment dropout were a preferred drug other than alcohol (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.12-2.50) and self-referral (OR 1.89, 95% CI 1.28-2.80). Statistically significant predictors of readmission to inpatient detoxification within a 1-year period were a previous history of detoxification treatment (OR 3.52, 95% CI 2.16-5.75) and residential instability (OR 1.82, 95% CI 1.11-2.99). INTERPRETATION: Although factors were identified that are associated with each of treatment dropout or readmission for detoxification, only the latter can be reliably predicted by them. (+info)