RESUMEN
BACKGROUND: The association between good mental health and housing circumstances is well established. Tenure, household crowding and housing affordability have all been linked to mental health and psychological distress. These cross-sectional relationships are collinear and confounded, and so provide little information on the possible effects of changing housing circumstance on mental health or psychological distress. To do this longitudinal data are needed. METHODS: In this paper we use the longitudinal data from the 11â 500 NZ households in the Survey of Families, Income and Employment (SoFIE), conducted in New Zealand from 2002 to 2010. We examine the cross-sectional associations of housing factors on psychological distress and use fixed-effects modelling of longitudinal data to examine any effects of changes in selected housing factors on changes in psychological distress. RESULTS: We show large significant cross-sectional associations between all the housing circumstances and psychological distress. These associations were not present in the fixed-effects models. Only changes in individual deprivation had a significant effect on changes in psychological distress. While a significant effect was found for moves to and from houses with a two-bedroom deficit, the small number of moves of this type means these results are not robust. CONCLUSIONS: These results show that the effect of house ownership and housing affordability on psychological distress is likely to be confounded in the cross-sectional models. Therefore, marginal changes to these housing factors are unlikely to yield large reductions in psychological distress. Our results suggest that reductions in psychological distress are more likely to be seen through interventions that target individual socioeconomic deprivation and severe household crowding.
Asunto(s)
Aglomeración , Vivienda , Renta/estadística & datos numéricos , Estrés Psicológico/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Vivienda/economía , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Propiedad , Factores SocioeconómicosRESUMEN
In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: ß = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: ß = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs.
Asunto(s)
Estado de Salud , Modelos Estadísticos , Impuestos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Pobreza , Análisis de Regresión , Autoinforme , Adulto JovenRESUMEN
Health behavior takes place within social contexts. In this study, we investigated whether changes in exposure to neighborhood deprivation and smoking prevalence and to household smoking were associated with change in personal smoking behavior. Three waves of biannual data collection (2004-2009) in a New Zealand longitudinal study, the Survey of Family, Income and Employment (SoFIE)-Health, were used, with 13,815 adults (persons aged ≥15 years) contributing to the analyses. Smoking status was dichotomized as current smoking versus never/ex-smoking. Fixed-effects regression analyses removed time-invariant confounding and adjusted for time-varying covariates (neighborhood smoking prevalence and deprivation, household smoking, labor force status, income, household tenure, and family status). A between-wave decile increase in neighborhood deprivation was significantly associated with increased odds of smoking (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.02, 1.14), but a between-wave increase in neighborhood smoking prevalence was not (OR = 1.04, 95% CI: 0.98, 1.10). Changing household exposures between waves to live with another smoker (compared with a nonsmoker (referent)) increased the odds of smoking (OR = 2.48, 95% CI: 1.84, 3.34), as did changing to living in a sole-adult household (OR = 1.52, 95% CI: 1.07, 2.14). Tobacco control policies and programs should address the broader household and neighborhood circumstances within which individual smoking takes place.
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Familia , Características de la Residencia/estadística & datos numéricos , Fumar/epidemiología , Adolescente , Adulto , Ambiente , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Oportunidad Relativa , Prevalencia , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: New Zealand has a goal of becoming a smokefree nation by the year 2025. Smoking prevalence in 2012 was 17%, but is over 40% for Maori (indigenous New Zealanders). We forecast the prevalence in 2025 under a business-as-usual (BAU) scenario, and determined what the initiation and cessation rates would have to be to achieve a <5% prevalence. METHODS: A dynamic model was developed using Census and Health Survey data from 1981 to 2012 to calculate changes in initiation by age 20 years, and net annual cessation rates, by sex, age, ethnic group and time period. Similar parameters were also calculated from a panel study for sensitivity analyses. 'Forecasts' used these parameters, and other scenarios, applied to the 2011-2012 prevalence. FINDINGS: Since 2002-2003, prevalence at age 20 years has decreased annually by 3.1% (95% uncertainty interval 0.8% to 5.7%) and 1.1% (-1.2% to 3.2%) for non-Maori males and females, and by 4.7% (2.2% to 7.1%) and 0.0% (-2.2% to 1.8%) for Maori, respectively. Annual net cessation rates from the dynamic model ranged from -3.0% to 6.1% across demographic groups, and from 3.0% to 6.0% in the panel study. Under BAU, smoking prevalence is forecast to be 11% and 9% for non-Maori males and females by 2025, and 30% and 37% for Maori, respectively. Achieving <5% by 2025 requires net cessation rates to increase to 10% for non-Maori and 20% for Maori, accompanied by halving or quartering of initiation rates. CONCLUSIONS: The smokefree goal of <5% prevalence is only feasible with large increases in cessation rates.
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Objetivos , Cese del Hábito de Fumar , Fumar/tendencias , Adulto , Censos , Etnicidad , Femenino , Predicción , Encuestas Epidemiológicas , Humanos , Masculino , Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda/epidemiología , Prevalencia , Distribución por Sexo , Política para Fumadores , Fumar/epidemiología , Prevención del Hábito de Fumar , Adulto JovenRESUMEN
BACKGROUND: Social and economic measures in early childhood or adolescence appear to be associated with drinking behavior in young adulthood. Yet, there has been little investigation to what extent drinking behavior of young adults changes within young adulthood when they experience changes in social and economic measures in this significant period of their life. METHODS: The impact of changes in living arrangement, education/employment, income, and deprivation on changes in average weekly alcohol units of consumption and frequency of hazardous drinking sessions per month in young adults was investigated. In total, 1,260 respondents of the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE) aged 18-24 years at baseline were included. RESULTS: Young adults who moved from a family household into a single household experienced an increase of 2.32 (95% CI 1.02 to 3.63) standard drinks per week, whereas those young adults who became parents experienced a reduction in both average weekly units of alcohol (ß = -3.84, 95% CI -5.44 to -2.23) and in the frequency of hazardous drinking sessions per month (ß = -1.17, 95% CI -1.76 to -0.57). A one unit increase in individual deprivation in young adulthood was associated with a 0.48 (95% CI 0.10 to 0.86) unit increase in average alcohol consumption and a modest increase in the frequency of hazardous drinking sessions (ß = 0.25, 95% CI 0.11 to 0.39). CONCLUSIONS: This analysis suggests that changes in living arrangement and individual deprivation are associated with changes in young adult's drinking behaviors. Alcohol harm-minimization interventions therefore need to take into account the social and economic context of young people's lives to be effective.
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Consumo de Bebidas Alcohólicas/epidemiología , Características de la Residencia , Clase Social , Adolescente , Adulto , Empleo/estadística & datos numéricos , Femenino , Humanos , Renta/estadística & datos numéricos , Modelos Lineales , Estudios Longitudinales , Masculino , Nueva Zelanda/epidemiología , Adulto JovenRESUMEN
It is hypothesized that unconditional (given without obligation) publicly funded financial credits more effectively improve health than conditional financial credits in high-income countries. We previously reported no discernible short-term impact of an employment-conditional tax credit for families on self-rated health (SRH) in adults in New Zealand. This study estimates the effect of an unconditional tax credit for families, called Family Tax Credit (FTC), on SRH in the same study population and setting. A balanced panel of 6900 adults in families was extracted from seven waves (2002-2009) of the Survey of Family, Income and Employment. The exposures, eligibility for and amount of FTC, were derived by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. Fixed effects regression analyses eliminated all time-invariant confounding and adjusted for measured time-varying confounders. Becoming eligible for FTC was associated with a small and statistically insignificant change in SRH over the past year [effect estimate: 0.013; 95% confidence interval (CI) -0.011 to 0.037], as was an increase in the estimated amount of FTC by $1000 (effect estimate: -0.001; 95% CI -0.006 to 0.004). The unconditional tax credit for families had no discernible short-term impact on SRH in adults in New Zealand. It did not more effectively improve health status than an employment-conditional tax credit for families.
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Autoevaluación Diagnóstica , Determinación de la Elegibilidad/estadística & datos numéricos , Familia , Impuestos/economía , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Adulto JovenRESUMEN
The analysis of repeated measures or panel data allows control of some of the biases which plague other observational studies, particularly unmeasured confounding. When this bias is suspected, and the research question is: 'Does a change in an exposure cause a change in the outcome?', a fixed effects approach can reduce the impact of confounding by time-invariant factors, such as the unmeasured characteristics of individuals. Epidemiologists familiar with using mixed models may initially presume that specifying a random effect (intercept) for every individual in the study is an appropriate method. However, this method uses information from both the within-individual/unit exposure-outcome association and the between-individual/unit exposure-outcome association. Variation between individuals may introduce confounding bias into mixed model estimates, if unmeasured time-invariant factors are associated with both the exposure and the outcome. Fixed effects estimators rely only on variation within individuals and hence are not affected by confounding from unmeasured time-invariant factors. The reduction in bias using a fixed effects model may come at the expense of precision, particularly if there is little change in exposures over time. Neither fixed effects nor mixed models control for unmeasured time-varying confounding or reverse causation.
Asunto(s)
Sesgo , Factores de Confusión Epidemiológicos , Interpretación Estadística de Datos , Modelos Estadísticos , Estudios Epidemiológicos , Humanos , Proyectos de Investigación , Factores de TiempoRESUMEN
BACKGROUND: In many countries single parents report poorer mental health than partnered parents. This study investigates whether there are gender differences in the mental health of single parents in New Zealand (and whether any gender difference varies with that among partnered parents), and examines key social and demographic mediators that may account for this difference. METHODS: We used data on 905 single parents and 4,860 partnered parents from a New Zealand household panel survey that included the Kessler-10 measure of psychological distress. Linear regression analyses were used to investigate both interactions of gender and parental status, and confounding or mediation by other covariates. RESULTS: High/very high levels of psychological distress were reported by 15.7 % of single mothers and 9.1 % of single fathers, and 6.1 % of partnered mothers and 4.1 % of partnered fathers. In an Ordinary Least Squares regression of continuous K10 scores on gender, parental status and the interaction of both (plus adjustment for ethnicity, number of children and age), female single parents had a 1.46 higher K10 score than male single parents (95 % CI 0.48-2.44; 1.46). This difference was 0.98 (95 % CI -0.04 to 1.99) points greater than the gender difference among partnered parents. After controlling for further confounding or mediating covariates (educational level, labour force status and socioeconomic deprivation) both the gender difference among single parents (0.38, -0.56 to 1.31) and the interaction of gender and parental status (0.28 greater gender difference among single parents, -0.69 to 1.65) greatly reduced in magnitude and became non-significant, mainly due to adjustment for individual socioeconomic deprivation. CONCLUSION: The poorer mental health of single parents remains an important epidemiological phenomenon. Although research has produced mixed findings of the nature of gender differences in the mental health of single parents, our research adds to the increasing evidence that it is single mothers who have worse mental health. Our findings on the potential explanations of the gender difference in sole parent mental health suggest that socioeconomic deprivation is a key contributor.
Asunto(s)
Trastornos Mentales/epidemiología , Padres Solteros/psicología , Familia Monoparental/psicología , Adaptación Psicológica , Adolescente , Adulto , Niño , Preescolar , Padre/psicología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Salud Mental , Madres/psicología , Nueva Zelanda , Análisis de Regresión , Factores Sexuales , Padres Solteros/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
BACKGROUND: There is evidence that smoking is associated with poorer mental health. However, the underlying mechanisms for this remain unclear. We used longitudinal data to assess whether smoking uptake, or failed quit attempts, are associated with increased psychological distress. METHODS: Data were used from Waves 3 (2004/05), 5 (2006/07) and 7 (2008/09) of the longitudinal New Zealand Survey of Family, Income and Employment. Fixed-effects linear regression analyses were performed to model the impact of changes in smoking status and quit status (exposure variables) on changes in psychological distress (Kessler 10 (K10)). RESULTS: After adjusting for time-varying demographic and socioeconomic covariates, smoking uptake was associated with an increase in psychological distress (K10: 0.22, 95% CI 0.01 to 0.43). The associations around quitting and distress were in the expected directions, but were not statistically significant. That is, smokers who successfully quit between waves had no meaningful change in psychological distress (K10: -0.05, 95% CI -0.34 to 0.23), whereas those who tried but failed to quit, experienced an increase in psychological distress (K10: 0.18, 95% CI -0.05 to 0.40). CONCLUSIONS: The findings provide some support for a modest association between smoking uptake and a subsequent increase in psychological distress, but more research is needed before such information is considered for inclusion in public health messages.
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Cese del Hábito de Fumar/psicología , Fumar/psicología , Estrés Psicológico , Adolescente , Adulto , Anciano , Recolección de Datos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: Improving social circumstances (e.g., an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data. METHODS: 15â 000 adults with at least two observations over three waves (each 2â years apart) of a panel study had data on smoking status, family, labour force, income and deprivation (both neighbourhood and individual). Fixed effects regression modelling was used. FINDINGS: The odds of smoking increased 1.42-fold (95% CI 1.16 to 1.74) for a one log-unit increase in personal income among 15-24-year-olds, but there was no association of increased smoking with an increase in income among 25+ year olds. Moving out of a family nucleus, increasing neighbourhood deprivation (e.g., 1.83-fold (95% CI 1.18 to 2.83) increased odds of smoking for moving from least to most deprived quintile of neighbourhoods), increasing personal deprivation and moving into employment were all associated with increased odds of smoking. The number of cigarettes smoked a day changed little with changing social circumstances. INTERPRETATION: Worsening social circumstances over the short run are generally associated with higher smoking risk. However, there were counter examples: for instance, decreasing personal income among young people was associated with decreased odds of smoking, a finding consistent with income elasticity of demand (the less one's income, the less one can consume). This paper suggests that improving social circumstances is not always pro-health over the short run; a more nuanced approach to the social determinants of health is required.
Asunto(s)
Empleo , Composición Familiar , Disparidades en el Estado de Salud , Renta , Características de la Residencia , Fumar , Clase Social , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Fumar/economía , Productos de Tabaco , Tabaquismo/economía , Adulto JovenRESUMEN
BACKGROUND: There has been little investigation of changes in socioeconomic measures and mental health (MH)/illness over time within individuals using methods that control for time-invariant unobserved confounders. We investigate whether changes in multiple socioeconomic measures are associated with self-reported MH using fixed effects methods to control for unobserved time-invariant confounding. METHODS: Data from three waves of a panel study with information on MH, psychological distress, labour force status, household income, area and individual deprivation. Fixed effects regression modelling was used to explore whether changes in socioeconomic exposures were associated with changes in MH. We also compared increases and decreases in exposure with changes in MH using first difference models. RESULTS: Respondents who moved into inactive labour force status experienced a 1.34 unit (95% CI -1.85 to -0.82) decline in SF-36 MH score and a 0.50 unit (95% CI 0.34 to 0.67) increase in psychological distress score. An increase in individual deprivation was associated with a 1.47 unit (95% CI -1.67 to -1.28) decline in MH score and a 0.57 unit (95% CI 0.51 to 0.63) increase in psychological distress. Increasing and decreasing levels of individual deprivation were associated with significant changes in both outcomes. CONCLUSIONS: This paper suggests that moving from employment to inactivity and changes in levels of individual deprivation may be more important for short-term MH outcomes than changes in household income or area deprivation. Providing short-term social and economic support for those experiencing financial/material hardship should be considered in interventions to reduce inequalities in MH.
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Trastornos Mentales/psicología , Salud Mental , Pobreza/economía , Calidad de Vida , Características de la Residencia , Adolescente , Adulto , Factores de Confusión Epidemiológicos , Femenino , Estado de Salud , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Vigilancia de la Población , Pobreza/etnología , Pobreza/psicología , Carencia Psicosocial , Autoinforme , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: By improving two social determinants of health (poverty and unemployment) in low- and middle-income families on or at risk of welfare, in-work tax credit for families (IWTC) interventions could impact health status and outcomes in adults. OBJECTIVES: To assess the effects of IWTCs on health outcomes in working-age adults (18 to 64 years). SEARCH METHODS: We searched 16 electronic academic databases, including the Cochrane Public Health Group Specialised Register, Cochrane Database of Systematic Reviews (The Cochrane Library 2012, Issue 7), MEDLINE and EMBASE, as well as six grey literature databases between July and September 2012 for records published between January 1980 and July 2012. We also searched key organisational websites, handsearched reference lists of included records and relevant journals, and contacted academic experts. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials and cohort, controlled before-and-after (CBA) and interrupted time series (ITS) studies of IWTCs in working-age adults. Included primary outcomes were: self rated general health; mental health/psychological distress; mental illness; overweight/obesity; alcohol use and tobacco use. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias in included studies. We contacted study authors to obtain missing information. MAIN RESULTS: Five studies (one CBA and four ITS) comprising a total of 5,677,383 participants (all women) fulfilled the inclusion criteria and were synthesised narratively. The in-work tax credit intervention assessed in all included studies is the permanent Earned Income Tax Credit in the United States, established in 1975. This intervention distributed nearly USD 62 billion to over 27 million individuals in 2011, and its administration costs were less than one per cent of its total costs. All included studies carried a high risk of bias (especially from confounding and insufficient control for underlying time trends). Due to the small number of (observational) studies and their high risk of bias, we judged this body of evidence to have very low overall quality.One study found that IWTC had no detectable effect on self rated general health and mental health/psychological distress five years after its implementation (i.e. a considerable change in the generosity of the permanent IWTC) and on overweight/obesity eight years after implementation. One study found no effect of IWTC on tobacco use five years after implementation, one a moderate reduction in tobacco use one year after implementation (odds ratio 0.95, 95% confidence interval (CI) 0.94 to 0.96), and one differential effects, with no effect in African-Americans and a large reduction in European-Americans two years after implementation (risk difference -11.1%, 95% CI -20.9% to -1.3%). No evidence was available for the effect of IWTC on mental illness and alcohol use. No adverse effects of IWTC were identified.One study also found no detectable effect of IWTC on the number of bad physical health days and of risky biomarkers for inflammation, cardiovascular disease and metabolic conditions eight years after implementation. One study found that IWTC had a large, positive effect on income from wages or salaries one year after implementation. Two studies found no effect on employment two and five years after implementation, whereas two found a moderate increase five and eight years after implementation and one a large increase in employment due to IWTC one year after implementation.No differences in outcomes between groups with different educational status were found for self rated health and mental health/psychological distress. In one study European-American women with lower levels of education were more likely to reduce tobacco use, while tobacco use did not change among African-American women with lower levels of education. However, no differences in tobacco use by educational status were observed in a second study. Two studies found that the intervention may have reduced inequity with respect to employment, where women with less education were more likely to move into employment (although one did not establish whether this difference was statistically significant), while two studies found no such difference and no studies found differences by ethnic group on employment rates. AUTHORS' CONCLUSIONS: In summary, the small and methodologically limited existing body of evidence with a high risk of bias provides no evidence for an effect of in-work tax credit for families interventions on health status (except for mixed evidence for tobacco smoking) in adults.
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Empleo/economía , Estado de Salud , Impuesto a la Renta/economía , Salud Mental , Pobreza/economía , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Humanos , Trastornos Mentales/epidemiología , Obesidad/epidemiología , Fumar/epidemiología , Estrés Psicológico/epidemiología , Desempleo , Mujeres Trabajadoras/psicología , Mujeres Trabajadoras/estadística & datos numéricosRESUMEN
Objective : To examine income-related inequalities in health in working age men and women in Australia and New Zealand. Methods : We used data from two longitudinal surveys, Wave 8 (2008) of the Household Income and Labour Dynamics in Australia (HILDA) Survey and Wave 7 (2008/2009) of the New Zealand Survey of Family Income and Employment (SoFIE). We compared concentration indices (a measure of income-related health inequality) that examined the distribution of general and mental health-related quality of life scores (from the SF-36) across income in working age (20-65 year old) men and women. Decomposition analyses of the concentration indices were done to identify the relative contribution of various determinants to the income-related health inequality. Results : General health (GH) scores generally decline with age, and mental health (MH) scores increase with age, in both surveys. Income-related health inequalities were present in both the HILDA and SoFIE samples, with better health in high income groups. Decomposition analyses found that income, area deprivation and being inactive in the labour force were major contributors to income-related health inequality, in both surveys, and for both health outcomes. Conclusions and implications : Despite some baseline differences in income-related health inequalities using Australian and New Zealand surveys, we found similar modifiable determinants, which could be targeted to improve health inequalities in both countries.
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Disparidades en el Estado de Salud , Indicadores de Salud , Renta/estadística & datos numéricos , Calidad de Vida , Adulto , Factores de Edad , Anciano , Australia , Femenino , Accesibilidad a los Servicios de Salud , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Salud Mental , Persona de Mediana Edad , Nueva Zelanda , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: It is well understood that health affects labour force participation (LFP). However, much of the published research has been on older (retiring age) populations and using subjective health measures. This paper aims to assess the impact of an objective measure of 'health shock' (cancer registration or hospitalisation) on LFP in a working age population using longitudinal panel study data and fixed effect regression analyses. METHODS: Seven waves of data from 2002-09 from the longitudinal Survey of Family, Income and Employment (SoFIE) were used, including working aged individuals who consented to have their survey information linked to health records (n=6,780). Fixed effect conditional logistic regression was used to model the impact of health shocks (hospitalisation or cancer registration) in the previous year on labour force participation at date of annual interview. Models were stratified by gender, age group (25-39 years, 40-54 years) and gender by age group. RESULTS: A health shock was associated with a significantly increased risk of subsequent non-participation in the labour force (odds ratio 1.54, 95%CI 1.30-1.82). Although interactions of age, sex and age by sex with health shock were not statistically significant, the association was largest in younger men and women. CONCLUSION: Using an objective measure of health, we have shown that a health shock adversely affects subsequent labour force participation. There are a number of policy and practice implications relating to support for working age people who have hospitalisations.
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Empleo/estadística & datos numéricos , Estado de Salud , Renta , Adulto , Factores de Edad , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores SocioeconómicosRESUMEN
BACKGROUND AND PURPOSE: There is a temporal relationship between cannabis use and stroke in case series and population-based studies. METHODS: Consecutive stroke patients, aged 18 to 55 years, who had urine screens for cannabis were compared with a cohort of control patients admitted to hospital without cardiovascular or neurological diagnoses. RESULTS: One hundred sixty of 218 (73%) ischemic stroke/transient ischemic attack patients had urine drug screens (100 men; mean [SD] age, 44.8 [8.7] years). Twenty-five (15.6%) patients had positive cannabis drug screens. These patients were more likely to be men (84% versus 59%; χ2: P=0.016) and tobacco smokers (88% versus 28%; χ2: P<0.001). Control urine samples were obtained from 160 patients matched for age, sex, and ethnicity. Thirteen (8.1%) control participants tested positive for cannabis. In a logistic regression analysis adjusted for age, sex, and ethnicity, cannabis use was associated with increased risk of ischemic stroke/transient ischemic attack (odds ratio, 2.30; 95% confidence interval, 1.08-5.08). However after adjusting for tobacco use, an association independent of tobacco could not be confirmed (odds ratio, 1.59; 95% confidence interval, 0.71-3.70). CONCLUSIONS: This study provides evidence of an association between a cannabis lifestyle that includes tobacco and ischemic stroke. Further research is required to clarify whether there is an association between cannabis and stroke independent of tobacco. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12610000198022.
Asunto(s)
Isquemia Encefálica/epidemiología , Cannabis/efectos adversos , Accidente Cerebrovascular/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Isquemia Encefálica/orina , Estudios de Casos y Controles , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/orina , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Accidente Cerebrovascular/orina , Trastornos Relacionados con Sustancias/orina , Nicotiana/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: In-work tax credit (IWTC) for families, a welfare-to-work policy intervention, may impact health status by improving income and employment. Most studies estimate that IWTCs in the USA and the UK have no effect on self-rated health (SRH) and several other health outcomes, but these estimates may be biased by confounding. The current study estimates the impact of one such IWTC intervention (called In-Work Tax Credit) on SRH in adults in New Zealand, controlling more fully for confounding. METHODS: We used data from seven waves (2002-2009) of the Survey of Family, Income and Employment, restricted to a balanced panel of adults in families. The exposures, eligibility for IWTC and the amount of IWTC a family was eligible for, were derived for each wave by applying government eligibility and entitlement criteria. The outcome, SRH, was collected annually. We used fixed effects regression analyses to eliminate time-invariant confounding and adjusted for measured time-varying confounders. RESULTS: Becoming eligible for IWTC was associated with no detectable change in SRH over the past year (ß=0.001, 95% CI -0.022 to 0.023). A $1000 increase in the IWTC amount a family was eligible for increased SRH by 0.003 units (95% CI -0.005 to 0.011). CONCLUSIONS: This study found that becoming eligible for IWTC or a substantial increase in the IWTC amount was not associated with any detectable difference in SRH over the short term. Future research should investigate the impact of IWTC on health over the longer term.
Asunto(s)
Estado de Salud , Renta/estadística & datos numéricos , Impuestos , Adulto , Determinación de la Elegibilidad , Empleo , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda , Pobreza/estadística & datos numéricos , Análisis de Regresión , Bienestar Social , Adulto JovenRESUMEN
BACKGROUND: Confounding of mediator-outcome associations resulting in collider biases causes systematic error when estimating direct and indirect effects. However, until recently little attention has been given to the impact of misclassification bias. OBJECTIVE: To quantify the impact of non-differential and independent misclassification of a dichotomous exposure and a dichotomous mediator on three target parameters: the total effect of exposure on outcome; the direct effect (by conditioning on the mediator); and the indirect effect (identified by the percentage reduction in the excess OR on adjusting for the mediator). METHODS: Simulations were conducted for varying strength of associations between exposure, mediator and outcome, varying ratios of exposed to unexposed and mediator present to mediator absent, and varying sensitivity and specificity of exposure and mediator classification. RESULTS: ORs before (total effect) and after adjustment (direct effect) for the mediator are both biased towards the null by non-differential misclassification of the exposure, but the percentage reduction in the excess OR is little affected by misclassification of exposure. Conversely, misclassification of the mediator rapidly biases the percentage reduction of the excess OR (indirect effect) downwards. CONCLUSIONS: If the research objective is to quantify the proportion of the total association that is due to mediation (ie, indirect effect), then minimising non-differential misclassification bias of the mediator is more important than that for the exposure. Misclassification bias is an important source of error when estimating direct and indirect effects.
Asunto(s)
Sesgo , Interpretación Estadística de Datos , Modificador del Efecto Epidemiológico , Ciencias Sociales/métodos , Simulación por Computador , Factores de Confusión Epidemiológicos , Humanos , Oportunidad Relativa , Proyectos de InvestigaciónRESUMEN
OBJECTIVES: Poverty, often defined as a lack of resources to achieve a living standard that is deemed acceptable by society, may be assessed using level of income or a measure of individual deprivation. However, the relationship between low income and deprivation is complex--for example, not everyone who has low income is deprived (and vice versa). In addition, longitudinal studies show only a small relationship between short-term changes in income and health but an alternative measure of poverty, such as deprivation, may have a stronger association with health over time. We aim to compare low income and individual deprivation as predictors of self-rated health (SRH), using longitudinal survey data, to test the hypothesis that different measures of poverty may have different associations with health. METHODS: We used three waves from the longitudinal Survey of Family, Income and Employment and fixed-effect linear regression models to compare low income (<50% median income at each wave) and deprivation (reporting three or more items from the New Zealand individual deprivation index) as predictors of SRH (coded 1-5; SD 1.1-1.2). We also compared the impact of duration of low income and deprivation on SRH using mixed linear models. RESULTS: In the fixed-effect models, moving into deprivation between waves was associated with a larger decline in SRH compared to moving into low income, which persisted in models including both low income and deprivation. Similar findings were observed for duration of low income and deprivation in mixed models. CONCLUSIONS: Moving into high levels of individual deprivation is a stronger predictor of changes in SRH than moving into low income. When investigating the association of hardship poverty with health, using alternative measures, in addition to income, is advisable.
Asunto(s)
Disparidades en el Estado de Salud , Renta , Modelos Estadísticos , Pobreza , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda , Vigilancia de la Población , Factores Socioeconómicos , Adulto JovenRESUMEN
This paper reports on a complex environmental approach to addressing 'wicked' health promotion problems devised to inform policy for enhancing food security and physical activity among Maori, Pacific and low-income people in New Zealand. This multi-phase research utilized literature reviews, focus groups, stakeholder workshops and key informant interviews. Participants included members of affected communities, policy-makers and academics. Results suggest that food security and physical activity 'emerge' from complex systems. Key areas for intervention include availability of money within households; the cost of food; improvements in urban design and culturally specific physical activity programmes. Seventeen prioritized intervention areas were explored in-depth and recommendations for action identified. These include healthy food subsidies, increasing the statutory minimum wage rate and enhancing open space and connectivity in communities. This approach has moved away from seeking individual solutions to complex social problems. In doing so, it has enabled the mapping of the relevant systems and the identification of a range of interventions while taking account of the views of affected communities and the concerns of policy-makers. The complex environmental approach used in this research provides a method to identify how to intervene in complex systems that may be relevant to other 'wicked' health promotion problems.
Asunto(s)
Abastecimiento de Alimentos , Promoción de la Salud/métodos , Actividad Motora , Política de Salud , Prioridades en Salud , Humanos , Nueva Zelanda , Estudios de Casos OrganizacionalesRESUMEN
OBJECTIVE: Investigations of smoking initiation often focus on the experiences of children and youth. However, prevalence data from the Tobacco Use Surveys (TUS) and the New Zealand (NZ) census suggest substantial uptake of smoking occurs after 15 years of age, including among young adults aged 18-24 years. Identifying initiation rates is difficult using cross-sectional prevalence data, particularly among older age groups, which are subject to cohort effects and where quitting and premature mortality reduce prevalence. We aimed to identify initiation rates using a prospective study design. METHODS: The SoFIE-Health longitudinal survey included 15,095 subjects aged 15 years or older who responded in the three years that include the health module: 2004/05, 2006/07 and 2008/09. We calculated the proportion of 'never smokers' who became regular smokers (initiation) by age at baseline. RESULTS: Initiation between 2004/05 and 2008/09 was 14.2% for 15-17 year olds, 7.0% for 18-19 years, 3.1% for 20-24 years and 1.4% for 25-34 years, with low levels of initiation (<1.0%) among older age groups. CONCLUSIONS: There were strong age-related gradients in smoking initiation. Substantial initiation occurs among older youth and young adults, but is rare after age 24. IMPLICATIONS: Efforts to prevent initiation of smoking should focus not only on adolescents but also on older youth and young adults.